A total wrist replacement is generally indicated when a wrist that has sustained a traumatic injury or has been affected by a severe degenerative disease such as arthritis is unresponsive to other treatments and no longer able to function properly. In some cases patients suffer from severe pain in the wrist and may have lost the ability to use it.
A wrist replacement eliminates pain and recovers diminished strength in the wrist by restoring length to the muscles and tendons of the fingers and wrist – improving motion and stability necessary to perform everyday activities.
Also called Total Wrist Arthroplasty, wrist replacement surgery replaces the damaged wrist joint with an artificial one. The procedure has grown increasingly popular over the years, as technology improves. Previously such severe wrist conditions unresponsive to other treatments were addressed with a procedure known as Wrist Arthrodesis. Unlike Wrist Arthroplasty, Wrist Arthrodesis promotes the fusion of wrist bones in order to eliminate pain – though substantially reduces wrist movement.
The Procedure
Following a complete physical examination and review of post surgery rehabilitation, the wrist replacement procedure is scheduled.
Wrist replacement surgery is performed under either general anesthesia (putting the patient to sleep) or regional anesthesia (putting only the arm to sleep). The procedure begins with an incision at the back of the hand and wrist. The tendons over the back of the wrist are moved in order to access the wrist joint area. 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 hand bones and the radius bone of the forearm are then prepared with special instruments and small holes are created in the bones for placement of the artificial joint. Once the joint is snugly fit into the wrist, a series of tests are performed to ensure proper range of motion and correct movement. 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 to restrict movement while keeping the wrist in a natural position as 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
Patients are monitored in the hospital for 24 hours following the surgery and then watched closely, in order to ensure that the joint does not become infected and loosening of the artificial joint does not occur. Patients are encouraged to keep their hand elevated above their heart for several days following surgery in order to avoid swelling and throbbing.
Any stitches that have not been absorbed by the body are removed approximately two weeks after the procedure. When the wound has healed, patients will wear an arm length cast that places the wrist in neutral position – for approximately four to six weeks.
Rehabilitation
Work with a physical therapist responsible for managing rehabilitation following wrist replacement actually began before the surgery in a pre-surgery visit, where the patient is told what to expect following the procedure. The first few postoperative visits with the therapist will center around pain management and prevention of swelling.
The prevention, or reduction, of swelling is important in the rehabilitation of any limb following surgery, because joints are far less likely to become stiff when swelling is minimal – facilitating range of motion exercises and re-strengthening of the limb.
Patients will gradually begin adding range of motion and strengthening exercises 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. The new wrist joint lasts approximately 10 to 15 years.