What to know about wrist replacement surgery

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The main purposes of a wrist replacement are to:

• Relieve pain: The primary purpose of wrist replacement surgery is to alleviate chronic pain in the wrist that does not improve through conservative treatments such as medication or physical therapy.
• Restore function: The procedure aims to improve the wrist’s function, allowing for better movement and use of the hand in daily activities.
• Improve quality of life: Wrist replacement surgery can significantly improve quality of life by reducing pain and enhancing wrist function.

Wrist replacement surgery is suitable for people with severe wrist pain and dysfunction that significantly impairs their quality of life. It is an option when conservative treatments are unsuccessful.

Arthritis is a common reason for wrist replacement surgery. Rheumatoid arthritis, osteoarthritis (OA), and post-traumatic arthritis are the primary types that affect the wrist, leading to severe joint damage and pain. Post-traumatic arthritis results from an injury to the wrist and is similar to OA, although it develops less gradually.

Suitable candidates are typically those in good overall health without conditions that would significantly increase the risk of surgery or impede healing and rehabilitation. Suitable bone quality is also important to support the implant.

Anyone considering wrist replacement surgery should consult an orthopedic surgeon specializing in hand and wrist surgery. The surgeon will evaluate the person’s specific condition, lifestyle, and overall health to determine whether wrist replacement is the most appropriate treatment option.

Learn more about OA of the wrist.

Wrist replacement surgery involves the following steps:

• Anesthesia: A person receives general or local anesthesia to ensure they do not feel pain.
• Incision: The surgeon makes an incision over the wrist to access the joint.
• Removal of damaged tissue: The surgeon removes the damaged bone and cartilage from the wrist.
• Implant placement: Artificial components made of metal and plastic replace the removed bone and cartilage. These components mimic the movement of a healthy wrist.
• Closure: The surgeon closes the incision with sutures or staples and immobilizes the wrist with a splint or cast.

To prepare for anesthesia, doctors usually instruct people not to eat or drink anything — including water — after midnight the day before their surgery.

Doctors may ask people to shower using a special antibacterial soap to help reduce the risk of surgical site infections.

Other ways to prepare for surgery include:

• Undergoing a preoperative medical evaluation: This includes assessments such as blood tests, imaging studies, such as X-ray and MRI, and consultations to ensure they are fit for surgery.
• Discussing medications: Before surgery, people should discuss all current medications, supplements, and over-the-counter drugs with their surgeon to determine whether adjustments are necessary.
• Stopping certain medications: Based on their doctor’s advice, people may need to temporarily stop treatments that could increase bleeding risk, such as blood thinners, nonsteroidal anti-inflammatory drugs, and certain supplements.
• Quitting smoking and limiting alcohol: Smoking and excessive alcohol consumption can impair healing. If applicable, doctors usually advise people to quit smoking and limit alcohol well before surgery.
• Preparing their home: People should arrange their living space for their return from the hospital, ensuring they have easy access to necessities and a safe environment to avoid falls.
• Planning for transportation and aftercare: People should also arrange a ride home from the hospital and someone to help with daily activities during the initial recovery phase.

Recovery from wrist replacement surgery typically involves the following steps:

• Immediate postoperative care: Initially, the focus is on pain management and reducing swelling. The wrist is immobilized with a splint or cast to ensure proper healing.
• Physical therapy: Rehabilitation plays a crucial role in recovery, typically starting a few weeks after surgery. Physical therapy helps improve the wrist’s range of motion, strength, and function.
• Long-term care: Full recovery and maximum improvement in wrist function can take several months. To achieve the best outcome, a person must follow their surgeon’s guidance and rehabilitation plan.
• Follow-up visits: Follow-up appointments every 1 to 2 years are necessary to monitor the healing process and identify any developing conditions.

According to the American Academy of Orthopaedic Surgeons (AAOS), a wrist replacement can restore, on average, 50% of wrist function and last 10 to 15 years if a person uses it carefully.

Wrist replacements are only suitable for light activity, and doctors do not advise lifting heavy objects or using the wrist for hard labor.

People who do not follow restrictions may have less favorable outcomes. Doctors only select people for surgery if they assess them as likely to follow postsurgery recommendations.

Wrist replacement surgery, like all surgical procedures, carries risks and potential complications.

The risks may include:

• infection at the incision site or around the prosthesis
• blood clots forming in the veins of the arm or other parts of the body
• nerve damage leading to weakness, numbness, or pain in the hand and fingers
• blood vessel damage that potentially causes bleeding and hematoma formation
• implant problems such as wear, loosening, dislocation, or breakage, possibly requiring revision surgery
• limited range of motion not fully restored to that of a healthy wrist
• stiffness and pain in the wrist despite the surgery
• complex regional pain syndrome, which causes prolonged pain, swelling, and changes in the skin
• anesthetic risks, including allergic reactions, breathing difficulties, and heart complications
• need for revision surgery due to implant failure or other issues over time

Some people may not be suitable for wrist replacement surgery or may choose an alternative option, such as:

• a wrist splint or brace to immobilize the wrist
• steroid injections to help reduce inflammation
• surgical removal or resection of the damaged bones
• fusion of the wrist or arthrodesis, which fuses the long bone in the forearm to the wrist bones, stabilizing the joint

Learn about types of arthritis surgery.

Most people experience a significant reduction in pain following wrist replacement surgery. This relief allows for better sleep, increased ability to perform daily activities, and improved quality of life.

While immediate pain relief is common, the long-term effectiveness of pain reduction can vary. Regular follow-ups and possible adjustments or revisions might be necessary.

Wrist replacement surgery aims to preserve or improve the wrist’s range of motion, but it may not match that of a typical wrist.

There may be some limitations in wrist strength compared to a typical wrist, but most people find that pain relief and improved motion outweigh this.

Wrist replacement surgery can improve quality of life for people with severe wrist pain and dysfunction. The procedure involves removing damaged parts of the wrist and replacing them with prosthetics.

Physical therapy is an important part of recovery, and people should follow their doctor’s advice for the best long-term outcome. With careful use, including avoiding heavy lifting and labor, wrist replacement can last 10 to 15 years.