25449 Revision of arthroplasty, including removal of implant, wrist joint

Name of the Procedure:

Revision of arthroplasty, including removal of implant, wrist joint Common name(s): Wrist revision arthroplasty, Wrist joint implant removal

Summary

Wrist revision arthroplasty is a surgical procedure involving the removal and potential replacement of an artificial wrist joint implant. This procedure is typically necessary when the initial wrist implant fails, becomes defective, or causes complications.

Purpose

The primary purpose of this procedure is to address issues related to a previously implanted wrist joint, such as implant failure, infection, or mechanical complications. The goals are to alleviate pain, restore wrist function, and improve the patient’s quality of life.

Indications

• Persistent wrist pain unresponsive to conservative treatment
• Implant loosening or mechanical failure
• Infection at the implant site
• Significant wear or damage to the implant
• Joint instability or dysfunction Patient criteria often include those who have had previous wrist joint replacement and are experiencing complications or failure of the initial implant.

Preparation

• Patients may be advised to fast for at least 8 hours prior to the procedure.
• Adjustments to current medications, especially blood thinners, may be necessary.
• Pre-procedure diagnostic tests such as X-rays, MRI, or blood tests are commonly required.
• Patients should arrange for someone to drive them home post-procedure and plan for an adequate recovery space at home.

Procedure Description

1. Anesthesia: General or regional anesthesia is administered to ensure the patient is comfortable and pain-free.
2. Incision: The surgeon makes an incision over the wrist to access the joint.
3. Removal of Implant: The existing implant is carefully removed, along with any damaged tissue or bone.
4. Preparation of the Joint: The joint is prepared for a new implant or for alternative treatment if no replacement is being inserted.
5. Replacement (if applicable): A new implant is positioned, ensuring proper alignment and function.
6. Closure: The incision is closed using sutures or staples, and a sterile dressing is applied.

Tools involved may include surgical instruments like scalpels, retractors, and specialized orthopedic tools for implant removal and insertion.

Duration

The procedure typically takes around 1.5 to 3 hours, depending on the complexity of the case.

Setting

Wrist revision arthroplasty is usually performed in a hospital or specialized surgical center equipped for orthopedic surgeries.

Personnel

• Orthopedic Surgeon (specializing in hand and wrist surgery)
• Anesthesiologist
• Surgical Nurses and Technicians
• Post-Operative Care Team

Risks and Complications

Common risks include:

• Infection
• Bleeding
• Blood clots
• Nerve or blood vessel damage Rare but possible complications:
• Implant failure or loosening
• Severe pain or stiffness
• Adverse reaction to anesthesia Management includes antibiotics for infections, pain management protocols, and close monitoring during recovery.

Benefits

• Relief from pain
• Improved wrist function and mobility
• Enhanced quality of life Benefits may be realized over several weeks to months as the wrist heals and rehabilitation progresses.

Recovery

• Immediate post-procedure care includes pain management, immobilization of the wrist, and monitoring for any adverse effects.
• Physical therapy is often recommended to regain strength and mobility.
• Full recovery may take several months, with periodic follow-up appointments to monitor progress.
• Patients may need to avoid heavy lifting and other strenuous activities for an extended period.

Alternatives

• Non-surgical treatments like physical therapy, medications, or wrist braces.
• Partial wrist fusion (arthrodesis) or complete wrist fusion, which reduces pain but limits mobility.
• Smaller joint debridement surgeries for minor issues. Each alternative has its own pros and cons, often balancing less invasiveness with varying degrees of relief and function restoration.

Patient Experience

During the procedure, patients will be under anesthesia and will not feel pain. Post-operatively, some discomfort and swelling are expected, managed by medications and therapies. Pain levels and recovery experiences can vary, but most patients feel significant relief from the symptoms prompting the revision surgery. Comfort measures include proper pain management, ice packs, and supportive devices such as slings or braces.