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Local surgeon performs finger joint replacements

Certified Hand Therapist Emily Tjosvold, with UCHealth SportsMed Clinic, works with patient Donna Sykes, who is recovering from surgery performed by Dr. Patrick Johnston, hand and elbow orthopedic surgeon with Steamboat Orthopaedic & Spine Institute. (Photo by John F. Russell)

In a mountain valley ripe with active, older individuals and aging athletes, knee joint replacement surgery is familiar along with artificial hips and shoulders. Finger joint replacements are less common in the joint replacement realm but are nevertheless important.

Fellowship-trained orthopedic surgeon Dr. Patrick Johnston, who moved with his family to Steamboat Springs five years ago, performs about 10 specialized knuckle joint replacement surgeries with implants each year. That work represents a portion of the 100 hand joint arthroplasty surgeries he completes annually as a hand and elbow specialist at Steamboat Orthopaedic & Spine Institute.

“MCP (metacarpophalangeal or knuckle) joint and finger joint replacements have gradually become more common,” Johnston said. “Things like this become more common as the research supports them and as more surgeons come out of their fellowship training having done the surgery frequently, making the surgeon more comfortable doing the surgery in practice.”



The doctor, 37, said finger joint surgeries or replacements are always done after patients exhaust conservative treatments, such as oral medications, supplements, lifestyle changes and joint injections. He said the overwhelming cause of pain and loss of function that finally pushes patients to finger joint surgeries or replacements is arthritis, including osteoarthritis, post-traumatic arthritis and rheumatoid arthritis. He also performs the very common arthroplasty surgery on the carpometacarpal joint at the base of the thumb that is completed by transferring a tendon.

Dr. Patrick Johnston, 37, performs about 10 surgeries each year for implants of artificial knuckle joints. (Courtesy photo)

In the right hand therapy clinic on the second floor of the SOSI building, Certified Hand Therapist Emily Tjosvold works with finger joint replacement patients slowly and carefully twice per week for eight weeks post-surgery. For the first month, patients wear a resting splint custom made at the clinic and are instructed not to bend their fingers more than 45 degrees, Tjosvold said.



The occupational therapist, an employee of UCHealth SportsMed Clinic, said the most commonly replaced finger joint is the knuckle of the middle finger. The doctor and therapist work in close collaboration, including in combined therapy visit with patients two weeks after surgery. Johnston’s office is located adjacent to the hand clinic in the SOSI complex, which opened last year in the former Sports Authority building.

Johnston is becoming known as the go-to hand surgeon in Northwest Colorado. The doctor said he was drawn to hand surgery because it incorporates aspects of orthopedic, vascular, plastic and neuro surgeries. He has performed the finger joint procedure on retirees, electricians and ranchers, including a rancher with severe arthritis who is a satisfied repeat customer. The rancher had surgery on his long finger and was so pleased he came back for the same surgery on the other hand.

Johnston tells the story of one patient he first met when she accompanied her husband for a medical visit, and the doctor noticed she was hiding her hands with angled fingers consistent with severe arthritis.

“With what I do for a living, I am always noticing people’s hands. I mentioned to her that there are treatment options for her hands. She had no idea prior to me mentioning it. She told me how self-conscious she was of her hands due to the deformities and how much the pain limited what she could do every day,” Johnston said.

The patient later underwent arthroplasty of her index, long, ring and small fingers.

“I was able to replace all of her MCP joints with silicone implants, centralize her tendons and get her fingers straight. The patient was thrilled with how she no longer had to hide her hands and had more functional, less painful hands,” Johnston said.

The Sykes ranching family in Jackson County are very complimentary of Johnston, who has performed successful finger, hand, wrist and elbow surgeries on five members of the active three-generational family.

“He is an awesome doctor and excellent in what he does, absolutely a caring man, and his skills are incredible,” said Donna Sykes, who is recovering from surgery due to an accident. “He is one of the very, very best, not only in just his skills, but his caring bed side manner and kind heart.”

Sykes said Johnston also repaired her elbow after an accident three years ago, and she happened to show that repair work to another surgeon in Denver who declared it “absolutely perfect. … You don’t see this kind of work.”

One type of two-piece finger joint implant the doctor uses is manufactured by New Jersey-based Integra LifeSciences and made out of a special type of carbon called pyrocarbon that is tailored for durability and biocompatibility.

Most finger joint replacements take place in patients in their 50s or older, and most of those gain full range of motion and function necessary for activities of daily living.

“My goal is for my patients to do what they want to do in life without being limited by pain,” Johnston said.


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