What is wrist replacement?
Wrist replacement surgery removes a damaged wrist joint and replaces it with an artificial joint called a prosthesis. Your wrist contains eight small bones, called carpals. The carpals form joints with your hand bones (metacarpals) and lower arm bones (ulna and radius). The wrist is a complex joint that also contains ligaments, tendons, cartilage, and lubricating fluid. It makes very intricate movements that are important for many everyday tasks.
Your doctor may recommend wrist replacement surgery if your wrist is severely damaged by arthritis, injury or infection. Wrist replacement is also called wrist arthroplasty, total wrist replacement, or wrist joint replacement. It can restore range of motion and wrist function with little or no pain.
Why is wrist replacement performed?
Wrist replacement is a major surgery that treats serious wrist damage when symptoms are severe or restrictive. This includes severe pain, deformity or disability, including poor grip strength and wrist weakness. The general goals of wrist replacement are to restore function, reduce disability, and improve your symptoms and quality of life. Ideal candidates do not have heavy daily demands on their wrist.
Wrist replacement treats severe or permanent wrist joint damage due to:
- Inflammatory forms of arthritis, including rheumatoid arthritis
- Osteoarthritis, or degenerative joint disease, which is the breakdown of cartilage and bones
- Wrist joint infections, also called septic arthritis
- Wrist joint injuries, including fractures, torn ligaments, and torn cartilage
Wrist replacement is not as common as other joint replacement surgeries. Generally, doctors will suggest wrist replacement only when less invasive treatments do not improve your pain and wrist function. Your doctor may also discuss wrist fusion as an alternative to wrist replacement. Ask your doctor about all of your treatment options and the risks and benefits of each. Also, consider getting a second option before scheduling surgery.
Who performs wrist replacement surgery?
Orthopedic surgeons and hand surgeons perform wrist replacements. Orthopedic surgeons have special training to treat problems of the bones and joints. They perform surgery and prescribe other treatments. Hand surgeons are orthopedic or plastic surgeons who further specialize in surgery of the hand, wrist, forearm and elbow.
How is wrist replacement surgery performed?
Wrist replacement surgery takes place in a hospital or surgery center. Unlike many other joint replacements, it can be an outpatient procedure. It’s also common to combine it with other procedures to correct problems in the hands and fingers, such as carpal tunnel release.
Wrist replacement involves making an incision in the back of the wrist to remove the damaged bones. This includes some of the wrist bones and the ends of the lower arm bones. Your surgeon shapes and prepares the remaining bone to hold the new joint. Your surgeon then places an artificial wrist joint made of metal and plastic, tests the new joint, and secures it permanently in place.
Your surgeon will use either a general anesthetic or a regional anesthetic for your wrist replacement surgery. General anesthesia is a mixture of IV (intravenous) medicines and gases that put you in a deep sleep.
Regional anesthesia is also known as a nerve block. It involves injecting anesthetic medication around certain nerves to numb a large area around the surgical site. The anesthetist may also administer a sedative in addition to regional anesthesia to keep you comfortable. Sedation may not be as “deep” as general anesthesia, but you will most likely sleep through the entire procedure.
What to expect the day of your wrist replacement
The day of your surgery, you can generally expect to:
- Talk with a preoperative nurse. The nurse will perform an exam, ensure all necessary tests are in order, start an IV, and answer questions.
- Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave jewelry and valuables at home or with a family member if possible. The surgical team will respect your privacy and give you blankets for modesty and warmth in the surgical suite.
- Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
You will likely have a sedative medication before the team takes you to the operating room (OR). The anesthesiologist or nurse anesthetist will start your anesthesia once you’re in the OR. The surgical team will monitor your vital signs and breathing throughout the procedure and during your recovery.
What are the risks and potential complications of wrist replacement?
Any surgery has risks. Complications can become serious and life threatening in some cases. Complications can develop during the procedure or throughout your recovery. Ask your surgeon how you can reduce your risks by following your treatment and recovery plan.
General risks of surgery
The general risks of surgery include:
- Anesthesia reaction, such as an allergic reaction and problems with breathing
- Bleeding, which can lead to shock
- Blood clot, in particular a deep vein thrombosis (DVT) that develops in the leg or pelvis. A DVT can travel to your lungs and cause a pulmonary embolism.
