There’s a Reason Success Rates for Wrist Replacement Are So Low: It Isn’t the Answer!

By Chris Centeno, MD /

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wrist replacement success rates show surgery is not the answer

You never realize how big a deal your hands are until something goes wrong with them and all of a sudden you can’t write, carry things, or type without pain. There are few good treatment options for problems with wrist arthritis and pain at the base of the thumb, and a recent study showing a scary low wrist replacement success rate isn’t encouraging. In the meantime, understanding that our wrists are all about stability and how they’re treated without surgery could keep you away from invasive procedures with bad results.

How Does the Wrist Work?

Wrist componentsThe wrist is one of those structures in the body that–when looking at anatomy drawing–you say to yourself, “What the heck is going on here?” You’ll find that there’s 8 irregularly-shaped little bones seemingly crammed between the arm bones and fingers. Why? Because your hand is a complex machine with many moving parts . These little bones allow you to move your fingers in a range of directions that engineers worldwide can’t even replicate without outright ripping off parts of the design.

wrist ligamentsOne of the things that isn’t usually depicted in anatomy drawings that’s critical in understanding the wrist are all of the little ligaments that hold this machine together. The picture to the left makes the complexity of the bones seem mild. Here you’ll see 20 or so ligaments on each side, each darting this way and that in a seemingly random pattern. What’s taking place in this image is all about your hand being able to grasp objects.

While understanding the function of each of these ligaments is beyond this post, the fact that these ligaments are often ignored in wrist treatments is likely why doctors are traditionally so bad at treating this part of the body–and why a prosthetic replacement for this marvel of nature’s complexity is ridiculous. The biomechanics are far too complex to replicate in plastic or steel, which is why wrist replacement success rates are so low.

A New Study Sheds Some Light on Wrist Replacement Success Rates

A new study explores the likelihood of complications following wrist replacement procedures that use an artificial joint. More than 100 surgeries of 3 different types (from complete replacement of the joint to partial replacements in the joint) were performed at an academic teaching hospital specializing in complex wrist surgery. Astonishingly, more than half of the patients reported complications! Serious contracture (when the ligaments and tendons become so scarred down the wrist won’t function) and failure of the implanted devices were the 2 most common side effects of the procedures. Many patients needed additional surgery to correct these issues, with 4 in 10 needing a second procedure and 1 in 10 needing up to 6 additional surgeries! Suffice it to say that the results were a disaster.

Is There a Better Way than Extreme Surgery to Heal the Wrist?

If we return to the diagrams above, it’s not hard to see why these surgeries are failing. The wrist is so complex that no amount of simple joint replacement devices or half-baked surgeries will ever be able to fix it without major issues. Why not try to heal what’s already there instead? Why not try to make nature’s crazy complexity work for you instead of against you? This is our approach to wrist treatment at Regenexx.

First, realize that usually what injures the wrist is a trauma that leads to 1 or more of the ligaments becoming loose. This then leads to extra motion in 1 or more of the 8 wrist bones which wears away cartilage over time. Hence, treatment should focus on restoring the integrity of the wrist ligaments. Thankfully, it turns out that ultra-precise, guided injections of new autologous biologics like platelet rich plasma and stem cells are great for helping the damaged ligaments heal.

As an example, we frequently see patients that first notice wrist pain during yoga. Sometimes it worsens to the point that certain poses can’t be performed or must be heavily modified. A detailed exam looking for wrist instability usually shows that at least 1 wrist ligament is lax, commonly related to an old injury that may or may not be easily recalled by the patient. Usually with 1 or 2 precise injections under ultrasound guidance we can reduce or eliminate the pain and help the patient avoid surgery. If left untreated, most of these patients would end up getting steroid shots, which would hurt cartilage in the wrist joints and inhibit the healing of the damaged ligaments, leading to eventual arthritis and surgery.

Wrist pain and arthritis can usually be easily treated without surgery and with precise injections. Right now, as this new study shows, considering a wrist joint replacement is not a good idea, as the technology just isn’t ready for prime time. Regenexx injection methods have been developed for a decade and are a better first choice for healing the pain in your wrists for good.

Category: Hand/Thumb, Wrist

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15 thoughts on “There’s a Reason Success Rates for Wrist Replacement Are So Low: It Isn’t the Answer!

  1. Jacqueline

    I have been dealing with arthritis in my knees for at least six to ten years..first it was one knee then progressed to both knees.. the right knee is I think worse then the left knee.. I have had shots in my knees …three times .. and the last time I had shot in both knees it seemed to work better then the three shots series of a more natural substance that I had injected before.. I had a fall off a ladys front porch in December of 2015 and this resulted in a broken arm,…rhis thank,God didnt need surgery

    but i have been,in,an,arm,sling since them,and have recently started therepy two times a week..all this meanwhile,also doing reflexology treatments obce ir two times a week since last july or august on a compkete tear of my other arms rotatorcuff and long muscle.. and now thank God when my left arm is healing my knees are giving me super fits and grinding when i move,and going up and down stairs is an almost nightmare impossibilty..PLEASE HELP ME..

