Wrist joint replacement

Procedure

In this procedure the wrist joint is replaced with a metal joint – much like a small hip replacement.  The advantage of this over a fusion is that you keep movement in the wrist. Government guidelines, from the National Institute for Clinical Excellence are that wrist replacement’  should be undertaken only on carefully selected patients, by surgeons with special expertise in interventions for the hand and wrist… with special arrangements for clinical governance, consent and audit or research.’ With this in mind if you do opt to have a wrist replacement the expectation is that you will be contacted for long term follow up.

At the moment we simply do not know how long a wrist replacement will last but more recent evidence does look promising, even in the higher demand patient, and it is projected that,  with more modern wrist replacement designs 86% of wrists will last at least 10 years.

The operation itself takes around an hour and a half to two hours and can be done under general anaesthesia – with you asleep; or under regional anaesthesia – with a numb arm. There will be a scar on the back of the hand, typically around 20cm. This can be quite a painful procedure and most people need one or two nights in hospital.

Aftercare

After the operation you will be given exercises to get the fingers and thumb moving immediately and will be in a cast for two to three weeks. After the first two weeks you will come back to have your stitches taken out and be given exercises to gets the wrist moving.

Return to work and driving

Most people will be off work and driving for 6 weeks, after this period heavy lifting should be avoided for a further 6 weeks.

Risks

Any procedure carries risks and whilst every care is taken to minimise the chances the following are some of the more common - but still rare  - complications that can arise:

Infection - Significant infection is very rare but if it does occur may require further surgery.

Stiffness, swelling and pain  - A degree of stiffness , swelling and pain following surgery is normal. Some people react badly to an operation and develop more of this. This in called complex regional pain syndrome (CRPS) and requires specialist treatment.

Failure - All artificial joints will eventually wear out.

Dislocation - In theory any artificial joint can dislocate. 

References

Reigstad, Ole, et al. "5-10 Year Prospective Follow-up of Wrist Arthroplasty in 56 Non-rheumatoid Patients." Journal of Hand Surgery 41.9 (2016): S6-S7.

Reigstad, O., et al. "Promising one-to six-year results with the Motec wrist arthroplasty in patients with post-traumatic osteoarthritis." J Bone Joint Surg Br 94.11 (2012): 1540-1545.