Potential complications of wrist replacement
Problems with wrist replacement are not common. However, complications of can be serious and include:
- Breakage or fracture of the new joint
- Loosening of the new joint causing pain and possibly requiring additional surgery to secure it
- Nerve, muscle or blood vessel damage
- Ongoing wrist stiffness and pain
- Wear and tear of the new joint, which may eventually require another replacement
Reducing your risk of complications
You can reduce your risk of certain complications by:
- Following activity, dietary and lifestyle restrictions and recommendations before your surgery and during recovery
- Informing your doctor if you are nursing or if there is any possibility of pregnancy
- Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
- Taking your medications exactly as directed
- Telling all members of your care team if you have allergies
How do I prepare for wrist replacement surgery?
The steps you take before surgery can help improve your comfort and outcome during recovery. You can prepare for a wrist replacement by:
- Answering all questions about your medical history and medications. This includes prescription medications, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
- Arranging for a ride home after surgery. Ask someone to stay with you for the first 24 hours, just in case you need help through the night.
- Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, electrocardiography (ECG), blood tests, and other tests as needed.
- Following dietary guidelines as directed.
- Losing excess weight before the surgery through a healthy diet and exercise plan.
- Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
- Performing wrist-strengthening exercises as directed before surgery.
- Stop smoking as soon as possible. Even quitting for just a few days can be beneficial and can help the healing process.
- Taking or stopping medications exactly as directed. For wrist replacement, this may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners, all of which increase the risk of bleeding.
Questions to ask your doctor
Facing surgery can be stressful. Consider making a list of questions to help you remember everything you want to ask your doctor. Questions you may want to ask include:
- Why do I need wrist replacement? Are there any other options for treating my condition?
- How long will the surgery take? When can I go home?
- What restrictions will I have after the surgery? When can I expect to return to work and other activities?
- When will I start physical therapy and where do I go for it? How much does it cost?
- What kind of assistance will I need at home?
- What medication plan should I follow before and after the surgery?
- How will you manage my pain?
- How should I contact you if problems arise? Ask for numbers to call during and after regular hours.
- When should I see you in follow-up after the surgery?
What can I expect after a wrist replacement?
Knowing what to expect can help make your road to recovery after wrist replacement as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert and your vital signs are stable. You will likely go home the same day, as wrist replacement is often an outpatient surgery. Sometimes, it is necessary to stay overnight in the hospital, depending on your condition.
Recovery after surgery is a gradual process. Recovery time varies depending on your general health, age, and other factors. Full recovery generally takes 3 to 6 months.
Some patients wear a cast for several weeks, followed by a splint for up to eight weeks. However, it’s possible that you may only require a splint. In addition, you will have physical therapy to improve wrist strength and movement after surgery.
You will need to avoid lifting and repetitive wrist movements for many weeks. Your surgeon will tell you when it is safe to return to your normal activities.
Will I feel pain?
There will be pain after a wrist replacement. Controlling pain is important for healing and a smooth recovery. It allows you to fully participate in physical therapy and rehabilitation. Contact your doctor if you are in pain despite following your pain control plan or if your pain gets worse or changes in any way. It could be a sign of a complication.
When should I call my doctor?
For questions between appointments, contact your doctor’s office. However, you should call your doctor right away or seek immediate medical care if you have any of the following:
- Breathing problems or shortness of breath
- Confusion or changes in level of alertness
- Chest pain, pressure or tightness
- Drainage of pus, redness or swelling around your incision
- Fever. It’s common to have a fever right after surgery. Your doctor will give you instructions about when to call for a fever.
- Inability to urinate or move your bowels
- Leg pain, redness or swelling, which could mean you have a blood clot
- Unexpected bleeding
How might a wrist replacement affect my everyday life?
Wrist replacement can reduce wrist pain and improve wrist function so you can lead a more active, better quality of life. It can help you be more independent and enjoy many activities, such as playing the piano or painting.
Wrist replacement can last 10 to 15 years if you are careful. You will need to protect your new wrist by avoiding:
- Contact sports
- Falls and activities with a high risk of falls, such as skating
- Heavy lifting
- Using tools that put a lot of pressure on the wrist, such as hammers and pneumatic tools