Joints Replacement

The wrist is made up of many joints and bones. It is probably the most complex of all the joints in the body due to the fact that every small carpal bone forms a joint with the bone next to it. Furthermore, ligaments connect all the small bones to each other and to the radius, ulna, and metacarpal bones. The ends of the bones are covered with an elastic tissue, called cartilage. This cartilage creates a slick surface that enables the bones to move smoothly.

If the cartilage is worn away or damaged by injury, infection, or disease, the bones themselves will rub against each other, wearing out the ends of the bones and causing a painful, arthritic condition. Arthritis of the wrist and hand is a very common and complex problem, however, the good news is that there are many surgical and nonsurgical treatment options available. Determining which solution is best for your medical situation will require the skill of a specialist. When you come to Polaris Healthcare, our orthopedic specialized team will implement cutting-edge technology, equipment, and resources to ensure the best treatment possible.

Different Types of Surgery

Joint Fusion

The arthritic surface is removed and the bones on each side of the joint are fused together. Joint fusion may be used to relieve pain and correct deformities that interfere with functioning. With a wrist fusion, you will lose some motion but you will regain a strong wrist. This is especially important if you work with your hands or need strength more than flexibility. Wrist fusion is usually the best surgical option for patients who are active.

Joint Reconstruction

The degenerated joint surface is removed in order to eliminate the rough, irregular bone-to-bone contact that causes pain and restricts motion. Once the degenerated portion of the joint surface is removed, it may be replaced with rolled-up soft tissue, such as a tendon, or with a joint replacement implant. Which type of surgery is used depends on the particular joint involved, your activities, and your own needs. Your hand surgeon can help you decide which type of surgery is the most appropriate for you.

Implants

There are several different types of implants. Most have two components, one for each side of the joint. These components are made of metal. A high-quality plastic, called polyethylene, is used as a spacer between the two metal components. Newer implant designs try to replicate the anatomy of the wrist.

One component is inserted into the radius of the forearm. The portion of this component that faces into the wrist joint has a curve that fits a second component placed on the wrist side. The component that inserts into the hand bone (the carpal component) has a flat surface that faces the first component. It inserts into a carpal bone through one long stem and one or two shorter stems. A plastic spacer fits between the components in the joint area. Spacers come in different sizes so they can match the hand. A spacer is normally flat on one side and rounded on the other. This design enables it to fit into the carpal component while it rocks on the radial component, creating a more natural wrist motion.

What to expect before and after surgery

You may meet with a member of the Polaris physical therapy team prior to your surgery in order to record baseline information regarding your condition. They may also provide you with some of the exercises you’ll use during your recovery. Following surgery, a cast will likely need to be worn for the first several weeks. When the cast is removed, a protective splint will need to be worn for the next six to eight weeks. Although pain relief is immediate, gradual exercises will need to be done for several weeks to restore movement and, eventually, to increase power and endurance.

Recovery

A cast will need to be worn for the first several weeks. When the cast is removed, a protective splint will be needed for the next 6 to 8 weeks. Although pain relief is immediate, gradual exercises will need to be done for several weeks to restore movement and, eventually, to increase power and endurance. Wrist arthroplasty can improve motion to about 50% of normal. The physical demands that are placed on the wrist prosthesis will have an effect on how long the implant lasts. There will be some limitations. Use of a hammer or pneumatic tools may need to be avoided. The amount of weight lifted will need to be limited. A fall on the outstretched hand may break the prosthesis, just as it might fracture a normal wrist, so activities that could result in a fall, such as roller sports, should be avoided. On average, a wrist replacement can be expected to last 10 to 15 years with careful use. As with all implants, long-term follow up is advised. Generally, follow up every year or every 2 years will identify any developing conditions or problems.