TOTAL WRIST ARTHROPLASTY

Done By:Taghreed Eyuni.9193004

Objectives :

By the end of this presentation you will be able to:

Define total wrist arthroplastyDiagnostic testsIdentify the indication of total wrist arthroplastyUnderstand the pre-operative managementIdentify the post-preparative managementIdentify the possible complications Identify the important topics that patient and family should be educated aboutReferences

Definition:

• Wrist arthroplasty surgery, also called replacement, removes the damaged bone and cartilage in a joint. The bone is resurfaced with implants made from metal alloy and polyethylene (plastic) to re-create the smooth gliding surface that were once intact. The purpose of the procedure is to restore movement and decrease or eliminate pain.

TWA

Diagnostic tests:

• The orthopedic surgeon who will perform the surgery will usually require a complete physical examination of the patient:

• Check the wrist for points of tenderness and swelling• Assess if range of motion has been decreased• Assess grip strength and forearm strength

Diagnostic tests:

• maging tests• X-rays. Using a small amount of radiation, simple X-rays can reveal bone

fractures, as well as evidence of osteoarthritis.• Computerized tomography (CT) scan. CT scans can provide more-

detailed views of the bones in your wrist. A CT scan takes X-rays from several directions and then combines them to make a two-dimensional image.

• Bone scan. In a bone scan, a small amount of radioactive material is injected into your bloodstream. This makes injured parts of your bones brighter on the resulting scan images.

• Magnetic resonance imaging (MRI). MRIs use radio waves and a strong magnetic field to produce detailed images of your bones and soft tissues. For a wrist MRI, you may be able to insert your arm into a smaller device rather than have your entire body slide into a full-size MRI machine.

Indication :

Several indications for TWA surgery that are not treatable by other methods include:

*Osteoarthritis,

*Rheumatoid arthritis,

*Bone fracture and trauma.

Benefits

• Eliminate or reduce pain• Enhance movement and mobility• Improve quality of life• Return to normal activity• Low-impact sports and activities

Pre-operative management

• Before surgery, patients are advised to take all of their normal medications, with the exception of blood thinners such as aspirin , ibuprofen, and other anti-inflammatory drugs that may cause greater blood loss during surgery. 

• physical therapist should prepares the patient before surgery to ensure readiness for rehabilitation post-surgery. The purpose of the preoperative examination is also for the physician to pre-record a baseline of information that will include measurements of the patient's current pain levels, functional wrist capacity, and the range of motion and strength of each hand.

Preparation

• Make sure that the patient is candidate for surgery

• Explain the procedure to the patient• Sign the consent• Prepare all the forums needed• Patient should be NPO by midnight• May need antibiotic as prophylactic before

surgery

Post-operative management

• Monitor the vital signs • Monitor any signs of bleeding and infection• Pain management (PCA)• Following surgery, the patient's wrist, hand, and lower

arm are placed into a bulky bandage and a splint for the wrist and finger motion.

• A small plastic tube may be inserted to drain any blood that gathers under the incision to prevent excessive swelling (hematoma). The tube is usually removed within 24 hours. Sutures may be removed 10–14 days after surgery.

Post-operative management

• gentle active wrist motions are encouraged.• Formal physical and occupational therapy with

digital motion, wrist motion, and edema-reducing protocols is started 10 days to 2 weeks after surgery. It typically takes 4 to 6 months to gain optimal ROM and strength.

Complications

• While uncommon, complications can occur during and after surgery. Some complications include infection, implant breakage, nerve damage, and fracture.  Although implant surgery is extremely successful in most cases, some patients still experience stiffness and pain. No implant will last forever and factors such as the patient’s post-surgical activities and weight can affect longevity.

Patient education

• Home Safety and Avoiding Falls:

• Place regularly used items medications, and reading materials, in easy-to-reach locations.

• Place frequently used cooking supplies where they can be reached without too much bending or stretching.

• Be aware of all floor hazards such as pets, small objects, or uneven surfaces.

• Do not let the patient lift heavy objects for the first three months and then only with surgeons permission.

Patient education

• Incision Care:

• Keep the incision dry.• Keep the incision covered with a light dry dressing until the staples

or sutures are removed.• Patient should request showering/bathing instructions from surgeon.• Notify the surgeon if there is increased drainage, redness, pain,

odor, or heat around the incision.• Take the patient’s temperature if he or she feels warm or sick.

Patient education

• Controlling Discomfort:

• Pain medicine should be taken at least 30 minutes before physical therapy.• Encourage patient to gradually wean him or herself from prescription pain

medication. Follow the surgeon's recommendations for taking over-the-counter medication in place of prescription pain medication.

• Have patient change position every 45 minutes throughout the day.• Use ice for pain control. Applying ice to the affected joint will decrease

discomfort, but do not use for more than 20 minutes at a time each hour. Use ice before and after the patient exercises according to their prescribed program. A bag of frozen peas wrapped in a kitchen towel makes an ideal ice pack. Mark the bag of peas and return them to the freezer (to be used as an ice pack later).

references

• Adey L, Ring D, Jupiter JB. Health status after total wrist arthrodesis for posttraumatic arthritis. J Hand Surg Am. 2005;30(5):932-936.

• 2. De Smet L, Truyen J. Arthrodesis of the wrist for osteoarthritis: outcome with a • minimum follow-up of 4 years. J Hand Surg Br. 2003;28(6):575-577.• "Wrist Replacement." University of Maryland Information Page. 

http://www.wristreplacement.com/ .• "Wrist Joint Replacement (Arthroplasty)." AAOS. <orthoinfo.aaos.org/fact/

thr_report.cfm?Thread_ID=347&to category=Hand> .•

star valely medical center “ orthopedic” http://www.saltriverortho.com/index.cfm?ID=80

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