Introduction
Although wrist fusion is the standard treatment for advanced wrist arthritis, in some patients a wrist arthroplasty (replacement) offers the chance of curing the pain while preserving motion. Joint replacement may be for the radiocarpal joint (flexion and extension of the wrist) or the distal radioulnar joint (rotation of the wrist).
Indications
People with painful arthritis of the wrist not settling with conservative treatment and for whom wrist fusion would be a poor option.
Preoperative Instructions
Wrist arthroplasty usually requires an overnight stay and you will be admitted on the morning of the surgery. The hospital will discuss the time of arrival and fasting arrangements. You would normally have to stop anticoagulant medication prior to this procedure, but Dr Stewart can advise you about your specific requirements.
Procedure
An incision is made on the back of the wrist and the joint exposed. The arthritic joint surfaces are removed and replaced with a metal and plastic joint replacement sized specifically for the patient’s wrist. The joint position is checked with x-rays intraoperatively.
Postoperative Instructions
Depending on the type of joint replacement, there will need to be between 2 and 6 weeks of immobilization of the wrist after the procedure, followed by 2-3 months of hand therapy to recover strength and rage of motion.
Risks
Although offering some advantages in terms of movement after the procedure, there are more complications with wrist replacement than with fusion. There is a small but present risk of infection with could mean the replacement needs to be removed. There could also be a problem with instability and dislocation which could require revision surgery.
Treatment Alternatives
Other than ongoing splinting, steroid injection and hand therapy, the main alternative to wrist arthroplasty is wrist fusion.