Millions of Americans have had hip, knee or shoulder replacements to relieve pain and improve their mobility.
Now: A similar procedure can be done on the wrist, a joint that used to be considered too complex to remove and replace.
With wrist replacement, or arthroplasty, patients can achieve pain relief while retaining more mobility than was possible with earlier procedures.
What you need to know…
A NEW APPROACH
Approximately 27 million American adults suffer from osteoarthritis — a condition that frequently affects the wrist. Millions more have rheumatoid arthritis or osteoporosis, conditions that also can lead to permanent damage to the wrist and other joints.
Until recently, the main surgical treatment for arthritic and damaged wrists was fusion, in which wrist bones are permanently fused to prevent the bones from rubbing together and causing pain. Fusion is very effective at easing pain but, depending on the procedure, allows for little or no joint movement.
Unlike the hip and knee joints, which have only two bones each, the wrists have eight bones — 10 if you count those in the forearm. The challenge for manufacturers was to design an artificial joint that gave patients a wide range of movement but also was durable enough to justify the risks and discomfort of surgery.
WHO SHOULD CONSIDER A WRIST REPLACEMENT?
Wrist replacement is a good choice for people whose persistent pain and stiffness interferes with their daily activities, and who have not been helped by medical treatments such as rest, splinting, stretching exercises and/or the use of anti-inflammatory medications.
Important: There isn’t enough data to predict how long the new wrist replacements will last. We think they’ll last 10 to 15 years — but no one knows for sure.
Because of this, I advise patients — particularly those who are younger and have decades of life ahead of them — to wait as long as they possibly can before having surgery. When a wrist replacement wears out, pain results and a new artificial wrist joint or fusion will be required.
Cost is also a factor. A total wrist replacement costs significantly more than wrist fusion. For this reason, patients with limited or no insurance might decide that the lower cost of a fusion procedure justifies having less wrist mobility.
Exception: If you’ve already had one wrist fused and need treatment for the other wrist, I always recommend joint replacement. You need at least one mobile wrist for many of the activities of daily living, such as brushing your teeth, buttoning a shirt, etc.
GETTING A WRIST REPLACEMENT
If you’re considering a wrist replacement, look for an orthopedic hand surgeon with experience in wrist replacements.*
Wrist replacement is typically a 45-minute outpatient surgery that doesn’t require general anesthesia — a nerve block is used to numb the arm.
The surgeon makes a two- to three-inch incision on the back of the wrist and removes the arthritic/damaged joint. The artificial joint, made of plastic and steel, is then inserted. There is a separate component that attaches to the radius, one of the bones in the forearm.
New development: We’ve found that many younger patients do just as well when they have a hemiarthroplasty, which involves replacing only half of the joint.
Hemiarthroplasty is a less extensive procedure that leaves more of the carpal bones in the wrist in place. This is important because an implant on the carpal bones is more likely to loosen and become unattached from those bones than other parts of the joint.
Unlike hip and knee replacements, arthroplasty usually doesn’t use bone cement. The prosthesis has a roughened surface that allows the body’s natural bone to grow into and anchor the steel parts, a process known as porous in-growth. It’s stronger and more stable than cement.
Long-term complications (after 10 to 15 years), including joint loosening or damage to the components, occur in 2% to 3% of arthroplasty cases. A revision replacement or fusion is required to treat the pain that occurs in these patients.
Postsurgical infection is possible but is no more likely with wrist replacement than with other surgical procedures.
WHAT TO EXPECT AFTER SURGERY
Patients regain, on average, about half of their normal wrist motion, usually within three to four months of wrist-replacement surgery. This range of motion, accompanied by a roughly equal level of fine control, is typically enough to do just about anything you want, including activities such as gardening, golf and tennis. In some cases, patients may regain up to 75% of their normal wrist motion following wrist replacement.
However, as a precaution, I advise my patients who have undergone wrist replacement not to lift anything heavier than about 10 pounds for the rest of their lives to avoid loosening the joint.
For four weeks following wrist-replacement surgery, a splint or cast is worn to keep the joint stable while it heals.
After that, patients meet regularly with a physical therapist — usually twice weekly for about two to four months — to perform stretching and strengthening exercises.
Caution: Unlike hip and knee replacements, the smaller devices used in wrist replacement may not set off scanners at airports — but we’ve had reports that they will set off scanners used in other settings, such as in courtrooms. Ask your doctor for a card that explains that you’ve had the procedure.
Also important: Bacteria can readily proliferate on foreign material in the body, including artificial joints. A lingering infection, even if you don’t have symptoms, can loosen the implant.
Be sure to mention to your dentist and all of your doctors that you have an artificial joint. You may be advised to take antibiotics for a few days prior to dental and medical procedures to help avoid infection.
