By THEA JOURDAN

Last updated at 10:58 PM on 29th December 2008

Many thousands of Britons suffer from arthritis in the hands. Roy Carter, 69, a volunteer ambulance driver from Hampshire, became one of the first to have new knuckles made from material used in the NASA space shuttle. Here, Roy tells his story to Thea Jourdan, while his surgeon explains the procedure.

THE PATIENT

Before I retired nine years ago, I was a postman handling thousands of letters a day. But there came a time when I couldn’t pick up the post because my knuckles on my right hand were so painful. I was very sporty when I was younger and I played hockey in the London League, so my hands were always getting knocked. I went to the doctor who diagnosed osteoarthritis, possibly caused by old hockey injuries that had been made worse through overuse. I was told there wasn’t much that could be done, so I just took ibuprofen to reduce the inflammation. It was still extremely painful though and I had difficulty sleeping. I couldn’t even pick up a cup of tea without shooting pains going through my hand. My wife, Eileen, had to do up my buttons on my shirt and I couldn’t even get my own cornflakes in the morning. They would often end up all over the floor because I had no dexterity in my hands. I didn’t like needing constant help but I’m just not the kind of person to get depressed. My daughter, who is a physiotherapist, suggested I think about getting a knuckle replacement operation. It sounded a bit extreme, but by then I was desperate.

Three years after I first went to my GP about this problem, I went back and asked for a referral to a specialist hand surgeon who carried out this type of operation. I was booked into see Mr Warwick at Southampton University Hospital. When we met, he wanted to try to see if injections alone could cure the problem. So I had several injections of a corticosteroid to try and reduce the inflammation. Although these eased the symptoms, the problem didn’t go away. Mr Warwick then decided two knuckles in my right hand were suitable for replacement surgery. He explained he wanted to use a new type of replacement joint made from pyrocarbon — which they used for the nose of the NASA Space Shuttle. This material is very hard, but flexible like bone. Mr Warwick said the traditional type of joint used is very basic and tends to wear out quickly. Hopefully, with my new hardwearing implants, I would never need to have the operation repeated. We agreed he’d replace one knuckle at at time to see how I got on. I had the operation three months later. When I came round from the general anaesthetic, my hand was in a plaster. It was quite sore but I had some painkillers. I went home the next day wearing a special splint and had therapy on my hand for six weeks. I also did special exercises every day to strengthen my knuckle joints.

A year later, I went back to have my second knuckle replaced as it was increasingly painful. That operation was also a great success. Now, I have no pain at all. I volunteer as an ambulance driver four days a week and I have no problem gripping the steering wheel. There is only a little scar to show I had the operation, but inside I have space age knuckles. I’d recommend this to anyone in the same position I was — it has transformed my life. Click to see entire news story.

About Osteoarthritis

Osteoarthritis of the Wrist

Osteoarthritis of the Elbow

Osteoarthritis of the Shoulder

Osteoarthritis of the Ankle

What is osteoarthritis?

Osteoarthritis is a type of arthritis that is caused by the breakdown and eventual loss of the cartilage of one or more joints. Cartilage is a protein substance that serves as a “cushion” between the bones of the joints. Osteoarthritis is also known as degenerative arthritis. Among the over 100 different types of arthritis conditions, osteoarthritis is the most common, affecting over 20 million people in the United States. Osteoarthritis occurs more frequently as we age. Before age 45, osteoarthritis occurs more frequently in males. After age 55 years, it occurs more frequently in females. In the United States, all races appear equally affected. A higher incidence of osteoarthritis exists in the Japanese population, while South African blacks, East Indians, and Southern Chinese have lower rates.

Osteoarthritis commonly affects the hands, feet, spine, and large weight-bearing joints, such as the hips and knees. Most cases of osteoarthritis have no known cause and are referred to as primary osteoarthritis. When the cause of the osteoarthritis is known, the condition is referred to as secondary osteoarthritis. Osteoarthritis is sometimes abbreviated OA.

What causes osteoarthritis?

