Wrist Replacement Versus Wrist Fusion

Question

Asked by Ellen Galo

Wrist Replacement Versus Wrist Fusion

Hi - I have serious damage to my right wrist from RA (add a little OA to that as well). My wrist bones/carpals look like swiss cheese! There is some evidence that the scaphoid bone broke open. Up until then, with meds, I could still bend my wrist fairly well, now it only bends 42 degrees total (about 20 each direction). I wear a splint 24/7 and that helps keep the pain down.

Question: Any experience with wrist replacements versus fusion? I asked several doctors, including my GP, my Rheum. Dr. and 2 hand surgeons about which would be better/safer, if I decided to go for surgery. Hand surgeon #1 said, you can do either, no rush, wait a few years, but that the fusion would cause less trouble and last longer. Hand surgeon #2 said, people are happier with wrist replacement, even if they have problems with it. However, both surgeons are 3 hours away, and 'problems' would cause me to miss a whole day of work, even for just an appointment. GP said, fusion is better, any movement would contribute to inflammation, thus problems. Rheumatologist agreed.

Ironically, I scheduled the fusion with #2 hand surgeon. He kept asking me if I was sure, if I was having pain all the time (I was then but with splint it got better). So - I cancelled, and not sorry. Seemed better to wait until absolute necessity, then do fusion with #1 doctor! (had better rapport with him anyway, tho' the other guy was very nice.)

Ellen

Answer

It may be six of one, half-dozen of the other - if you wrote down the pros and cons to each procedure, they may come out more or less even.

I don't quite get what your GP means with movement contributing to inflammation, because if your wrist was replaced, there wouldn't be a joint there that could be inflamed, but I've had a long week and my brain is fried. However, both my wrists have been fused for decades - one from the RA, run from a synovectomy that ended up fusing - and the lack of movement doesn't seem to create too much problems in my everyday life. Since you're wearing a splint, you already know how well you'd function with a fused wrist, so that might give you some insight. It's my impression that wrist replacement, like finger replacements, have yet to be as effective long term as need and hip replacements, so that may factor into your decision, as well. You might want to ask your doctor if you go for fusion now, can you get the replacement later when the success rate of wrist replacement may increase, which would enable you to do both.

Answered by Lene Andersen, MSW