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about the Hand & Wrist> Wrist Replacement
Surgery What is Wrist Replacement Surgery? Wrist replacement surgery (also known as wrist arthroplasty) is a technique that has been developed in recent years in response to the need to effectively improve a wrist joint that has been severely damaged by arthritis. The majority of patients considered for this surgery have rheumatoid arthritis. When other, more conservative methods of treating disabilities in the wrist have proven inadequate, joint replacement surgery may represent the best hope for long–term improvement to the wrist joint. Dramatic advances in the procedures and devices used to replace the wrist joint may now bring profound relief within reach to those people who suffer from chronic pain and loss of motion of the wrist joint. Many people are familiar with joint replacement surgery because of the strides that have been made the past two decades in replacing shoulder, hip, and knee joints. While replacements of wrist and ankle joints—joints of the smaller extremities—are more uncommon procedures; they also hold great promise for improving the capability of these important parts of the body. The human hand, like the foot, is a critical and complex mechanism constructed of dynamic interrelated parts such as bones, tendons, and ligaments. For wrist replacement surgery to be a viable treatment option for you, it is important that you be familiar with this procedure and the rehabilitation process that follows. Reasons for Wrist Replacement Surgery? The joints of our bodies are cushioned with a material called cartilage, and with osteoarthritis, degeneration of the cartilage may take place. The cartilage cushioning the surfaces of bones is lost, causing the grinding of bones against each other. The joint lining (the synovium) becomes overgrown and inflammed leading to pain and limited wrist motion. Rheumatoid arthritis may also cause destruction of the smaller joints of the fingers and thumb. Rheumatoid arthritis is a chronic inflammatory disease that causes pain, stiffness, and swelling in the joints, usually in a symmetrical pattern (if one hand has it, the other one will also). In Rheumatoid arthritis, the joint lining (synovium), normally smooth and shiny, becomes inflamed, painful and swollen. The disease, which lasts over a long period of time, can cause damage to cartilage, bone, tendons and ligaments. Traumatic arthritis results when fracture, dislocation, or accident damages the joint or the ligaments surrounding it. This damage predisposes the wrist to arthritis because the structures supporting the joint have become weakened or misaligned. A small percentage of patients with traumatic arthritis may be candidates for wrist replacement surgery. There are eight bones in the wrist, known as the carpal bones that allow it to extend back and flex down. These small bones articulate with the bones of the forearm (the radius and the ulna), and with the metacarpal bones radiating out into the palm and the thumb. Inflammatory arthritis causes destruction of the carpal bones as well as the radius and ulna leading to joint pain and stiffness. One common symptom of arthritis or other injury to the wrist is diminished grip strength. The fingers of the hand are able to move because tendons within them are connected to the muscles of the forearm. As arthritis weakens the wrist and hand, strength and “pinch” in the fingers and thumb are also affected. Without sufficient wrist movement, grip strength is significantly affected. There is a pad of cartilage between each of the eight bones of the wrist joint that allows them to move against each other. Cartilage is slick elastic connective tissue that protects bones. Very tough and malleable (such as the cartilage we can feel in our earlobes), this substance provides the smooth gliding surface necessary for efficient joint motion. Individuals who suffer from arthritis experience a loss of this cartilaginous surface. As the cartilage degenerates, the ends of the bones become exposed. When the unprotected joint surfaces contact each other, the result is pain. Surgical Procedure for Wrist Replacement? Many people with arthritic conditions manage their discomfort with non–surgical treatments including proper medication, physical therapy, exercise, rest, and joint protection. If these conservative care methods do not achieve relief, surgery may be recommended. Most people undergo surgery to relieve their pain. For many people, wrist replacement surgery also leads to better movement and coordination of the hands, fingers, and arm. Another benefit is an improvement in the appearance of the hand and wrist. Wrist replacement surgery can lead to significant improvements in daily activities such as eating, driving and personal hygiene. While the main reason for wrist replacement surgery is to relieve pain, the procedure may also provide an opportunity to correct any deformities. Wrist replacement surgery may be combined with other procedures to correct disorders of tendons, nerves or the small joints of the fingers and thumb. The wrist joint is approached through an incision over the back of the wrist. The diseased bones of the wrist are removed and replaced with a specially designed artificial joint called a prosthesis. This prosthesis is primarily made of metal with a small spacer of polyethylene (a type of medical grade plastic). The materials are identical to those used for hip and knee replacements. The wrist replacement prosthesis is attached to the bones of the arm and hand once the destroyed bones have been removed. Most cases require the use of a small amount of bone cement to secure the prosthesis to the bones. The prosthesis is made of two parts that form a new surface that resembles the normal bones of the forearm and wrist. This prosthesis allows forward, backward and sideways movement. Rehabilitation of Wrist Replacement Surgery? In most cases, the wrist is immobilized for three to four weeks after surgery. This allows the ligaments of the wrist to heal. Those ligaments provide the stability of the prosthesis. After the three to four week period, therapy begins with exercises designed to maximize range of motion. During this time, a splint is used to immobilize the wrist between exercise sessions. A hand therapist is usually consulted to supervise your recovery, which will vary in time depending on your commitment to therapy, your bone structure, and your muscle strength before and after surgery. Most patients require three to six months to totally recover from wrist replant surgery. A progressive improvement in pain and movement should be noted. Possible Complications of Wrist Replacement Surgery? There are number of things to watch for after any form of surgery: call your doctor if you notice any drainage or foul odor from your incision, or if your temperature rises over 100.4 degrees. Your doctor should also be notified of any increased tenderness, redness or swelling. As with other joint replacements, prosthetic complications may occur such as dislocation, breakage or loosening. Your surgeon will likely ask that you avoid lifting over ten pounds once the joint replacement has been performed. Excessive lifting may lead to joint dislocation, loosening or breakage of the prosthesis. Wrist replacement surgery is a relatively new procedure that must be performed by an experienced hand surgeon using one of the high–quality prostheses that is currently available. Since joint replacements consist of man–made materials, they may not last forever. While the majority of prostheses performed ten to fifteen years ago remain functional, secondary surgery may be required. While not everyone with wrist arthritis is a candidate for joint replacement, most people do experience significant improvement in their pain, movement and appearance after surgery. Consult your hand surgeon to see if wrist joint replacement surgery is the best option for you. The information provided herein is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting a licensed physician. © 2000 DynoMed.com, LLC, Indianapolis, IN |