Think of all the things your wrist joint does. It helps you bend, straighten, and rotate your hand. It allows you to wave, wash your hands, wash your hair, drive a car, walk your dog, open mail, button shirts, twist a jar’s lid, text, type, and pick things up. You use your wrist hundreds of times throughout the day for various tasks, big and small. Many daily tasks can be painful if your joint is severely damaged or stiff. If a wrist injury isn’t treated properly, it can lead to stiffness and loss of mobility, deformity, nerve damage, development of arthritis, increased risk of re-injury, and permanent disability requiring a wrist arthroplasty. Wrist pain isn’t something you ignore. If you suspect you might need a wrist arthroplasty, seeking medical advice for proper diagnosis and treatment is important to avoid these complications. If you want the most experienced and highly-rated orthopedic specialists, you’ll find them at OCC – Advanced Orthopedic & Sports Medicine Specialists in Denver, Parker, or Aurora, Colorado.

OVERVIEW

Medical science has advanced considerably over the years regarding replacing damaged joints. Knee and hip replacements have become commonplace, but chances are you have not heard all that much about wrist replacement surgery. This is because it is somewhat less common, but as with other types of joint replacement, it can restore a good quality of life to a patient who needs it. Wrist arthroplasty, or wrist replacement, is a surgical procedure that replaces the radiocarpal joint, which connects the hand to the arm. Wrist arthroplasty works by removing the damaged cartilage and bone in the wrist joint and replacing it with a prosthesis or implant. There are several different types of prostheses. 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 in an attempt to replicate the function of a healthy joint. On average, it can be expected to restore about 50% of normal wrist motion and last 10 to 15 years with careful use. The ideal candidate has severe arthritis but does not place significant stress on the wrist. Therefore, young active patients and individuals with high physical demands are not considered good candidates for wrist arthroplasty.

ABOUT THE WRIST

The wrist joint, also known as the radiocarpal joint, is a complex structure that connects the forearm to the hand, allowing for a wide range of motion. It comprises multiple bones, ligaments, and tendons, which work together to provide stability and mobility. Eight small carpal bones are arranged in two rows and connect with the radius and ulna of the forearm. The radius is the larger small carpal bones arranged in two rows, and it connects with the radius and ulna of the forearm. The radius is the larger of the two forearm bones on the thumb side. The ulna is the smaller forearm bone located on the pinky side. The ends of the bones at the joints are covered with a smooth, elastic tissue called cartilage. Cartilage provides cushioning and creates a slick surface that enables the bones to move smoothly against each other during joint motion. Cartilage can wear out from use over time or can be damaged by trauma or disease such as osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis. The wrist is an ellipsoidal type synovial joint. This means that it can move along two axes. The wrist can move up and down and side to side.

There are 4 medical terms for these movements:

• Flexion describes when the hand is bent down  toward the front of the forearm
• Extension describes when the hand is bent up toward the back of the forearm
• Adduction describes when the hand is bent sideways toward the little finger
• Abduction describes when the hand is bent sideways toward the thumb

WHAT IS WRIST ARTHROPLASTY?

There are two types of wrist arthroplasty; partial (PWAD), and total (TWA). Both are surgical procedures used to treat wrist conditions, such as arthritis or trauma, but they differ in approach, benefits, and risks. Partial wrist arthroplasty is more common than total wrist arthroplasty. Here are several reasons why partial wrist arthroplasty might be considered better than total wrist arthroplasty in certain situations:

1. Preservation of Joint Function

• Partial Wrist Arthroplasty: In PWA, only part of the wrist joint is replaced, typically targeting the damaged or arthritic area while preserving the healthy joint components. This allows for more natural wrist movement and a better range of motion than TWA, where the entire joint is replaced.
• In TWA, the entire wrist joint is replaced, which can limit wrist mobility and may feel less natural compared to preserving part of the original anatomy.

2. Less Invasive

• Partial Wrist Arthroplasty: PWA tends to be less invasive than TWA because only a portion of the wrist is addressed. This means less bone and tissue are removed, leading to potentially quicker recovery times and fewer complications.
• TWA is more invasive and involves removing larger portions of the wrist joint. This can lead to more extensive rehabilitation and a higher risk of complications like infection or implant loosening.

3. Lower Risk of Implant Failure

• Partial Wrist Arthroplasty: Since fewer components are replaced and some natural joint structure is retained, PWA often has a lower risk of implant failure. It also avoids placing as much stress on the replacement parts.
• TWA carries a higher risk of implant loosening, wear, or mechanical failure over time due to the complete reliance on the artificial joint.

