I'm thinking about going for a wrist joint replacement for my terrible, terrible arthritis. I'd like to know what different surgeons have to say about this without getting three or four opinions. Is there any information like that available?
Not long ago, a systematic study was done to compare the results of arthrodesis (wrist fusion) to arthroplasty (wrist joint replacement). Complication rates for the two procedures were compared. The results for arthroplasty were a little bit hard to compare because surgeons used different techniques and different implants. Likewise, different ways to fuse the wrist were employed.
Since that time, another study was done asking surgeons to place a value on expected gains from these two procedures. Experienced surgeons who are members of the American Society for Surgery of the Hand were surveyed. In general, they favored arthrodesis over arthroplasty. But there were some indications that the value they placed on fusion over replacement wasn't necessarily based on better results from that procedure.
For most patients, the decision may rest on their expectations and goals. Wrist replacement will preserve wrist motion but may come with a higher risk of complications. Wrist fusion may be more appealing because there are fewer re-operations required. Both procedures have a risk of delayed wound healing and/or infection.
With any implant, there is a risk of subsidence (implant sinks down into the bone), pain requiring removal of the hardware, and implant imbalance. The implant can come loose or dislocate. On the other hand, major problems associated with fusion include nonunion, formation of a false joint called pseudoarthrosis, and deep infection. Any of these problems may require additional surgery.
Many improvements have been made in wrist implants since they were first introduced. Likewise, surgical technique has improved. The notion that arthroplasty is no better than arthrodesis in terms of improving function may be a value judgment offered by surgeons who don't perform arthroplasties. It is predicted that as more studies are done, results of arthroplasty will continue to improve -- much like hip and knee replacements gained in favor as the procedure evolved.
Christi M. Cavaliere, MD, and Kevin C. Chung, MD. Total Wrist Arthroplasty and Total Wrist Arthrodesis in Rheumatoid Arthritis: A Decision Analysis From the Hand Surgeons' Perspective. In The Journal of Hand Surgery. December 2008. Vol. 33-A. No. 10. Pp. 1744-1755.
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