Wrist replacement





Definition

Wrist replacement surgery is performed to replace a wrist injured or damaged beyond repair. An artificial wrist joint replacement is implanted.


Purpose

Traumatic injuries or severe degenerative diseases affecting the wrist (such as osteoarthritis and rheumatoid arthritis with bony destruction) may require replacement of the painful wrist joint with an artificial wrist joint. The purpose of wrist replacement surgery is to restore wrist motion for activities of daily living and non-contact sports. A wrist replacement recovers lost strength by restoring length to the muscles and tendons of the fingers and wrist, maintains a useful arc of motion and provides the stability required for an active life.


Description

Surgery to replace a wrist starts with an incision through the skin on the back of the wrist. The surgeon then moves the tendons extending over the back of the wrist out of the way to access the joint capsule on the back of the wrist joint, which is then opened to expose the wrist joint area. A portion of the carpal bones and the end of the radius and ulna are then removed from the wrist to allow room for the new artificial wrist joint. The bones of the hand and the radius bone of the forearm are prepared with the use of special instruments to form holes in the bones; the stems of the artificial joint components can then fit in. Next, the components are inserted into the holes. After obtaining a proper fit, the surgeon verifies the range of motion of the joint to ensure that it moves correctly. Finally, the surgeon cements the two sides of the joint and replaces the tendons back into their proper position before closing the wound.

A total wrist replacement implant consists of the following components:

  • An ellipsoid head that simulates the curvature of the natural wrist joint and allows for a functional range of motion. This ensures that the patient may flex and extend the wrist and move it side-to-side.
  • An offset radial stem that anchors the implant in the forearm. The special shape of this component is designed to assist the function of the tendons used to extend the wrist and to ensure the stability of the implant.
  • An elongated radial tray surface with a molded bearing usually made of polyethylene. This component is required to distribute forces over the entire surface of the artificial joint.
  • A fixation stem that is secured to the patient's bone to add stability and eliminate rotation of the artificial joint within the bone.
  • A curved metacarpal stem that secures the artificial wrist within the hand.

Diagnosis/Preparation

The orthopedic surgeon who will perform the surgery will usually require a complete physical examination of the patient by the primary care physician to ensure that the patient will be in the best possible condition to undergo the surgery. The patient may also need to see the physical therapist responsible for managing rehabilitation after wrist replacement. The therapist prepares the patient before surgery to ensure readiness for rehabilitation post-surgery. The purpose of the preoperative examination is also for the physician to pre-record a baseline of information that will include measurements of the patient's current pain levels, functional wrist capacity, and the range of motion and strength of each hand.

Before surgery, patients are advised to take all of their normal medications, with the exception of blood thinners such as aspirin , ibuprofen, and other anti-inflammatory drugs that may cause greater blood loss during surgery. Patients may eat as they please the night before surgery, including solid food, until midnight. After midnight, patients should not eat or drink anything unless told otherwise by their doctor.


Aftercare

Following surgery, the patient's wrist, hand, and lower arm are placed into a bulky bandage and a splint. A small plastic tube may be inserted to drain any blood that gathers under the incision to prevent excessive swelling (hematoma). The tube is usually removed within 24 hours. Sutures may be removed 10–14 days after surgery.


Risks

Some of the most common risks associated with wrist replacement surgery are:

  • Infection. Infection can be a very serious complication following wrist replacement surgery. Infection following wrist replacement occurs in approximately 1–2% of cases. Some infections may appear before the patient leaves the hospital, while others may not become apparent for months, or even years, after surgery.
  • Loosening. There is also a risk that the artificial joints may eventually fail, due to a loosening process where the metal or cement meets the bone. There have been great advances in extending how long an artificial joint will last, but most will eventually loosen and require revision surgery. The risk of loosening is much greater in younger, more active people. A loose artificial wrist is a problem because of the resulting pain. Once the pain becomes unbearable, another operation is usually required to either revise the wrist replacement or perform a wrist fusion.
  • Nerve injury. All of the nerves and blood vessels that go to the hand travel across the wrist joint. Wrist replacement surgery is performed very close to these structures, introducing a risk of injury either to the nerves or the blood vessels.

Normal results

Wrist replacement surgery often succeeds at restoring wrist function. On average, a wrist replacement is expected to last for 10–15 years.


