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Overview

Total wrist Replacement surgeries are recommended to people suffering from painful arthritis and are not responding to other medical procedures. This surgery is not as common as the knee or hip surgery. During a wrist replacement surgery the infected or painful parts of the wrist joint are replaced by artificial components. The main reasons of total wrist replacement are pain relief and ensuring the functioning of wrist and hand.

 

Wrist Structure

A wrist joint is a complex joint that connects the hand and the forearm. It is a collection of multiple bones and joints. At the base of hand there are two rows of bones called distal and proximal. Each row consists of four bones. These bones are known as carpals. The distal is in contact with radius and ulna bones of the forearm. The long thin bone that forms the basis of fingers and thumb is connected to the proximal row. The ends of the bones are covered by a smooth substance called articular cartilage. The articular cartilage helps the wrist joint to move easily and avoids the wear and tear of wrist bones.

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Causes

Although wrist replacement is not a very common surgery, it can be recommended in the following cases:

  • Osteoarthritis:
    With the growing age the articular cartilage experiences a wear and tear. Due to the wearing out of cartilage, the movement of the wrist becomes painful.
  • Rheumatoid arthritis:
    This is a chronic inflammatory disease which results in the swelling of bones. This disease results in pain and stiffness of the joint.
    Osteoarthritis as well as rheumatoid arthritis affects the strength of hand and fingers and makes gripping and pinching difficult.
  • Severe fractures:
    In rare cases of severe fracture of the wrist joint, a total wrist replacement is recommended.

 

Artificial Wrist Joint

Many different types of implants are available. In most of the implants there are two components. These component are made up of metals are fixed on each side of the joint. The component that is on the hand bone side is inserted into the carpal bone using one long and one or two shorter stems. Polyethylene is used as the liner between the two metal components. A liner is generally flat on one side and rounded on the other. This design of liner helps in a much natural wrist motion. Liners are available in different sizes according to the different sizes of the hand.


Preparations for the Surgery

As in case of any other surgery, this surgery too requires a good physical health that helps the patient to recover soon. One must get a total physical examination done by a general physician. In case the patient is on the medication for chronic diseases, like heart disease, the medications may be needed to stop. Blood thinners are also advised to be stopped. Proper arrangements should be made at home that helps the patient with daily tasks for a few weeks of surgery.

 

The Surgery

The total wrist replacement surgery is carried out to provide relief from pain in the wrist joint. During the surgery the effected part or parts are replaced by artificial components. There are cases in which fusing the bones of the wrist may provide pain relief and improve gripping. But, fusing the bones does not allow the bending of the wrist. In such cases wrist replacement is a better option.

Before the surgery a general anesthesia is given to the patient. A wrist replacement is generally combined with other processes to correct the disorders of small joints of finger and thumb.

An incision or cut is made at the back of the wrist. The damaged end of the arm bone is removed. In many cases the first row of carpal is also removed. First component of the implant is inserted into the radius bone of the forearm. It is held in place by bone cement made up of polymethylmethacrylate.

The carpal component is then inserted into the hand bone or is screwed with the remaining row of carpal bone. This component is inserted into the carpal bone using one long and one or two shorter metallic stems. Bone cement is used if required to hold the components in place.

An appropriate liner is attached between the metal components of the implants.

 

Recovery Process

The patient is relieved from the hospital after 2-4 days of the surgery. In general, wrist replacement surgery recovery time is around 8-10 weeks. A cast is needed to be worn for the first few weeks. After a few weeks the cast is removed but a protective splint is to be worn for the next 5-6 weeks. Doses of antibiotics are given to avoid the risks of infections. Medication for pain relief is given for the first 1-2 days. Few hand and wrist exercises may be advised by the doctor to avoid swelling and stiffness and for quick recovery. It is advised not to put excessive weight on the wrist. In case there is severe pain in the wrist even after several weeks of surgery it is recommended to see the doctor at the earliest.

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