Evidence-based medicine is a relatively new concept in hand surgery. A lack of high-level evidence often leads to uncertainty in the effectiveness of various procedures and regional variation in their use. Rheumatoid hand surgery has been plagued by a lack of quality data that has caused controversy between rheumatologists and hand surgeons. Research over the past 16 years has strived to provide data that can be used to provide evidence-based care for rheumatoid arthritis patients. The Silicone Arthroplasty in Rheumatoid Arthritis study is a prospective, long-term cohort study of rheumatoid arthritis patients with severe metacarpophalangeal joint deformity who have elected to undergo or not to undergo metacarpophalangeal joint arthroplasty; the study was funded for 10 years by the National Institutes of Health and has provided invaluable results on the effectiveness of this procedure in terms of outcomes and cost, improving knowledge for both physicians and patients.