A 60-year-old woman with rheumatoid arthritis and persistent pain in right middle finger metacarpophalangeal joint despite no signs of significant joint degeneration on plain radiographs (A). B, Appearance of metacarpal head with significant cartilage loss. C, Silicone spacer before capsular and extensor tendon closure. D, Radiograph after metacarpophalangeal joint arthroplasty.