New procedure offers relief for those with chronic wrist pain

People with chronic pain in their wrists are finding relief and returning to their active lifestyles. Hear how in this Medical Moment.

Hip and knee replacements have changed the way many spend their golden years. New wrists may do the same.

Surgeons are now successfully replacing joints that were once too complicated to remove.

When James Murphy stashed his skiis at the end of the season, he was afraid they'd be in storage for good.

The avid sportsman tackled some of America's toughest slopes, but rheumatoid arthritis took its toll. James suffered constant pain and stiffness in his wrists.

"It was difficult because I only had two fingers that I could hold on to the pole with,” says James. “I couldn't plant as much as I wanted to."

In the past, the best way to relieve pain was to fuse bones together -- limiting mobility. Now, orthopedic specialists replace the entire wrist -- much more complicated than a hip or knee replacement.

"There are eight bones in the wrist. If you add that to the two forearm bones, you're talking about ten bones that need replacement," says Dr. Randall Culp, hand and wrist specialist at the Philadelphia Hand Center.

Surgeons make an incision in the back of the wrist. They implant metal parts to support the forearm and fingers. Then a plastic spacer holds the joint together and allows movement.

"We're also using what we call porous in-growth,” says Dr. Culp. “We don't use bone cement anymore. This is all done through your own bone growing into the prosthesis."

James needed weeks of physical therapy to regain strength, but the pain was gone immediately after surgery.

"Gonna feel a whole lot better by the time ski season comes around," says James.

A thrill-seeker excited about getting back to nature.

Doctors say the wrist prosthesis is a newer one so they are still studying how long it will last. They say most patients will do well for at least ten years.


RESEARCH SUMMARY
TOPIC: REPLACING WORN OUT WRISTS
REPORT: MB #2995

BACKGROUND: The wrist is a complicated joint, composed of 10 different bones. The ends of those bones -- as all bones -- are covered with cartilage, which enables them to glide smoothly past one another. If that cartilage is worn away or damaged, bone will rub against bone and eventually wear down the ends of the bones. This causes a painful condition called osteoarthritis. Another type of arthritis that can affect the wrist is rheumatoid arthritis, a chronic disease that causes stiffness, swelling and pain in the joint.

TREATMENTS: Nonsurgical treatments for arthritis of the wrist include icing, splinting, activity modification and medications. Steroid injections are sometimes recommended to reduce pain in the joint as well. If first-line treatments don't ease pain, surgery may be an option. Currently, the three surgeries available to treat wrist arthritis are removing arthritic bones (also known as wrist reconstruction); joint fusion, which makes the wrist solid and prevents any movement; and wrist replacement. Only patients who are willing to avoid heavy duty tasks involving the wrist are candidates for wrist replacement surgery, which is similar to a hip or knee replacements.

WRIST FUSION: Traditional surgery for arthritis of the wrist is fusion surgery. Fusion can be either partial or total. In partial wrist fusion, the arthritis bones are fused together using a small plate. This type of fusion leaves the patient with some movement of the wrist. Total wrist fusion completely eliminates motion in the wrist and is only recommended for patients who can get by with one wrist, and especially for patients who have no arthritis in the other wrist.

A SUBSTITUTE JOINT: Because the wrist is a much more complicated joint than the hip or knee, doctors are still working on the ideal wrist replacement. The latest designs have two metal components. One fits into the radius, or the bone of the forearm. The other fits into the hand bone using one long stem and one or two shorter stems on either side. A plastic spacer joins the two metal components together at the joint area and allows natural movement of the wrist. Like hip or knee replacement, wrist replacement can be performed as an outpatient procedure.

RECOVERY: The American Society for Surgery of the Hand says after wrist replacement, patients should expect to wear a cast for the first several weeks. When it's removed, a protective splint is worn for the next six to eight weeks. At the same time, the patient will need to do rehabilitative exercises to restore wrist movement. On average, patients should expect to get a wrist replacement every 10 to 15 years after the first one.

FOR MORE INFORMATION, PLEASE CONTACT: Thomas Jefferson University Hospital at (800) JEFF-NOW www.jeffersonhospital.org


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