In patients with rheumatoid arthritis, metacarpophalangeal joint deformities can significantly affect hand function. Flexible hinge implant arthroplasty, designed in the 1960s, remains the most accepted and widely performed technique for treatment of severely involved metacarpophalangeal joints in rheumatoid arthritis. An arc of motion of 40 degrees to 60 degrees can be expected after arthroplasty, with improvement of finger extension and ulnar deviation. Silicone implant arthroplasty, although technically challenging, is the standard surgical procedure for improving hand function in these patients. Complications include recurrent ulnar deviation, extensor lag, implant fracture, infection, and silicone-induced particulate synovitis. Despite these limitations, patient satisfaction is high with enhancement of hand appearance and function and relief of pain.