The Problem with Wrist Replacement…

While the wrist might look like a random jumbled mess of bones, it is actually a precisely designed and very complex joint. Your wrist is designed to perform fine and intricate maneuvers that no other joint in the human body can accomplish. If the wrist was immobile, for example, many tasks you perform with your hands would be difficult if not impossible, such as writing, driving, carrying objects, and so on. In fact, the wrist is something most of us likely take for granted. That is, until something goes wrong, and then we realize just how important the wrist is to just about every task we perform.

When something does go wrong, most surgical options aren’t ideal. Today we’re going to focus on the most extreme surgical option, wrist replacement.

Wrist Anatomy

When you first look at a musculoskeletal anatomy image of the wrist, it may seem a bit perplexing, seemingly lacking any rhyme or reason. The wrist consists of eight pebble-sized irregularly-shaped bones that appear to be crammed into a space between the fingers and the proximal end of the lower-arm bones (ulna and radius). But the structure of  the wrist is far from random, and the complexity of the musculoskeletal design doesn’t end with the bones. The wrist has an even more complex design when you factor in all of the tiny ligaments that provide stability and support and hold the machine that is the wrist all together.

If you look at the picture to the left, you’ll see many of these ligaments going all different directions, and the design of the ligaments is what gives the hand the ability to grasp objects and perform many other functions. In surgery, these ligaments are often ignored, and it’s often instability due to these ligaments that really needs to be addressed. You can see why the biomechanics that are at play here, in the functioning of all of these tiny bones and ligaments, are impossible to fully replicate with a plastic or steel artificial device used in a wrist replacement, and it is indeed why success rates are so low following wrist replacement surgery.

Shining a Spotlight on Wrist Replacement Outcomes

One study explored the rate of complications following a wrist replacement. After studying the outcomes on 100 wrist replacement surgeries (ranging from full to partial replacements), researchers found that over 50% of the patients reported complications! The two most common complications were severe contractures, which is caused by scarred ligaments or tendons and can disable the function in the wrist, and failure of the prosthetic wrist replacement device. What do these complications mean? In many cases, additional surgeries will be required, such as to replace the failed device or address the scarred tissue. In this study, 40% required a second surgery and an astounding 10% required as many as six additional surgeries!

Nonsurgical Solutions for Wrist Treatment

It’s important to understand that the majority of wrist injuries stem from an original trauma that resulted in ligament laxity. This could have been a sprained wrist years ago that healed and wasn’t given a second thought; however, over time, that loose ligament has left one or more wrist bones without the proper support, leading to the slow wearing down of cartilage. As an example, we see patients who begin having wrist pain during yoga exercises. These patients often have to modify poses to keep wrist pain at bay. An exam will typically show one or more wrist ligaments are loose, and we know this isn’t a current injury because some cartilage breakdown has occurred. While some patients might recall a wrist sprain years prior, many have no idea how the ligaments became damaged, and none of these patients knew they even had loose ligaments. Hence, it is the ligaments that really need to be addressed to restore support and stability to the wrist and stop or slow the progression of arthritis (the breakdown of cartilage).

Before going down the surgery road, many patients will opt for steroid shots to address pain and inflammation in their wrist; however, we highly advise against this. First, steroids are toxic to the cartilage in the wrist joints. Second, steroids will inhibit healing of the injured ligaments, which will eventually lead to arthritis and, ultimately, surgery. It’s also important to note, that studies have shown that steroids lose their effectiveness with each subsequent injection.

So how do we address the ligaments? Thankfully, one or two precise image-guided injections of the patient’s own orthobiologics, such as platelet-rich plasma or stem cells, can address wrist pain by tightening up those lax ligaments, which will address instability, and can help eliminate the need for surgery.

Proactively addressing instability by treating the wrists you already have will keep your wrists healthy and properly functioning. Treating instability sooner rather than later will give you a better chance at success and keep you away from a highly invasive wrist surgery, such as a wrist replacement, which will never allow the artificial wrist to function like the highly complex original.