Total wrist replacement (wrist arthroplasty) is performed when arthritis pain is severe, and has not responded to other treatments. Both rheumatoid and osteoarthritis cause pain, and both can affect finger and hand strength, making it difficult to pinch or grip. The primary candidate for wrist replacement has severe arthritis, but does not place significant stress on the wrist.
Although replacing the wrist reduces pain and restores strength, a synthetic wrist, which is usually made of metal and plastic, will not be as strong as the original. In a patient with severe arthritis in both wrists, replacing one wrist and fusing the other is recommended. In this way, the replacement wrist offers good range of motion, while the fused wrist provides enough strength to handle stressful activity.
Total Wrist Replacement Procedure
The first step in total wrist replacement is making an incision through the skin on the back of the wrist. Tendons are moved aside, and the joint capsule surrounding the wrist joint is cut into. To make room for the prosthesis (synthetic wrist), some of the wrist's carpal bones are removed. The end of the radius is then shaped to fit the prosthesis. Special rasps bore holes in the hand bones and in the forearm's radius bone to accommodate the metal stems of the prosthesis. After fitting the stems as tightly as necessary, the prosthesis is put in place and its range of motion checked. If the surgeon is pleased with the result, the metal stems are cemented into place. After the tendons are put back in place, the incision is closed.
Complications of Total Wrist Replacement
Some of the most common complications following total wrist replacement are infection, injury to nerves and blood vessels, and loosening of the metal stems from the bones. A loose prosthesis can cause pain, treatment of which may require another wrist replacement. Younger and/or more active patients are more likely to have their prostheses loosen. When treated with care, a wrist replacement can last 10 years or longer.
Recovery from Total Wrist Replacement
After total wrist replacement, the wrist is usually put in a bandage-covered splint. A drainage tube is put in, typically only for a day, to remove excess blood and prevent swelling. Within 5 to 7 days, the patient sees the surgeon to have the wrist checked and, within 10 to 14 days, has the stitches removed. Recovery from total wrist replacement can be painful, and pain medication is provided as necessary. To avoid swelling and throbbing, the hand is kept elevated while the patient is sleeping or sitting.