Silicone rubber (silastic) implants have dominated finger arthroplasty for over 50 years. They have not yet been surpassed. New research highlights opportunities for improving silastic finger implants addressing problems with the stems and bodies of the implants. The future will lie with hard bearing implants. The materials and designs of these have been based upon large joint arthroplasty with some success but also notable failures such as pyrocarbon PIP (proximal interphalangeal) joint arthroplasties.
A particularly rich area for arthroplasty is in the treatment of thumb carpometacarpal (CMC) joint arthritis. There are many options including both hemi-arthroplasties and total joint replacements. Currently there is no one define best option.
Pyrocarbon spacers have been used widely in the wrist and thumb base; their merits and demerits will be discussed.
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Professor Grey Giddins
Consultant Orthopaedic and Hand Surgeon, Royal United Hospitals Bath NHS Foundation Trust
Grey Giddins has worked as an orthopaedic and hand surgeon in Bath since 1995. He works in a very supportive team of three hand surgeons and four hand therapists with a wide range of practice including a full range of elbow, wrist and hand trauma and elective conditions. Grey has particular interests in the management of common hand injuries, the mechanism and outcome of falls on the wrist, and minimal access surgery for many common elective hand conditions such as finger ganglia, corrective osteotomies and closed fusions. He runs a specialist practice in obstetric brachial plexus injuries, wrist and DRUJ (distal radioulnar joint) pathology, and rheumatoid arthritis. He also has an interest in surgical error and its avoidance.
Grey is a visiting professor in the Department of Mechanical Engineering at the University of Bath, where he researches tendon injuries, mechanisms of falling and joint replacement failures. He has an NIHR grant to develop a novel drill guide system. Grey has developed a novel jig to measure DRUJ instability and is developing jigs to measure instability in other joints.
He was President of the British Society for Surgery of the Hand in 2017 and Editor-in-Chief of the Journal of Hand Surgery (European Volume) from 2012-2016.