Treatment of wrist arthritis most often begins with simple treatments, and when these fail to provide relief, there may be surgical options. Fortunately, unlike the hips and knees, we don't walk on our hands, so many people learn to adequately manage their symptoms of wrist arthritis without major surgery. In some patients, however, arthritis symptoms become disabling, and ultimately surgery may become necessary.
Wrist Fusion Surgery:
In people with more widespread arthritis of the wrist — especially when the arthritis involves the ends of the forearm bones — the option becomes a total wrist fusion. In this case, a large plate and metal screws are inserted across the wrist joint. The wrist will never bend again, but in people with severe arthritis, the primary goal is pain relief. A wrist fusion usually provides a strong and pain-free joint to allow resumption of most activities.
Wrist Replacement Surgery:
The advantage of a wrist replacement is that, unlike a fusion, patients who have a joint replaced will have movement of the wrist. The disadvantage is that this is generally not a good procedure for active and younger patients, as the implants are not designed to withstand significant forces. Furthermore, wrist replacement surgery is relatively uncommon, so unlike hip and knee replacements, there are few surgeons performing this complex procedure.
When the arthritis is more widespread in the wrist, a surgery called a proximal row carpectomy (or PRC) removes three of the small wrist bones to remove the worn out joints of the wrist. The proximal row carpectomy may be an option in people who need mobility of the wrist and therefore don't want a fusion, yet are too active to have a replacement. In addition, a carpectomy may be a better option for people who are not good candidates for fusion, such as smokers who have a high chance of complications, such as nonunion, with fusion surgery.
Results After Surgery:
In patients who undergo surgery for wrist arthritis, most will find relief of some or all of their pain. While function is not normal after wrist arthritis surgery, it is most often better than the patient experienced before surgery. Mobility of the wrist is variable, depending on which surgical option was chosen.
Weiss AC, et al. "Total Wrist Arthroplasty" J Am Acad Orthop Surg March 2013 vol. 21 no. 3 140-148
Wyrick JD. "Proximal Row Carpectomy and Intercarpal Arthrodesis for the Management of Wrist Arthritis" J Am Acad Orthop Surg July/August 2003; 11:277-281.