25251 Removal of wrist prosthesis; complicated, including total wrist

Name of the Procedure:

Removal of wrist prosthesis; complicated, including total wrist replacement removal

Summary

In layman's terms, this procedure involves surgically taking out a previously implanted wrist prosthesis, which may have become problematic or is no longer needed. This is considered a complex surgery due to the intricacies involved in removing the entire prosthetic apparatus from the wrist.

Purpose

• Medical Conditions Addressed: Complications from a wrist prosthesis, such as infection, mechanical failure, or severe pain.
• Goals: To eliminate issues associated with the prosthetic wrist and prepare the area for either a new prosthesis, other reconstructive surgeries, or natural healing processes.

Indications

• Persistent wrist pain unrelieved by conservative treatments.
• Prosthesis infection.
• Loosening or failure of the prosthetic components.
• Extensive wear or damage to the prosthesis.
• Severe inflammation.

Preparation

• Pre-procedure Instructions: Patients may need to fast for 8 hours prior to surgery. They should also inform the healthcare team about any medications they are currently taking, as some may need to be adjusted or stopped before the procedure.
• Diagnostic Tests: Blood tests, imaging studies like X-rays or MRI scans, and a thorough physical examination of the wrist.

Procedure Description

1. Anesthesia: The patient is given general anesthesia to ensure they are asleep and pain-free during the surgery.
2. Incision: A surgical incision is made near the wrist to access the prosthesis.
3. Removal: The surgeon carefully dissects any surrounding tissue and removes the prosthetic components, which may involve cutting or loosening the prosthesis.
4. Debridement: Any infected or damaged tissue is cleaned out.
5. Closure: The incision is carefully closed with sutures or staples.
6. Post-Op Care: The area is dressed, and a splint or brace may be applied.

• Tools: Scalpel, retractors, prosthesis removal tools, and surgical sutures.
• Anesthesia: General anesthesia is commonly used.

Duration

The procedure typically takes between 2 to 4 hours, depending on the complexity of the case.

Setting

The procedure is typically performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic or hand surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologists

Risks and Complications

• Common Risks: Infection, bleeding, and pain at the surgical site.
• Rare Risks: Nerve damage, blood vessel injury, non-healing of the bone, and anesthesia-related complications.
• Possible Complications: Prolonged immobilization, joint stiffness, and limited range of motion. Management may include antibiotics, pain medications, and physical therapy.

Benefits

• Relief from persistent pain and discomfort.
• Elimination of infection or mechanical issues.
• Improved wrist function and quality of life, though results vary per individual.

Recovery

• Post-procedure Care: Keeping the wrist elevated, applying ice, and following pain management protocols.
• Recovery Time: Initial recovery typically takes a few weeks, but full recovery, including rehabilitation, can take several months.
• Restrictions: Limited use of the affected wrist for the first few weeks, with gradual reintroduction of activities as healing progresses.
• Follow-Up: Regular check-ups with the surgeon to monitor progress.

Alternatives

• Conservative Treatments: Physical therapy, wrist braces, and anti-inflammatory medications.
• Revision Surgery: Replacement of the old prosthesis with a new one.
• Fusion Surgery: Permanently joining the wrist bones to eliminate movement and pain.

Patient Experience

• During Procedure: The patient will be under general anesthesia and will not feel or remember the surgery.
• After Procedure: The patient may experience pain and swelling, which will be managed with medications. Discomfort and limited use of the wrist should be expected initially, with gradual improvement as healing occurs.
• Pain Management: Pain relief is typically managed with prescribed medications and over-the-counter pain relievers as healing progresses.