Wrist Joint Replacement
Simple, everyday tasks, like opening a jar, turning a doorknob, or getting dressed, can be frustrating with progressive pain and stiffness in the wrist. Many wrist conditions will improve with nonsurgical treatments, yet severe arthritis or joint damage could eventually require surgery.
Wrist joint replacement (wrist arthroplasty) modifies damaged portions of the wrist joint with artificial components with the intention to relieve pain and preserve some of the wrist’s natural range of motion. Unlike wrist fusion, which permanently joins the bones together to eliminate movement, wrist replacement is designed to reduce pain while allowing the wrist to continue bending and rotating.
Wrist Anatomy
The wrist is a complex area made up of 8 carpal bones and the two long bones of the forearm, the radius and the ulna, and are connected by strong ligaments that help stabilize the joint. The configuration of these bones and soft tissues allow us to bend, straighten, rotate, and position the hand for countless daily activities.
The ends of the bones are covered with articular cartilage that cushions the joint and allows the bones to glide against one another with very little friction. The joint is surrounded by a thin lining called the synovium, which produces lubricating fluid to help the wrist move.
When cartilage wears away, the bones begin rubbing directly against one another, which leads to pain, swelling, stiffness, weakness, and decreased range of motion.
What Is Wrist Joint Replacement?
Wrist joint replacement is a surgical procedure that removes damaged joint surfaces and replaces them with specially designed artificial components.
Most modern wrist replacements consist of metal components that attach to the radius and one or more of the carpal bones with a plastic spacer between them to create a new joint that removes friction and painful bone-on-bone contact.
Wrist replacement can significantly reduce pain and improve function, but patients are cautioned that it does not recreate a completely normal wrist, and some limitations in strength and motion should be expected. Artificial joints can also wear over time, and patients are encouraged to avoid repetitive heavy lifting and high-impact activities after surgery.
Why Might Wrist Joint Replacement Be Needed?
Wrist joint replacement is most often recommended when pain, stiffness, and loss of function significantly affect your quality of life and nonsurgical treatments no longer provide enough relief. Before recommending surgery, your orthopedic surgeon will typically explore conservative options such as activity modification, splinting, anti-inflammatory medications, corticosteroid injections, and physical or occupational therapy.
Several conditions can damage the wrist joint, including:
Osteoarthritis
Osteoarthritis is the most common form of arthritis. It develops as the smooth cartilage that cushions the joint gradually wears away, allowing the bones to rub against one another. Although osteoarthritis is more common in weight-bearing joints, it can also affect the wrist, particularly after years of repetitive use or previous injury.
Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune disease in which the body’s immune system mistakenly attacks the lining of the joints. The resulting chronic inflammation eventually damages cartilage, weakens ligaments, and changes the alignment of the wrist, leading to pain, swelling, disfigurement, and decreased function.
Post-Traumatic Arthritis
A previous wrist fracture or ligament injury can alter the way the joint functions, even after it has healed. Years later, the damaged joint surfaces may develop arthritis.
Advanced Joint Damage
Less commonly, severe joint destruction caused by certain inflammatory conditions, avascular necrosis (loss of blood supply to bone), or failed previous wrist surgery may make wrist replacement an appropriate treatment option.
Is Wrist Joint Replacement Right for You?
Wrist replacement is not the best solution for every patient. The decision depends on the severity of joint damage, the condition of the surrounding bones and ligaments, your age, overall health, activity level, and personal goals.
In general, wrist replacement may be considered for patients who:
- Have severe wrist arthritis that has not improved with nonsurgical treatment
- Experience persistent pain that interferes with daily activities
- Want to maintain some wrist motion rather than eliminate it
- Have reasonable bone quality to support an implant
- Understand the activity limitations that help protect the artificial joint
Patients who perform heavy manual labor or routinely lift substantial weight may not be ideal candidates because excessive stress can shorten the lifespan of the implant. This is something that will be discussed during evaluation.
