The author has had the opportunity to treat a large number of rheumatoid hands for the last 30 years and the results have been rewarding. There are different types of deformities: The early ulnar drift, the moderate ulnar drift and the severe ulnar drift. For the moderate ulnar drift, when the joint is well preserved, a dorsal synovectomy is performed with the plication of the radial collateral ligament on the radial side and tendon transfer, namely, extensor indicis propius is transferred to the radial side of the extensor hood, and extensor digiti quinti minimi is transferred to the radial aspect of the extensor hood. The extensor hood is rerouted over the summit of the MP joint. For the moderate and severe ulnar drift, when there is subluxation or dislocation of the MP joints, and there is already alteration of articular cartilage, a synovectomy is again done through a dorsal approach. A dorsal synovectomy is performed of all metacarpal phalangeal joints. Then resection of the metacarpal heads is followed, the ulnar intrinsics are resected, the radial collateral ligament is preserved. Then silicone prostheses are inserted through drill holes on each metacarpal head. These prostheses are then inserted into the bases of the proximal phalanges. The radial collateral ligament is then repaired and transferred proximally to the distal part of the metacarpal. Again for this procedure the extensor indicis propius and extensor digiti quinti minimi are transferred on the radial side of the extensor apparatus. Eventually the extensor hood is centralized over the dorsum of the MP joint by plicating the extensor hood on the radial side. The post-operative care will be explained, the final results from 5 to 20 years will be shown in a series of l50 cases.