Joint Replacement - Wrist

When a deteriorating wrist joint is unresponsive to other treatment options and pain and limited function hinder a patients quality of life, a total wrist replacement may be indicated. A wrist replacement, eliminates pain and restores strength and function to the wrist by replacing the damaged wrist joint with an artificial one.

About the Wrist Joint
The wrist joint is comprised of some of the smallest bones in the upper body and represents one of the most complex joints. It has eight "carpal bones" arranged two rows of four and an intricate network of joints connecting one carpal bone to the next. The wrist joint is actually a joint comprised of many smaller joints. Covering the ends of the bones at each joint is cushioning articular cartilage, which is thinner in the wrist joint than in other large weight-bearing joints.

Often vulnerable to injury because of its range of motion and involvement in day-to-day activities and sports, it is at greater risk for joint instability leading to deterioration.

Today, advanced implants and joint replacement techniques for small bones and joints help facilitate the decision to undergo joint replacement, particularly for joints of the hand and wrist so instrumental in everyday activities. Previously such severe wrist conditions unresponsive to other treatments were addressed with a procedure known as Wrist Arthrodesis. Unlike Wrist Arthroplasty, Wrist Arthrodesis fuse wrist bones together in order to eliminate pain. But wrist fusion reduces wrist movement considerably.

The Procedure
Once a patient's medical history and physical examination results are thoroughly assessed, the procedure is explained in detail and scheduled.

Performed under either general or regional anesthesia - depending on which is determined to be the best for a particular patient - the wrist replacement procedure begins with an incision at the back of the hand and wrist. Tendons over the back of the wrist are then moved in order to access the wrist joint. A portion of the carpal bones and the ends of the radius and ulna are then removed in order to make room for the artificial joint - which consists of both metal and plastic. The end of the radius bone is shaped to accommodate the prosthesis.

The distal end of the radius and the carpal bones of the hand, are prepared with special instruments. Small holes are created in the bones in order to place the artificial joint. Once the artificial joint is fit snugly into the wrist, a series of tests are performed in order to ensure proper range of motion and correct movement can be achieved. The stems of the prosthesis are then permanently secured in place, the tendons are returned to their proper position, and the skin is closed with sutures.

The wrist is placed in bandages and a small splint is used in order to restrict movement and keep the wrist in a natural position while it heals. A small draining tube may be placed in the wound immediately following surgery to prevent fluids from accumulating in the wound - reducing the chance of swelling and the subsequent stiffness it can cause.

Following the Procedure
Over a 24-hour period, patients are monitored in the hospital in order to ensure that the wound does not become infected and to confirm that the artificial joint does not loosen. Patients are then sent home with instructions reduce activity and keep their hand elevated above their heart for several days in order to avoid pain and swelling.

Remaining stitches that have not been absorbed by the body are removed approximately two weeks following the procedure. Once the wound has healed, patients are placed in an arm length cast that places the wrist in neutral position - for approximately four to six weeks.

Preventing swelling is important in the rehabilitation of any limb following surgery, because joints are far less likely to become stiff and lose range of motion when swelling is minimal. This helps in quickly regaining strength and range of motion.

A personalized rehabilitation program is established for each patient, with range of motion and strengthening exercises increasing over time in order to help stabilize the wrist joint. Exercises specific to the types of movement the patient most often makes in work or other daily activities will be developed specific to the patient.

Recovery of a total wrist replacement generally takes three to six months. Today's new wrist joints lasts approximately 10 to 15 years.