Alternatives

An alternative to wrist replacement is wrist fusion (arthrodesis). Wrist fusion surgery eliminates pain by allowing the bones that make up the joint to grow together, or fuse, into one solid bone. The surgery reduces pain, but also reduces the patient's ability to move the wrist. Wrist fusions were very common before the invention of artificial joints, and they are still performed often.

See also Arthroplasty .


Resources

BOOKS

Ferlic, D. C. A Colour Atlas of Joint Replacement of the Wrist and Hand (Single Surgical Procedures, 41). St. Louis: Year Book Medical Pub, 1986.

Gilula, L. A. Imaging of the Wrist and Hand. Philadelphia: W B Saunders, 1996.

Weinzweig, J., ed. Hand & Wrist Surgery Secrets. New York: Hanley & Belfus, 2000.

PERIODICALS

Courtman, N. H., D. H., Sochart. I. A., Trail. and J. K. Stanley. "Biaxial Wrist Replacement. Initial Results in the Rheumatoid Patient." The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand 24 (February 1999): 32-34.

Cuenod, P., E. Charriere, and M. Y. Papaloizos. "A mechanical comparison of bone-ligament-bone autografts from the wrist for replacement of the scapholunate ligament." Journal of Hand Surgery (American) 27 (November 2002): 985-990.

Takwale, V. J., D., Nuttall. I. A., Trail. and J. K. Stanley. "Biaxial total wrist replacement in patients with rheumatoid arthritis. Clinical review, survivorship and radiological analysis." Journal of Bone and Joint Surgery (British) 84 (July 2002): 692-699.

Meuli, H. C. "Recent literature on total wrist replacement not carefully reviewed." The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand 24 (October 1999): 635.


ORGANIZATIONS

The American Academy of Orthopaedic Surgeons (AAOS). 6300 North River Road, Rosemont, Illinois 60018-4262. (847) 823-7186; (800) 346-AAOS. http://www.aaos.org .


OTHER

"Wrist Replacement." University of Maryland Information Page. http://www.wristreplacement.com/ .

"Wrist Joint Replacement (Arthroplasty)." AAOS. <orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=347&to category=Hand> .


Monique Laberge, Ph.D.

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?



Wrist replacement surgery is performed by an orthopedic surgeon in an orthopedic hospital or in a specialized clinic.

QUESTIONS TO ASK THE DOCTOR



  • Will the surgery restore my wrist flexibility?
  • How long will rehabilitation require?
  • What are the chances of infection?
  • Is alternative treatment available?
  • How much wrist replacement surgery do you perform each year?
  • What appearance will my wrist have after surgery?

User Contributions:

Bill Renville
Report this comment as inappropriate
Jan 31, 2008 @ 8:20 pm
To the TOP Doctors in your group. I need your help! I am looking for a referral for the BEST!, the absolute BEST Orthapedic Wrist Surgeon in Pittsburgh PA. I do not care which hospital he practices at, I just want to know which Surgeon is the BEST! If the best is in Cleveland, Harrisburg etc. a few hours away, list that also. Why is it that when I call the Hospitals and ask them who the best qualified, most experienced Doctor / Wrist Surgeon is, they ONLY refer me to Doctors in their hospital. Please send me an unbiased referral of the Best two or three Wrist Surgeon's are in Pittsburgh. You see, my son had his wrist broken very, very bad in an accident and he was operated on where a metal plate was installed to put the wrist back together. Unfortunately, we believe the metal plate is causing "blockage" in wrist movement and we may need additional surgery to correct the situation and therefore, we need a recommendation for the TOP 1,2 or 3 Surgeons in Western PA.

