Wrist replacement surgery is performed to replace a wrist injured or damaged beyond repair. An artificial wrist joint replacement is implanted.
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.
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:
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.
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.
Some of the most common risks associated with wrist replacement surgery are:
Wrist replacement surgery often succeeds at restoring wrist function. On average, a wrist replacement is expected to last for 10–15 years.
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 .
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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.
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.
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 .
"Wrist Replacement." University of Maryland Information Page. http://www.wristreplacement.com/ .
"Wrist Joint Replacement (Arthroplasty)." AAOS. http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=347&topcategory=Hand .
Monique Laberge, Ph.D.
Wrist replacement surgery is performed by an orthopedic surgeon in an orthopedic hospital or in a specialized clinic.