The development of a total wrist arthroplasty.

For many individuals the preservation of wrist motion is essential for augmentation of fine motor control of the hand and fingers. When significant functional disability exists at the wrist, currently available surgical treatment includes soft tissue arthroplasty, carpectomy, or arthrodesis. A total wrist joint arthroplasty offers the patient the potential of a pain-free, stable, and mobile wrist. Based upon the principles of total joint replacement as applied to the hip and knee, the prosthesis is secured to the carpus and radius with methylmethacrylate cement, following removal of the navicular, lunate, and head of the capitate. The design of the prosthesis provides for the two planes of motion normally seen at the wrist; 90 degrees of flexion and extension and 50 degrees of radial ulnar deviation are permitted by the design. Candidates for total wrist arthroplasty are patients who exhibit far-advanced disease at the wrist and who might be considered as candidates for arthrodesis, but in whom the permanent loss of motion would represent a significant handicap. To date 17 arthroplasties have been performed in 14 patients. The longest follow-up is 14 months. All but 2 patients have gained a useful range of motion. All patients have noted dramatic relief of pain and deformity, permitting them to perform tasks which were preoperatively impossible.