Thank you.
debbie harmon
Report this comment as inappropriate
Dec 19, 2008 @ 12:12 pm
I,am thinging about now this done can you give me recoved times hospital stay all the answer to me fares.
earl lambert
Report this comment as inappropriate
Jan 23, 2009 @ 2:14 pm
I shattered my wrist almost 30 yrs ago and had it fused due to the massive fracturing I had of my wrist bones. Is their any hope that a wrist replacement would benefit me. I have only about 2 inches of forward movement in it and no lateral movement at all. Ive always hoped for some type of replacement for yrs. Please let me know. Thanks
Bruce McCall
Report this comment as inappropriate
Aug 30, 2009 @ 8:20 pm
I recently shattered the lower 1/3 of my radius/ulna bones.the ortho sx dr plated + screwed. Would wrist replacement benefit me?
bruce
Report this comment as inappropriate
Oct 22, 2009 @ 9:21 pm
can anyone tell me the difference in fusion or replacement for my golf game. I do not want to give it up . I've read that the replacement can not withstand jarring motions...golf.comments are appreciated
Report this comment as inappropriate
Jul 8, 2010 @ 1:13 pm
If I had metal replace the bones in my wrist, because it shattered.Is there any possible way for it to be normal again or do I have to live with this arthritis and pain for the rest of my life?
Report this comment as inappropriate
Jul 20, 2010 @ 8:08 am
I am looking for a doctor in Metro Atlanta Georgia area that does total wrist arthroplasty. Any information that anyone can give me would be appreciated.
Report this comment as inappropriate
Nov 9, 2010 @ 1:13 pm
I want to know if once a wrist is fused can you still have a Joint replacement surgery will it improve motion. I had my right wrist fused July 14th, 2010 and have been informed that the fusion did no work as intended to eliminate my pain. I have a deformed left hand and would love to get rid of this pain
Report this comment as inappropriate
Nov 15, 2010 @ 12:12 pm
I would like a list (3-4) of the best, most experienced orthopedic surgeons in the Dallas/Ft. Worth, TX area who have performed wrist replacement surgeries. Thank you.
Report this comment as inappropriate
Nov 22, 2010 @ 1:01 am
Arm had been cut due to major accident and want to transplant arm. Please advise.

Regards.

R.S.Verma
Carol Niemi
Report this comment as inappropriate
Jun 22, 2011 @ 7:19 pm
I recently broke my radius suffered ligament damage and nerve damage. I have had 2 surgeries. The first one was to place a plate and pins in my wrist, the second was to try to repair the ligaments. My doctor keeps hinting of a possible wrist replacement. I am 51 yrs, old and very active in sports including golf, volleyball and softball. My doctor says that a wrist replacement would limit my sports. Would I still be able to play the above sports after a wrist replacement?
Gail
Report this comment as inappropriate
Apr 18, 2012 @ 5:17 pm
I had a wrist replacement done a week ago. Now the first knuckles in my middle and ring finger look black or bruised. What does this mean? Is it normal?
PJ Davis
Report this comment as inappropriate
Jul 3, 2012 @ 2:14 pm
I have severe RA in my left wrist and there is no hope for repair. Like the question above, I am looking for the most experienced and BEST wrist replacement (Arthroplasty) Surgeon in the US. I am too young in my opinion for fusion, but where i live there are no surgeons who provide this surgery. Please let me know my options on the top rated surgeons in this surgery. Rated by the AMA, no outside sources, please.
lucy
Report this comment as inappropriate
Jul 19, 2012 @ 12:12 pm
I had wrist surgery in May, and the past two weeks I have had a bad sinus infection and the mucus has a strong metal smell, and now I have a knot on top of my wrist!! Is there metal getting into my system?
joe
Report this comment as inappropriate
Sep 24, 2012 @ 7:07 am
I had my wrist fused 2002 . I want to know if I could have wrist replacement surgery done to get movement in my wrist again because I love the game of golf and could I and would I be able to play again with a wrist replacement.
Mary
Report this comment as inappropriate
Oct 9, 2012 @ 8:08 am
I live in the Boston Ma area I was told I need a wrist replacement. I have pain and lost range of motion so daily tasked are getting difficult. Can you recommend a doctor in my area that has done this surgery with great results. I have one doctor from newton Wellesley hospital who I like, but if there is a doctor that does this on a regular basis and has a good record then I will go to him. I don't know how often my doctor has done this. I hope you can help me out. I am very scared about having this surgery but I know I need this or something , that will give me use of my hand again.
Thank you
Mary
Report this comment as inappropriate
Nov 12, 2012 @ 9:09 am
I have been a R.A. person sense 1982.I am now 62. I had a wrist replacement done in 2009. I now have adhesions caused from the surgery and my fingers don't want to straighten out. I have a large mass in the center of my hand that are adhasions. Like a rock. He did a tendin extention on two fingers but it didn't help. My doctor that did the surgery doesn't want to do anymore surgeries because he may cause more adhesions. I wish I could of quit work than and just put up with the pain alittle longer and it may have fused on it's own, like the left wrist did. But I couldn't so I choose replaecment and should of had more information. My advice from my experiences are to take the lesser advasive. That may be fusion. I would of gladly put up with a stiff wrist rather than curled up fingers that get in the way and are painful at time. I just want to warn people so it doesn't happen to them like me.

Comment about this article, ask questions, or add new information about this topic:

CAPTCHA


Wrist Replacement forum