The first joint of the cat's knuckle is not removed, it's CHOPPED OFF. I can't stand it when they try to sugar coat the procedure. (no offense Catty1)

I tell people, "Chop all your fingers and toes off at the first joint, then force yourself to walk on all fours. THAT'S what a cat has to endure.

Later on, cats can develop arthritis in their paws, litterbox and biting problems.