Pain level is main factor in opting for wrist replacement
DEAR DOCTOR K:
We've all heard of hip and knee replacements -- but is it true that you can have your wrist replaced too?
We like to think of ourselves as irreplaceable, but the truth is that some of our parts are replaceable. The joint replacements you hear most about are those of the knees and hips, but surgeons also have been replacing hand joints for decades.
Joint replacement (arthroplasty) in the hands is actually more challenging than in larger joints such as the hips or knees. That's because of the hands' intricate bone structure and smaller joint size. Joint replacement surgery in the hands is a delicate procedure. You wouldn't use the word "delicate" to describe a hip or knee replacement, even though the surgery does require considerable precision.
Wrist arthroplasty involves removing damaged bone or joints and replacing them with artificial, or prosthetic, joints. The artificial joints provide patients with a better range of motion and more stability. This makes everyday tasks like writing much easier.
Wrist arthroplasty can be done as an inpatient or outpatient procedure. Sometimes general anesthesia is used; other times, you are awake, but feel no pain because the nerves from your hand are numbed.
In the surgery, the surgeon removes the first row of carpal bones (the bones that lie between the forearm and the hand). Then the surgeon shapes the end of the radius (the main forearm bone) to fit one part of the artificial joint, which is attached to the end of the bone. The other part of the artificial joint fits over carpal bones in the wrist. A plastic spacer fits between the two components.
Now the two artificial joint surfaces move easily against each other, creating a flexible and pain-free wrist. (I've put an illustration on my website, AskDoctorK.com.) Individual knuckle and finger joints may also be replaced.
People with rheumatoid arthritis are most likely to benefit from a total wrist replacement, but it can also help people with osteoarthritis or traumatic arthritis.
Wrist replacement is major surgery and recovery takes several weeks. If you're considering joint replacement, weigh the benefits and risks. Age is an important factor. But the final decision is based on your level of pain and how much your wrist stiffness and pain limit your activities.
Wrist replacement surgery may be a good option if one or more of the following apply to you:
-- You cannot complete normal daily tasks without help.
-- You have significant pain every day.
-- Pain keeps you awake at night despite the use of medications.
-- Nonsurgical approaches have not relieved your pain.
-- Less-complicated surgical procedures are unlikely to help.
-- Pain keeps you from doing daily activities or your job.
-- Pain doesn't subside when you rest.
-- You suffer severe side effects from the medications.
Joint replacement surgery is one of the great advances of medicine in the past 40 years. I speak as a grateful recipient of a hip replacement.
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)
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