The expansion of the available types of implants for the metacarpophalangeal joint has significantly changed in the last few years. Specific indications remain for the use of the silicone implant replacements as well as specific instances in which the ball and socket type of metal and steel and pyrocarbon prostheses may be selected. This instructional course will review the current biomechanical properties of these prostheses, the surgical indications and the specific insertion technique that is unique to each of the devices. Each instructional course lecturer will present the specific surgical tips to assess the ideal implantation of each of the prosthesis and review the specific indications for them. It will be seen that silicone implants will remain the procedure of choice in significant moderate to advanced rheumatoid disease reconstruction. The ball and socket type implants may be preferably utilized in osteoarthritis, post-traumatic arthritis and early rheumatoid disease with minimal clinical deformity. The participants will receive information on the ideal surgical technique of implantation for each device and review the individual postoperative therapy protocols.