25446 Arthroplasty with prosthetic replacement; distal radius and partial or entire carpus (total wrist)

Name of the Procedure:

Arthroplasty with prosthetic replacement; distal radius and partial or entire carpus (total wrist)

Summary

Arthroplasty with prosthetic replacement involves surgically replacing the damaged or diseased wrist joint, including the distal radius and part or all of the carpus, with a prosthetic device to restore function and reduce pain.

Purpose

This procedure addresses severe wrist arthritis or significant trauma resulting in joint damage. The goal is to alleviate pain, improve wrist function, and restore range of motion.

Indications

• Severe osteoarthritis or rheumatoid arthritis of the wrist
• Post-traumatic arthritis or injury
• Irreparable joint damage
• Significant loss of wrist function and mobility
• Pain not relieved by conservative treatments

Preparation

• Patients may need to fast for a specified period before the surgery.
• Medications may need adjustment, especially blood thinners.
• Preoperative assessments, such as X-rays, MRI, or CT scans, and blood tests, will be conducted.

Procedure Description

1. A surgical incision is made over the wrist.
2. The damaged portions of the distal radius and carpus are carefully removed.
3. The prosthetic components are positioned and secured into place, replacing the removed joint parts.
4. The surgical site is closed using sutures or staples, and a dressing is applied.

Anesthesia: General or regional anesthesia is typically used to ensure the patient is pain-free during the surgery.

Duration

The procedure usually takes about 2 to 3 hours.

Setting

The procedure is performed in a hospital or surgical center equipped for orthopedic surgeries.

Personnel

• Orthopedic surgeon
• Surgical nurse
• Anesthesiologist
• Surgical technician

Risks and Complications

Common risks include infection, bleeding, and blood clots. Other potential complications are prosthetic joint failure, nerve damage, and stiffness. These risks are managed with antibiotics, proper surgical techniques, and postoperative care.

Benefits

Patients can expect reduced pain and improved wrist function. Benefits are typically noticed within a few months post-surgery, following rehabilitation.

Recovery

• Postoperative care includes pain management, antibiotics, and immobilization.
• Physical therapy is critical for restoring movement and strength.
• Full recovery may take several months, during which certain activities may be restricted. Follow-up appointments are necessary to monitor progress.

Alternatives

• Non-surgical options like medication, splinting, or corticosteroid injections.
• Joint fusion (arthrodesis), which stabilizes the wrist but reduces motion.
• Pros and cons: Non-surgical treatments typically offer temporary relief, while joint fusion limits movement but provides pain relief.

Patient Experience

The patient will be under anesthesia during the procedure, ensuring no pain. Postoperatively, they may experience discomfort managed through pain medication. Initially, wrist movement will be limited, but it will improve with adherence to physical therapy and follow-up care.