Wrist Replacement (Wrist Arthroplasty)

What is a wrist replacement?

Wrist replacement is surgery to remove a damaged wrist joint and replace it with an artificial joint. The replacement part, called a prosthesis, is typically made of metal, with a polyethylene (plastic) spacer. It’s manufactured to work like a normal, healthy wrist. Arthroplasty is the medical term for joint replacement.

Your wrist is a complex joint containing many small bones. It connects your hand and forearm (the lower half of your arm, from your elbow to your hand). Your wrist joint is also called your radiocarpal joint.

Your wrist joint helps you bend, straighten and rotate your hand. It moves during many everyday activities, such as waving, washing your hair, typing or picking something up. If your joint is severely damaged or stiff, many daily tasks can be painful.

What’s the difference between wrist replacement and wrist fusion?

Joint fusion (arthrodesis) is surgery that permanently connects the bones that form a joint. It helps stabilize your joint and reduce pain.

After wrist fusion, you aren’t able to move your joint at all. But with wrist arthroplasty, you can still move your joint after surgery. Fusions generally provide excellent lifelong pain relief, without any restriction on lifting or grasping, or impact on types of activities (like the use of a hammer, power tools, or a tennis racquet).

Why is wrist replacement surgery done?

Wrist replacement is another option used to treat wrist pain from arthritis after all other treatments have failed. First-line, nonsurgical treatments usually include:

• Changes to your activity.
• Pain medications (anti-inflammatories and acetaminophen).
• Wrist splints and topical medications.
• Physical or occupational therapy.
• Steroid injections (cortisone).

The most common conditions that can lead to wrist pain are:

• Injury, such as a bone fracture.
• Arthritis in your wrist, including osteoarthritis (a degenerative joint disease) and rheumatoid arthritis (an inflammatory disease).
• Failed wrist fusion.
• Osteonecrosis, when bone tissue dies because it doesn’t receive enough blood.

If all other treatment options fail, wrist arthroplasty can help:

• Eliminate clicking, cracking or grinding sounds during movement.
• Maintain range of motion (the distance your wrist joint can flex or extend).
• Reduce stiffness and swelling.
• Relieve joint pain.
• Restore pain-free motion to your wrist, hand and fingers.

How common are wrist replacements?

Joint replacement is common in various sites of the body. But wrist replacement surgery is performed less frequently than other types of arthroplasty, such as:

• Hip replacement.
• Knee replacement.
• Shoulder replacement.

What happens before wrist arthroplasty?

Wrist replacement should be performed only by an experienced orthopaedic surgeon, preferably one who subspecializes in hand surgery. Before recommending the procedure, the bone and joint specialist will:

• Ask you about your general health and any medical conditions you have.
• Ask about your wrist pain, how long it’s been happening and how it affects your life.
• Examine your wrist for strength and range of motion.
• Order X-rays of your wrist to get pictures of the bones involved.
• Perform other tests to make sure you’re healthy enough for surgery (for example, blood tests).
• Make sure that other, more conservative treatment options have been tried, and that other surgical options were discussed with you.

What happens during wrist replacement?

Wrist replacement is performed in a hospital or outpatient surgical center. The procedure usually takes less than two hours.

The surgical team will:

1. Give you anesthesia through an IV in your arm to put you to sleep. Most patients will also get an upper extremity block to provide longer-lasting post-operative pain relief.
2. Make an incision (cut) on the top of your wrist.
3. Remove your joint and cut away damaged cartilage and bone.
4. Insert the prosthesis.
5. Attach it to the bones on each side of your joint with pins, screws or bone cement.
6. Make sure the artificial joint is in place and secure.
7. Test that your joint moves appropriately.
8. Ensure that surrounding tissues such as tendons and nerves are back in place.
9. Close the incision, usually with stitches.
10. Wrap your wrist in sterile bandages and a splint.

Wrist replacement surgery may be combined with other procedures to correct associated problems in tendons, nerves and thumb or finger joints.

What are the pros and cons of wrist replacement?

Your healthcare team will review the benefits and risks associated with wrist replacement.

Benefits include:

• Better range of motion in your wrist.
• Improved function of your wrist, hand and arm.
• Less stiffness and swelling in your wrist.
• Pain relief.

Wrist replacement complications are rare but may include:

• Blood clots.
• Infection in your joint/prosthesis.
• Infection of the wound.
• Malfunction of the prosthesis (it can break, loosen or become dislocated).
• Nerve injury.

How long does it take to recover from wrist replacement surgery?

Recovery from a wrist replacement usually takes about six to 12 weeks. After the cast is removed, you’ll likely wear a splint.

Your healthcare team will encourage you to do exercises to strengthen your wrist. Although it may hurt at first, movement should become less painful over time. The surgeon may also recommend physical or occupational therapy to help you recover.

How should I take care of myself after wrist arthroplasty?

Some strategies may help you recover more quickly and safely at home. They also will help your new joint last longer.

• Arrange for someone to help you with daily tasks immediately after surgery. Premade meals, paper plates and clothing with big sleeves will all make your life a bit easier.
• Avoid any major strain on the prosthesis, such as using a hammer and moving your joint in extreme positions.
• Don’t lift more weight than your healthcare team recommends. This may be as little as five pounds to prevent premature wear and failure of your implant.
• Prevent falls that could injure your wrist. For example, make sure any tripping hazards are removed from your home. And avoid sports and other activities that have a high fall risk.

How long does a wrist replacement last?

A prosthetic joint lasts an average of 10 to 15 years.

When should I seek medical attention after a wrist replacement?

Call your surgeon if you notice any signs of infection, including:

• Fever or chills.
• Pain that won’t go away or gets worse.
• Pus or a bad smell coming from the incision.
• Redness or swelling around the incision.

Also, notify your healthcare team if you eventually experience signs that the implanted joint is failing, such as:

• Decrease in joint function or strength.
• Instability (feeling like it might give out).
• Pain.
• Stiffness.
• Swelling.

A note from Cleveland Clinic

If injury or arthritis causes constant pain in your wrist, an orthopaedic surgeon may recommend wrist replacement. This type of arthroplasty removes a damaged wrist joint and replaces it with an artificial (manmade) joint. The procedure can reduce pain and improve your ability to perform daily tasks.