For some individuals, wrist fusion (arthrodesis) could provide a better long-term solution. Fusion permanently joins the wrist bones together, eliminating painful movement while creating a stable, strong wrist. Although the trade-off is limited wrist movement and potential loss of fine hand coordination, for some patients it’s worth it to relieve the pain and improve strength in the joint. There are also partial wrist fusions that can maintain motion as well as interpositional arthroplasty procedures that remove a portion of the wrist and place a tissue spacer in the joint allowing for some continued motion. Your surgeon will discuss the advantages and disadvantages of each procedure and recommend the option that best matches your lifestyle and expectations.
Wrist Replacement Options
Modern wrist replacement systems recreate the natural mechanics of the joint, but not every wrist replacement is exactly the same. Your surgeon will recommend an implant based on your anatomy, the amount of arthritis present, bone quality, and the stability of your wrist.
During surgery, damaged cartilage and small amounts of bone are carefully removed before the implant is positioned. In some situations, additional procedures might be necessary to perform at the same time to improve alignment, balance the surrounding soft tissues, or address problems involving nearby joints or tendons:
- Tendon balancing or tendon transfers if longstanding arthritis has caused tendon imbalance or rupture (most common in advanced rheumatoid arthritis).
- Ligament reconstruction or repair if the wrist is unstable.
- Bone grafting if there is bone loss that needs to support the implant.
- Distal ulna procedures (such as distal ulna resection or arthroplasty) if arthritis also involves the distal radioulnar joint (DRUJ), where the radius and ulna meet near the wrist.
- Carpal tunnel release if the patient also has symptomatic carpal tunnel syndrome.
- Removal of hardware from a previous fracture or surgery if it interferes with implant placement.
Risks and Potential Complications
Every surgical procedure, including wrist arthroplasty, carries some degree of risk. Potential but uncommon complications of wrist replacement include:
- Infection
- Bleeding
- Blood clots
- Injury to nearby nerves or blood vessels
- Stiffness
- Persistent pain
- Implant loosening or wear over time
- Implant dislocation or instability
- Fracture around the implant
- Need for revision surgery if the implant fails
Following your surgeon’s postoperative instructions can help reduce many of these risks and improve the chances of a successful outcome.
Preparing for Surgery
Preparing for wrist replacement begins several weeks before your procedure. Your surgical team will review your medical history, medications, and overall health to make sure surgery can be performed as safely as possible.
- Before surgery, you may undergo:
- A physical examination
- X-rays or other imaging studies
- Blood work or additional medical testing, if needed
- Medication review
- Medical clearance from your primary care physician or specialists, when appropriate
You may be asked to temporarily stop certain medications that increase bleeding risk. If you smoke, quitting before surgery can improve healing and reduce the risk of complications.
Your surgeon will also explain what to expect on the day of surgery, including anesthesia, postoperative care, pain management, and your recovery plan.
Recovery and Rehabilitation
Recovery is gradual and requires patience. Most people notice steady improvement over several months, but keep in mind that every patient heals at a different pace.
Immediately after surgery, your wrist will typically be protected in a splint or dressing. Elevating the hand and moving your fingers can help reduce swelling during the first few days, but these activities need to be cleared by your surgeon.
Your surgeon may recommend working with a hand therapist or occupational therapist to keep the soft tissues malleable, restore motion, improve strength, and safely return to everyday activities. Therapy is an important part of recovery and can help maximize the function of the new joint.
Patients typically resume light activities within several weeks, and returning to more demanding activities may take several months. It is generally advised to avoid repetitive heavy lifting, intense force, contact sports, and high-impact activities that can place excessive stress on the area.
Regular follow-up appointments allow your surgeon to monitor healing and evaluate the performance of the implant.
Anything Else to Know
Although it is less commonly performed than hip or knee replacement, advances in implant design and surgical techniques have improved outcomes for many individuals with severe wrist arthritis. The success of wrist replacement depends on the procedure itself, but also on patient selection and following postoperative recommendations.
If chronic wrist pain is limiting your ability to work, enjoy hobbies, or complete everyday tasks, an evaluation by an orthopedic hand and wrist specialist at Premier Orthopaedic and Trauma Specialists can help determine whether wrist replacement, wrist fusion, or another treatment option is the best choice for your needs.
