What is a cheilectomy? It's a minor procedure where the surgeon removes bone spurs from an arthritic joint. In hands, we often perform them in a finger with a mucus cyst due to arthritis in the interphalangeal joints (the knuckles on the end of the finger). These cysts rarely come back after debriding the cyst and removing the bone spurs. However, until recently, most surgeons only offer cheilectomy for treating mucus cysts and not for the stiffness and pain caused by the arthritis itself.
This article in the Journal of hand surgery reports the results of a series of patients with painful and stiff fingers treated with cheilectomy. This is a novel article since cheilectomy is not traditionally offered to patients with pain and stiffness. Most surgeons would offer such patients a fusion. A fusion creates a painless joint by joining the two bones into one. This gets rid of pain, but results in a motionless joint. A cheilectomy is an attractive alternative in that it preserves motion of the joint. But is cheilectomy effective at reducing pain and stiffness or not???
The study, published by Dean Sotereanos, followed 78 patients followed for a median of 36 months (24-62). There were 21 patients who had a concomitant mucus cyst that was removed at the time of surgery. Pain improved from a VAS average of 8. Interestingly, stiffness also improved. Total distal interphalangeal joint motion improved by 20 degrees. These were both statistically significant improvements.
Follow up X-rays shows that the bone spurs were gone, but the joint erosions remained. This is not surprising considering the underlying arthritis of the joint was not treated by this surgery.
Comment:
In my practice, I usually offer steroid injections as the first line of treatment for mucus cysts or for painful arthritic finger joints. However, in patients who have persistent cysts, stiffness, or pain after injections, I usually offer a finger fusion if the arthritis involves the distal interphalangeal joint (the one near the fingertip). If the joint is more proximal than that, I offer fusions or artificial joint replacement. However, considering the results of this article, a cheilectomy may be an attractive and less invasive option. It will be interesting to see if the results are durable beyond 5 years.
