Wrist Replacement

Mr Mike Hayton
FRCS (Trauma and Orth) FFSEM (UK)
Consultant Orthopaedic Hand Surgeon

Wrist replacements are becoming increasingly common. These are performed when patients have got regular pain and misery from an arthritic joint. The vast majority of wrist replacements are performed in patients with rheumatoid arthritis or psoriatic arthritis, but increasing numbers have been performed in patients with osteoarthritis.

Generally speaking, the modern generation of wrist replacements includes a two-piece component, one of which is metal and one of which is a special type of plastic.
Previous non-operative treatments may include splintage and pain killers.

Symptoms

Pain and decreased range of movement are symptoms that may lead to a total wrist replacement

Clinical examination

The arthritic wrist is usually swollen and stiff.

Investigations

X-rays usually confirm the diagnosis. The features of arthritis on an x-ray are loss of joint space previously occupied by the articular cartilage, new bone formation at the edges of the joint (osteophyte), cysts in the bone and hardening of the ends of the bone with increased white appearance (sclerosis)

Operative treatment for wrist replacement

Surgery is performed under general anaesthetic or regional anaesthesia, where the arm is made numb. The surgery takes approximately sixty minutes. During the procedure the arthritic ends of bone are removed and the wrist replacement components are inserted. The current wrist replacements do not require cement, but allow the bones to grow onto the stems of the implants for stable fixation.

Post-operative rehabilitation

If the surgeon is happy with the stability and movement obtained at the time of surgery patients are rested for the first one to two weeks to allow swelling to settle, before undertaking a gradual rehabilitation programme under the care of a Hand Therapist.

Complications

The risks associated with total wrist replacement include infection (less than 1%), dislocation (the joint comes undone), fracture, tendon and nerve injury, pain syndrome. However, these complications are quite rare and we quote in the region of an 80 to 90% success rate following this type of surgery.