5. Option for Future Surgeries

• Partial Wrist Arthroplasty: PWA leaves the door open for future surgical options, such as a conversion to total wrist arthroplasty or wrist fusion if needed. Since it preserves more of the wrist structure, it allows more flexibility if the disease progresses.
• Total Wrist Arthroplasty: Revision surgeries after TWA can be more complex and less predictable, especially because the entire wrist joint has already been replaced.

6. More Natural Wrist Mechanics

• Partial Wrist Arthroplasty: PWA can maintain more natural wrist mechanics by preserving key ligaments and bones contributing to stability and movement.
• TWA changes the natural anatomy of the wrist, leading to a loss of the fine-tuned mechanics of the joint. This can feel less natural during motion.

CAUSES

Arthritis is a common reason for wrist replacement surgery:

• Osteoarthritis is wear-and-tear arthritis where the wrist cartilage gradually breaks down over time. Osteoarthritis commonly affects older individuals, but it can also develop earlier in people who have experienced repetitive stress or prior injuries to the wrist.
• Rheumatoid arthritis is an autoimmune disease where the immune system attacks the lining of the joints. It is one of the leading causes of wrist arthroplasty because it can affect multiple joints in the wrist, causing severe pain and loss of function over time.
• Post-traumatic arthritis affects patients with previous wrist injuries, especially fractures involving the joint surfaces that worsen over time and require surgical intervention.
• Psoriatic arthritis is an inflammatory form of arthritis associated with psoriasis and can cause joint damage and deformities in the wrist.

Other causes include:

Severe wrist deformity or instability that leads to abnormal alignment of the wrist bones, such as congenital deformities, severe ligament damage, or wrist instability from chronic conditions. Failed previous wrist surgeries like partial fusions or other joint preservation techniques that have failed to relieve symptoms or resulted in complications 

SYMPTOMS

• Consistent pain
• Stiffness
• Swelling
• Weakness
• Redness
• Significantly reduced range of movement
• A feeling the wrist might give out
• Clicking, cracking, or grinding sounds when attempting to bend the wrist

NON-SURGICAL TREATMENTS

• Changes to activity level
• Over-the-counter non-steroidal anti-inflammatories such as aspirin and acetaminophen
• Wrist splints and topical medications
• Physical or occupational therapy
• Steroid (cortisone) injection

WHEN IS SURGERY INDICATED?

A wrist arthroplasty, or wrist replacement, is usually recommended when other treatments have not been effective and a patient has severe wrist pain or arthritis. Partial wrist arthroplasty is typically indicated when only a portion of the wrist joint is damaged, and it is possible to preserve some of the native joints. Common indications include: post-traumatic arthritis (limited to specific joints), localized rheumatoid arthritis, localized cartilage defects, Kienbockk’s Disease, where the lunate bone (a crescent-shaped carpal bone in the wrist that’s important for wrist movement and support) is necrotic (dead or dying tissue) but the remaining wrist bones are still healthy. Common indications for total wrist arthroplasty include: extensive involvement affecting the entire wrist, advanced osteoarthritis that involves all or most of the wrist joint, extensive post-traumatic arthritis, widespread avascular necrosis (a disease that occurs when bone tissue dies due to a loss of blood supply) or failed previous surgery. Each patient’s condition, age, activity level, and goals will help determine whether partial or total wrist arthroplasty is the best option.

GETTING THE RIGHT DIAGNOSIS.  GETTING THE RIGHT DOCTOR.

The level of care you receive is heavily dependent on the doctor you choose. For this reason, you need to find the right one for you. You can implicitly trust the highly skilled orthopedic specialists at OCC –Advanced Orthopedic & Sports Medicine Specialists in Denver, Parker, or Aurora, Colorado for the best care. Years of experience in performing wrist arthroplasty is much more likely to help develop the confidence, accuracy, efficiency, and adaptability necessary to give you a successful outcome from wrist surgery. After a thorough exam,  diagnostic tests such as X-rays, CT scans, MRI, or nerve conduction studies may be ordered.  Sometimes they perform an arthroscopy. This involves making a small incision and using a tiny camera to look at the wrist. Advanced Orthopedic will work closely with you on the best treatment plan to determine whether a partial or total wrist arthroplasty would be best for you. Each type of wrist arthroplasty has its own benefits and limitations, and the decision is made based on the patient’s condition, lifestyle, and expectations. All of which will be discussed in detail to get you back to the activities you once enjoyed.