Am I eligible for a wrist joint replacement?

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Q:  I'm wondering if it's time to get a wrist joint replacement. I know these artificial joints are available. How do I found out if I might be eligible?

A: You'll probably want to consult with your primary care physician who will likely refer you to a hand surgeon. Wrist replacements referred to as distal radioulnar joint (DRUJ) prostheses aren't exactly new but they are still being perfected.

Surgeons have had to go back to the drawing board on several occasions while working out the bugs in wrist replacement. Too many patients have suffered continued wrist and hand pain or had the earlier prototypes crack, break loose, or get infected.

But before you leap into the plusses and minuses of different prosthetic choices, you'll probably have to pass the rehab test. That's a period of three-to-six months of conservative (nonoperative) care. A physical or occupational (hand) therapist will work with you to reduce pain and improve motion, strength, and function.

If you have already completed a serious program of hand therapy, then you may, indeed, be a good candidate for surgery. Wrist replacement may not be the first choice recommended.

There are other reconstructive surgeries that can be tried first. The specific type of surgical treatment recommended will depend on the underlying problem, cause of the problem, bone density, and soft tissue integrity. So, you are basically back to the drawing board in seeking a medical evaluation and exploring all options available.

Reference: Arnold H. Schuurman, MD, PhD, and Teun Teunis, BSc. A New Total Distal Radioulnar Joint Prosthesis: Functional Outcome. In The Journal of Hand Surgery. October 2010. Vol. 35A. No. 10. Pp. 1614-1619.

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