Total Wrist Replacement
Artificial wrist joints have become very successful in the last 10 years and their long term survival has improved with the introduction of newer and better designs of the implant and also better fixation techniques. These operations are generally required in advanced arthritis. The pain relief after the operation is excellent and function is preserved. There is good grip strength, good forearm rotation and also some wrist movements. Patient satisfaction is very good
Most patients who need wrist fusion have Rheumatoid arthritis or one of the other varieties of arthritis. The joint is severely damaged leading to pain and disability and even basic tasks are impossible to carry out. In the early stages of arthritis, medications often control symptoms well. Sometimes operations like synovectomy may improve the wrist function for a year or two. If the arthritis has advanced and there is significant joint damage causing pain and disability then the choice is to undergo either Total wrist fusion or Total Wrist Replacement.
Total Wrist Replacement has the advantage that wrist movements are possible giving a better balanced function. Finger movements and grip is improved and there is good forearm rotation. Your wrist will be assessed to make sure that the tendons that carry out the movements are in good order and x-rays are carried out to check if the bone stock is adequate so that good fixation of the artificial joint to the bone can be achieved. If these requirements are not met and also if you use a walking stick in the same hand then it may be appropriate to undergo wrist fusion rather than replacement. The surgeon will discuss all these issues with you so that you can make the right choice.
The results of wrist replacement are very good and the implant can last 10 - 15 years. The risks include infection (2%), dislocation, limited movements (stiffness), and late failure and loosening of the implant.
Consultant Hand Surgeon
FRCS (Trauma & Orth)