Introduction

Arthritic conditions, such as rheumatoid arthritis or osteoarthritis, fractures, dislocations, or long-time instability of the wrist bones can destroy all or most of the cartilage that forms the smooth surface of the many wrist bones. When that happens, the wrist becomes painful and loses motion.

When the pain and functional impairment keeps you from your daily activities, you may seek the advice of your physician. You may also be a candidate for wrist replacement surgery. The surgery is complicated. However, wrist replacement surgery can now offer relief to many people who suffer from wrist arthritis.

Before the Surgery

When you and your doctor decide that wrist replacement is necessary, your doctor will ask you questions about your personal and medical history. A physical examination will also be conducted.

Be sure to tell your doctor of all health issues, including allergies and any prescription and/or over-the-counter medications you are taking. Any medications, such as aspirin, ibuprofen, and other anti-inflammatories, may cause greater blood loss during surgery.

The Surgery

Wrist replacement surgery is typically an inpatient procedure using a general anesthetic to put you to sleep.

The wrist joint is reached through an incision over the back of the wrist. The soft tissues, muscles, and tendons are moved out of the way to help your surgeon see the wrist joint. Your surgeon will remove a small amount of your radius bone (the smaller of your forearm bones) and most of the first row of wrist bones to make room for your new wrist implant.

After the wrist bones have been removed, special instruments called reamers will be used to prepare the central canals in the radius for the stems of the prosthesis.

Your new wrist will consist of a specially designed artificial joint made of metal with a small spacer made of a medical-grade plastic. The prosthesis comes in two parts. One is called the radial component, fitting against the end of the forearm bone (radius). The other is called the distal or meta-carpal component, replacing the small bones of the wrist.

Once your surgeon prepares the bones, he or she will likely use trial implants to determine the proper size of the implant. When the trial parts are in place, the joint will be put through a range of motions to make sure it moves correctly.

Then your surgeon will insert the permanent implant. When he or she is satisfied, the implant is in good working order, the tissues over the wrist are repaired and the incision is closed. Your wrist will be placed in a splint and wrapped in a bulky bandage. This will keep your wrist from moving during the early healing phase.

After Surgery and in the Hospital

In the recovery room, your nurse will monitor your blood pressure, respiration rate, and pulse until the anesthetic wears off. When you are alert, you will be taken to your hospital room. You will be provided with pain medication to relieve any discomfort. Antibiotics may also be given if infection is felt to be a threat.

You will be told to keep your hand elevated above the level of your heart for several days to avoid swelling and a throbbing feeling. While sitting and sleeping, you will need to keep your wrist propped up on a stack of pillows.

Once you are released, you may be scheduled for a follow-up medical exam within seven days for a dressing change and a status evaluation of the incision and wrist replacement

Leaving the Hospital

Two months after surgery, you will probably begin strengthening exercises to tone the muscles of the wrist and hand. At three months, your doctor may allow you to begin normal activities. X-rays may be taken at this point to confirm the healing process.

Your surgeon will probably want to see you from time-to-time to check the status of the joint. Once again, X-rays may be taken to check for possible loosening of the new joint.

You should be aware of the possibility of complications and notify your surgeon if there is any concern. Some signs include excessive pain at the joint, redness or swelling more than usual, a foul odor or a feeling that the joint is loosening.

Your new wrist will not work exactly like the old one. An early goal in your recovery will be to find new ways to do familiar activities to keep stress to a minimum on your wrist.