Primary osteoarthritis is mostly related to aging. With aging, the water content of the cartilage increases, and the protein makeup of cartilage degenerates. Eventually, cartilage begins to degenerate by flaking or forming tiny crevasses. In advanced cases, there is a total loss of cartilage cushion between the bones of the joints. Repetitive use of the worn joints over the years can irritate and inflame the cartilage, causing joint pain and swelling. Loss of the cartilage cushion causes friction between the bones, leading to pain and limitation of joint mobility. Inflammation of the cartilage can also stimulate new bone outgrowths (spurs, also referred to as osteophytes) to form around the joints. Osteoarthritis occasionally can develop in multiple members of the same family, implying a hereditary (genetic) basis for this condition.

Secondary osteoarthritis is caused by another disease or condition. Conditions that can lead to secondary osteoarthritis include obesity, repeated trauma or surgery to the joint structures, abnormal joints at birth (congenital abnormalities), gout, diabetes and other hormone disorders.

Obesity causes osteoarthritis by increasing the mechanical stress on the cartilage. In fact, next to aging, obesity is the most powerful risk factor for osteoarthritis of the knees. The early development of osteoarthritis of the knees among weight lifters is believed to be in part due to their high body weight. Repeated trauma to joint tissues (ligaments, bones, and cartilage) is believed to lead to early osteoarthritis of the knees in soccer players. Interestingly, recent studies have not found an increased risk of osteoarthritis in long-distance runners. Crystal deposits in the cartilage can cause cartilage degeneration and osteoarthritis. Uric acid crystals cause arthritis in gout, while calcium pyrophosphate crystals cause arthritis in pseudogout.

Some people are born with abnormally formed joints (congenital abnormalities) that are vulnerable to mechanical wear, causing early degeneration and loss of joint cartilage. Osteoarthritis of the hip joints is commonly related to structural abnormalities of these joints that had been present since birth. Hormone disturbances, such as diabetes and growth hormone disorders, are also associated with early cartilage wear and secondary osteoarthritis.

Arthritis of the Hand

Arthritis is a debilitating disease that effects as many as 40 million Americans – nearly one of every 6 people. Approximately 21 million people have osteoarthritis, and another 2.1 million have rheumatoid arthritis. It is estimated that by 2020, 60 million people will suffer from the disease. Arthritis is a term that is used to describe the degeneration of cartilage. There are different types of arthritis:

Rheumatoid Arthritis (RA):

is a systemic disease that can affect all of the joints of the body. The disease attacks both the joint surface and soft tissues of the joints. There is currently no known cause for the disease.Osteo Arthritis (OA): is a wearing away of the cartilage between the joints.

Post Traumatic Arthritis (TA):

can develop after injury to a joint. All forms of arthritis can cause inflammation, pain, deformity and lack of function of the joint involved. The prevalence of arthritis in the hand is high and can affect the MCP joint (knuckle), PIP joint (middle finger joint), and the base of the thumb. The causes of arthritis in the hand can be due to a previous injury, and wear and tear on the joint.

Arthritis in the Hand

The joints of the hand act as hinges between the bones of the hand. These joints are called metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. These joints are important for gripping and holding things. A patient suffering from arthritis of the finger joints will suffer from pain, swelling, loss of function, and deformity.

Patient Resources

		Rheumatoid Arthritis HQ This site is premised on the belief that if you don't understand your own disease and condition, it is not possible to get proper medical treatment for it... and that this will become more so in coming years. Our mission is to help people help themselves.

		National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases, the training of basic and clinical scientists to carry out this research, and the dissemination of information on research progress in these diseases.

		Federation of European Societies for Surgery of the Hand The objective of FESSH is to define the highest standards for treatment in hand pathologies, to identify the optimal training programs in our area of specialization while promoting uniformity among the different countries of Europe and to implement and sustain study and research.

		Arthritis Foundation The Arthritis Foundation is the only national not-for-profit organization that supports the more than 100 types of arthritis and related conditions. Founded in 1948, with headquarters in Atlanta, the Arthritis Foundation has multiple service points located throughout the country. The Arthritis Foundation is the largest private, not-for-profit contributor to arthritis research in the world, funding more than $380 million in research grants since 1948. The foundation helps people take control of arthritis by providing public health education; pursuing public policy and legislation; and conducting evidence-based programs to improve the quality of life for those living with arthritis.

		The American Society for Surgery of the Hand The mission of the American Society for Surgery of the Hand (ASSH) is to advance the science and practice of hand surgery through education, research and advocacy on behalf of patients and practitioners. Founded in 1946, the American Society for Surgery of the Hand is the oldest medical specialty society in the United States devoted entirely to continuing medical education related to hand surgery.