Wrist Arthritis and Wrist Replacement
Wrist arthritis can cause pain, stiffness, swelling, loss of grip strength and difficulty with everyday activities. The wrist, or radiocarpal joint, is a complex joint made up of multiple small bones and ligaments. Because of this complexity, the treatment of wrist arthritis needs to be carefully tailored to the pattern of arthritis, the patient’s age, activity level, work demands and goals.
Treatment Options
Wrist arthritis is a specific subspecialty area of Dr Ye’s practice. Treatment is not limited to one operation. Depending on the stage and pattern of disease, options may include motion-preserving procedures such as wrist arthroscopy, joint debridement, denervation, interposition arthroplasty and selective partial wrist fusions. These operations aim to relieve pain while preserving as much wrist movement and function as possible.
For some patients with more advanced or end-stage arthritis, wrist replacement may be considered. Wrist replacement surgery aims to relieve pain while preserving wrist motion, rather than fusing the wrist completely. Modern options range from hemi-resurfacing procedures through to total wrist replacement systems such as Motec, which has shown encouraging early and medium-term results in specialist centres and registry data.
Surgical Planning
In patients with complex distal radioulnar joint (DRUJ) arthritis or instability, particularly where the problem involves rotation of the forearm rather than only wrist flexion and extension, DRUJ replacement may also be considered. Options such as the Aptis-Scheker DRUJ prosthesis can provide a reconstructive solution for carefully selected patients with difficult DRUJ instability, arthritis or failed previous procedures.
These are highly nuanced procedures. The best treatment depends on the exact location of arthritis, the condition of the surrounding ligaments and tendons, previous surgery, bone quality, patient expectations and the amount of motion that needs to be preserved. In some patients, a joint-sparing or biological reconstruction may be preferable. In others, hemiarthroplasty, total wrist replacement, DRUJ replacement or fusion may be more appropriate.
Comprehensive Treatment Approach
Dr Ye offers the full spectrum of treatment for complex wrist arthritis, from minimally invasive and joint-preserving procedures through to biological reconstruction and joint replacement. This includes arthroscopic treatment, denervation, selective fusion, interposition procedures, vascularised bone and joint reconstruction, hemiarthroplasty, total wrist arthroplasty and DRUJ replacement.
Experience and Training
Dr Ye has undertaken fellowship training in complex hand and wrist reconstruction and has travelled internationally to gain further experience with advanced wrist arthroscopy, small joint arthroplasty and wrist replacement techniques. This international experience has provided further insight into patient selection, implant choice, surgical technique and rehabilitation for these highly specialised procedures.
Risks, Outcomes and Treatment Decisions
As with all joint replacement surgery, wrist replacement carries risks. These may include stiffness, swelling, infection, loosening, implant wear, instability, fracture, persistent pain and the possibility of revision surgery. However, for appropriately selected patients, wrist replacement and related reconstructive procedures can provide meaningful pain relief while preserving useful wrist and forearm motion.
Dr Ye will discuss the full range of treatment options and help determine whether a motion-preserving procedure, biological reconstruction, partial fusion, total wrist fusion or wrist replacement is most suitable for each individual patient.