Wrist Arthroplasty

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 the Colorado Center of Orthopaedic Excellence in Colorado Springs, 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.

Read more about Wrist Arthroplasty on our new Colorado Springs Orthopedic News Site – Colorado Springs Orthopedic News. Schedule an appointment with a wrist specialist today.