I'm scheduled to have both of my wrists replaced with implants that are now available. I know there can be potential problems with any surgery. Fill me in on the most likely complications so I can be mentally prepared.
Yes, there are hip, knee, shoulder, elbow, finger, and now wrist joint replacements! Wrist replacement is also known as total wrist arthroplasty or TWA. As with any surgical procedure, there can be intraoperative (during surgery) and postoperative (after surgery) problems that develop. These might include blood clot formation, heart attack, complications from the anesthesia, infection, and damage to blood vessels or nerves. The risk of these things is fairly low, but it can still happen and does affect some patients.
In the specific case of total wrist arthroplasty (TWA), the most common problems or complications are infection, failure of the wound to heal, loosening of the hardware, wrist dislocation, tendon rupture, and impingement. One of the biggest reasons complications develop is from implant malpositioning. Implant loosening tends to be another major cause of problems.
As with any new surgical procedure, one of the first things surgeons look for are those patients who can benefit the most from the new treatment. This is one way to reduce or even avoid complications. In the case of wrist joint replacement, patients with wrist rheumatoid arthritis were the only candidates at first. Total wrist arthroplasty (TWA) makes it possible for these patients to avoid a wrist fusion or wrist bone removal (sometimes the only other surgical options).
Even so, anyone with severe bone loss, infection, bone subluxation (partial dislocation), or who uses a walking aid (cane, walker) is still not considered a "good" candidate for this procedure. When present, any of these factors is a contraindication to surgery. In other words, these problems keep the patient from having this procedure.
Over time and with improvements in implant design, fixation, and surgical techniques, more patients have been included in the list of potential or good candidates for total wrist arthroplasty (TWA). And fewer intraoperative and postoperative problems are developing. For example, stiffness after TWA can be prevented with the use of a postoperative wrist splint that holds the wrist in 30-degrees of extension.
Implant systems that have a locking screw option may decrease the risk of implant loosening. TWA should not be used in young adults (younger than 50 years old) or for anyone who is unable to follow directions for activity restrictions. Don't hesitate to talk with your surgeon if you have any questions about these precautions as they might apply to you. And good luck!