Total Wrist Replacement

How safe and effective is total wrist replacement surgery?

Dramatic improvements in implant design have made total wrist replacement surgery a viable option for patients seeking relief from disabling wrist joint pain, says an MUSC Health orthopedic surgeon.

“The last implants that were introduced about two to three years ago have made a dramatic difference in functionality,” says Dr. Arnold-Peter Weiss. “They’re functioning at the level of total knee and hip replacements, and we expect these latest implants are going to last decades.”

He should know. Dr. Arnold-Peter Weiss is the designing surgeon for the latest generation wrist replacement implant, which is widely used in the United States and has earned plaudits for its optimization of motion, improved stability, and functionality.

MUSC: A Leader in Total Wrist Replacement Surgery

A professor of orthopedics at MUSC and at Brown University Medical School in Rhode Island, Dr. Weiss provides specialized hand and wrist joint replacements and reconstructive services for patients who come to MUSC from the Southeast and across the country. He treats patients who have significant joint pain from wrist, thumb, or finger arthritis and patients who require revision surgery.

His presence at MUSC Health puts the state’s only academic medical center at the forefront of centers where the highly specialized surgery is performed.

“We’re the only center in the Southeast and one of only three or four centers nationally that offer this surgery,” he says. “Total wrist replacement is very specialized and a little tricky. It requires expertise and familiarity, and MUSC is the Southeast’s leading center with the greatest case volume and experience in total wrist replacement surgery.”

Wrist replacement surgery is not new. It’s been around for almost a century. In fact, the first attempted wrist replacement was made of ivory and didn’t do very well. Practically speaking, the first wrist replacement was performed about 35 years ago, but problems with the design caused dislocation from the bone, instability, and poor durability, he says.

State-of-the-Art Wrist Implant

The alternative for thousands of people with wrist arthritis from fracture or who had rheumatoid arthritis was a wrist fusion involving a metal plate. The disadvantage, however, was that the wrist would not bend. People had no satisfactory option.

“The bigger joints like hips and knees got the most attention, and there was a lot of implant development in those areas,” he says. “The less common joints, like wrist, elbow, and ankle, didn’t get as much attention and thus lagged behind in the development because not as many patients needed those procedures.”

Until recently. “We’ve worked on those problems, and we have the fifth generation implant of basic wrist implants,” Dr. Weiss says. “This current implant is state of the art. The design has changed to fit the wrist precisely. It’s very predictable, stable, and it works very well. It has finally come to equal the success of implants for other joints.

“The point of wrist replacement is to restore movement that is pain-free and allows patients to manage everyday tasks, from taking a cap off a bottle and taking care of their personal hygiene to participating in sports such as tennis, golf, or even sailing. Because this procedure is predictable, we can tell people the results they’ll have.”

Wrist Replacement Procedure and Recovery

Dr. Weiss performs about two of the outpatient procedures weekly at MUSC Health. The surgery takes between 45 to 90 minutes, depending on the complexity of the case. He uses a nerve block (local anesthesia) to numb the arms and then makes a four-inch incision on the back of the wrist to insert the implant, which consists of a special metal alloy and high-density polyethylene to lubricate its surface. These materials are used in all joint replacement devices, he says.

After surgery, the patient wears a short splint from the palm to the forearm for eight to 10 days. Patients who have good bone quality don’t need a cast; those with poor-quality bones wear a cast for three weeks to strengthen the bone. All patients can move their fingers so they can drive and resume daily activities. Therapy is optional, and not everybody needs it.

By three weeks, patients can move their wrists, he says, and they slowly regain their motion up to a year. “By one year, patients can move their wrist 40 to 45 degrees backward and forward. The arc of motion for a normal wrist is 80 degrees. It’s not the wrist someone is born with, but this wrist replacement really is changing how people live their lives and is a solution to their problem,” says Dr. Weiss, who holds 24 U.S. patents on orthopedic joint implants and devices used worldwide.

Durability and function are key advantages of this implant. According to studies, patients can count on the newest implant lasting 20 to 25 years, Dr. Weiss says. Thus, the surgery is reserved for people 45 to 50 and above, with the exception of patients who have had rheumatoid arthritis since childhood.

“My patients are happy,” Dr. Weiss says. “Those who’ve had failed surgeries and endured ligament instability and pain now have a predictable alternative. Total wrist replacement has changed how people live their lives.”

Dr. Weiss evaluates self-referral and referred patients at MUSC Health Orthopaedics at West Ashley Medical Pavilion, 2060 Sam Rittenberg Blvd., and in Mount Pleasant at 1105 Chuck Dawley Blvd. Building A. To make an appointment at either location, call 843-876-0111. He performs surgery primarily at Rutledge Tower on the MUSC campus and occasionally at West Ashley.