Wrist Replacement (Total Wrist Arthroplasty)

⚙️What This Procedure Involves

An incision is made on the back of the wrist. The extensor tendons are retracted. The damaged carpal bones are removed (partial or complete carpectomy depending on the design). The distal radius is prepared and a metal component is cemented or press-fit. A polyethylene component articulates against the radial component and is fixed to the remaining carpus or into the metacarpals. Modern designs are modular and low-profile. The operation takes one and a half to two hours.

💡Why It May Be Recommended

Wrist replacement is considered for patients with inflammatory arthritis (rheumatoid) or severe degenerative arthritis who wish to preserve motion and have low physical demands. It is an alternative to wrist fusion for patients who need bilateral wrist surgery (having one fused and one replaced preserves more overall function).

⚖️Non-Operative Alternatives

Splinting, injection, medication (particularly disease-modifying drugs for rheumatoid), and activity modification. Wrist fusion (arthrodesis) is the main surgical alternative and is more durable but eliminates motion.

📋Preparing for Surgery

X-rays and CT to assess bone stock. Assessment of tendon integrity. Discussion of activity restrictions — wrist replacement is not suited for heavy manual work.

✅Expected Benefits

Preservation of approximately 30–50 degrees of the flexion-extension arc. Pain relief. Improved hand function for daily activities. Modern implant designs have improved survivorship compared to earlier generations.

⚠️Common Risks

• Limited arc of motionExpected

  Approximately 30–50 degrees of total flexion-extension. Less than normal but more than fusion.

• Reduced grip strengthExpected

  Less than wrist fusion but adequate for most daily activities.

• Activity restrictionsExpected

  No heavy lifting, impact activities, or manual work with the replaced wrist.

🔴Less Common but Serious Risks

• LooseningLong-term

  Component loosening. The most common cause of failure. Higher risk than hip or knee replacement.

• Imbalance and dislocationUncommon

  Component dislocation.

• Tendon ruptureUncommon

  Extensor tendons may be damaged by the implant.

• InfectionUncommon

  Prosthetic infection.

• Periprosthetic fractureUncommon

  Fracture around the implant.

• Conversion to fusionLong-term

  If the replacement fails, conversion to wrist fusion is the salvage procedure.

💉Anaesthetic Considerations

General or regional anaesthesia.

🏃Recovery and Rehabilitation

Splint for four to six weeks. Gentle wrist exercises from four weeks. Hand therapy for grip strengthening. Lifelong activity restrictions — no heavy lifting, impact, or twisting. Full recovery three to six months.

📅Follow-Up

X-rays at six weeks, three months, one year, then annually. Lifelong surveillance.

❓Frequently Asked Questions