Wrist Joint Replacement (Wrist Arthroplasty)

The wrist is a complex joint made up of 8 carpal bones aligned in two rows. These bones connect to 5 metacarpal bones in the palm and the ends of the forearm bones (ulna and radius) in the arm. Each bone forms a joint with its adjacent bone. Thus, the wrist is made up of many small joints. The ends of all the bones are covered with a white, shiny material called articular cartilage, which allows the bones in a joint to move smoothly against each other. Injury, infection and diseases such as osteoarthritis and rheumatoid arthritis can damage or wear out the articular cartilage. This may cause the wrist bones to rub against each other producing pain, stiffness and swelling.

Wrist joint replacement surgery, also referred to as wrist arthroplasty, involves the replacement of a severe arthritic wrist joint with an artificial joint made of metal and plastic components. It relieves pain and restores function when conservative treatment fails to provide relief.

Wrist arthroplasty is performed under general or regional anesthesia. An incision is made over the back of the wrist. The tendons and nerves are moved away to expose the wrist joint and prevent any damage. The damaged joint surfaces of the arm bones are removed with a surgical saw. The first row of carpal bones may also be excised. The radius is hollowed out and an artificial component is fitted with bone cement. Depending upon the design of the prosthesis, the carpal component is placed in the remaining row of carpal bones or into the third metacarpal bone. A plastic spacer is then fit between the metal components.

With the new prosthesis in place the wrist joint is tested through its range of motion. The muscles and tendons are moved back in place. The incision is closed and the wrist is bandaged with a sterile dressing.

Your arm is placed in a cast for the first few weeks after the surgery and you will be prescribed medications to control pain. Elevating the wrist on a pillow above heart level will help reduce swelling and discomfort. Once the cast is removed, a splint is placed for another few weeks. Physical therapy will also be advised to restore movement to the wrist joint.

Although wrist replacement surgery is considered safe, there are certain risks and complications associated with any type of surgical procedure. Some of the risks and complications include infection, fracture of the wrist bone, dislocation of the wrist, damage to the nerves or blood vessels, blood clots (deep vein thrombosis), loosening or wear of the implants, and failure to relieve pain.

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