Patient profile:	This 52-year old woman has a history of juvenile rheumatoid arthritis which was initially diagnosed at the age of 3.  She has had multiple joint replacements and revisions.  These x-rays demonstrate advanced rheumatoid arthritis of the fingers and wrist of her left hand.  She was suffering with severe pain and deformity.
Pre-operative diagnosis:	Rheumatoid arthritis of the fingers and wrist of the left hand
1) Surgical treatment of fingers:	Metacarpal phalangeal joint replacement
Implant (prosthesis):	Buechel-Pappas™  M-P joint replacements
2) Surgical treatment of wrist:	Total wrist joint replacement
Implant (prosthesis):	Biax™ wrist joint replacement
Surgical Outcome:	The patient’s pain was relieved and there was marked improvement in her hand and wrist function.