Wrist joint replacement: when to have surgery for arthritis

If you are suffering from arthritis in your wrist, joint replacement surgery might be an option if your condition is not responding to other treatments. Hip and knee joint replacements are more common as procedures because the wrist itself is anatomically more complicated. The procedure, however, is certainly possible and has proven to be effective in providing pain relief. In this article, one of our highly experienced wrist surgeons Dr Stephen Lipscombe explains more.
 

Is wrist joint replacement surgery a fairly new treatment?

Wrist joint replacement surgery has been possible for years although it doesn’t have the quantity of data available for knee and hip replacements which have been available for much longer. Fewer surgeons also complete wrist replacement surgery.
 

Who makes an ideal candidate for the procedure?

As with all joint replacement surgery, the longevity of the implant is key. You can expect most joint replacements to last at least 20 years before problems can occur with implant failure and pain. The activity status of the patient can accelerate this process.

Traditionally, wrist replacement surgery has been aimed at low demand patients suffering from inflammatory joint disease. Newer implants do allow increased activity levels although I would still only recommend such replacements in office/light manual workers.
 

What happens during a total wrist replacement?

The procedure is completed under a general anaesthetic (with the patient asleep) or regional block in the main theatres. Antibiotics are administered before the procedure starts to reduce the chance of developing a disastrous infection.

An incision is performed on the back of the wrist. Tendons are mobilised and the wrist capsule opened, exposing the degenerate wrist joint. Saw cuts are completed to remove painful cartilage surfaces and allow the implant to be positioned.

There are a number of implants but most are impacted into position relying upon bony ingrowth. Some parts of the replacement are secured using screws. A highly engineered plastic spacer allows smooth movement at the replacement. The capsule and soft tissue are closed and a resting splint applied.
 

How effective is wrist joint replacement for wrist arthritis?

Most patients will experience excellent relief of pain and preservation of wrist movement. It is important to note that joint replacement surgery rarely improves movement in the stiff joint, although the preservation of painless movement, albeit stiff, is preferred for daily activity.
 

What are the benefits of the procedure?

The wrist replacement preserves wrist motion and reliably relieves pain. Other procedures for wrist arthritis are possible but they rely upon healthy cartilage at different areas in the wrist joint. If this cartilage is damaged, complete fusion of the wrist was previously the only surgical option. Wrist replacement surgery now provides another useful option.
 

What can I expect following surgery?

The wrist is supported in a resting splint for two weeks and elevated in a sling. The sutures are then removed and movement commenced using a removable splint. At six weeks the splint can be discarded and strengthening exercise continued. By this stage, most patients are pleased with the pain relief they experience and are returning to normal daily activity.



You can book an appointment with Mr Lipscombe via his Top Doctor’s profile here if you would like his expert opinion in your case.