    1. Regenexx Team Post author

      Jacqueline,
      Goodness, that’s a lot to deal with. In order to figure out how best to help, would you say your most pressing issue is your knees or your arm and shoulder?

  2. Carol Jensen

    X-ray shows cartilage is gone in both wrists. The pain is getting worse. Cortisone shots lasts only 2 months. Surgery was scheduled but it postponed it for now. Is there anything that might help me from regenexx?

    1. Regenexx Team Post author

      Carol,
      Unfortunately cortisone shots, especially repeated ones, have very negative effects on joints as they kill the local stem cells. The result of that is without any natural repair capability, the damage cycle gets out of control and cartilage damage ensues. The important part is to figure out what caused the need for the cortisone shots in the first place. Often one or more of the many ligaments in the wrist becomes loose, and this laxity causes additional wear and tear on the cartilage, which in turn causes more instability and so on. In general terms, the first thing to address would be looking into the ligaments and if lax treating them to get them to do their job correctly again, and then treating the wrist itself to turn the tide from breakdown to repair. If you would like to speak to one of our physicians about your particular case and the chances that we can help, please fill out the Regenexx Candidate form on this page:http://www.regenexx.com/hand-basal-joint-cmc-arthritis-treatment/. The page will also give you more information on how we treat hand/wrist issues. This blog is a patient outcome report of two women with hand/thumb arthritis: http://www.regenexx.com/blog/texting-thumb-treatments/

  3. chris

    In your posts it seems there is a trend toward using ultrasound guidance for your injections more and more. How do you decide between using ultrasound and fluroscopy? If a patient needs multiple injections with fluroscopy, do they need to be worried about the radiation amount?

  4. Steve Trivoli

    Hi,

    After reading some of these comments, I was never told by any doctor that steroid injections help deteriorate cartilage. I have had many steroid shot in my life. I am wondering now if that is the reason I am having so many joint issues now. I was given them decades ago when it was considered a panacea for many issues. In my case it was for dermatitis. There were side affect. I have had shoulder surgery several years ago with a 95% recovery. Now my right shoulder is going out. I also have now been diagnosed with basal joint arthritis. Not to mention upper & lower back diagnosis’s that are not encouraging. Would you surmise that there is nothing that can be done for me due to my history of steroid injections?? Also what is your opinion of Hyluronic Acid & Curcumin as therapies?

    Thanks for your possible response…

    1. Regenexx Team Post author

      Steve,
      It is definitely troubling that doctors still use steroid shots routinely.
      Hyaluronic Acid is a lubricant, which temporarily helps some people with pain. It doesn’t have any regenerative properties however, so think WD40. Curcumin is great. It’s one of the main ingredients in the Advanced Stem Cell Support Formula that we spent a year testing compounds with stem cells to create. http://www.regenexx.com/regenexx-advanced-stem-cell-support-formula/ Curcumin blocks inflammatory cytokines that are involved in joint destruction (IL1-beta, PGE2, NO, IL-6 and IL-8). In fact in one study it showed up NSAID drugs by also blocking the joint destructive compound known as NO (Nitric Oxide). It’s been tested in the lab with cartilage and tendon cells and shown to reduce inflammation in those specific cells. It’s also been shown to take the bad toxic stew that destroys arthritic joints and turn it around so that cells can move back to their normal state of pro-repair. This is very important, as few patients understand that these toxic chemicals that accumulate in their joints are as bad or worse as not having any cartilage, in that they further destroy the joint and lead to chronic swelling and pain. Curcumin also promotes mesenchymal stem cells to produce more cartilage.
      Steroid shots are not good. What they do is kill the local stem cells whose job it is to keep up with the daily repair of cartilage, meniscus, bones, etc. Without that repair going on things breakdown. Long-term steroid shots are obviously more problematic than one or to in a lifetime, though even one or two can cause Osteonecrosis, bone infection, tendon damage, etc.
      Age, weight, severity of arthritis don’t affect outcome. What does tend to cause less robust outcome is arthritis in many joints: http://www.regenexx.com/blog/regenexx-research-review/. That’s not to say we haven’t helped may people with arthritis in many joints, just that the results can be less robust.

  5. Tania Bourgoin

    Hi, I am in Victoria, BC Canada
    I have had rheumatoid disease since 2002. I received a few cortisone injections in my right wrist. Now both my ulna and radius bones are obliterated. The surgeon gave me the option of having either a wrist replacement or to have it fused. I have chosen to have it fused since there is not a great success rate for the replacement surgery. I do have pain in my left wrist aswell, not a lot of inflammation so I have never had it injected. Would I be a candidate for the REGENEXX procedure?

    1. Regenexx Team Post author

      Tania,
      We’ve successfully treated many RA patient’s joints. That said, establishing Candidacy in a particular case involves submitting the Candidate Form which results in a phone call with one of our Physicians. They read your MRI’s, take a medical history, etc, and based on their experience and our extensive registry data, rate your Candidacy as good, fair or poor. It’s great that you’ve avoided cortisone injections in that wrist, as they generally escalate the situation very quickly! Alternatively, that can be done at the time of the initial exam. http://www.regenexx.com/hand-basal-joint-cmc-arthritis-treatment/

  6. Steven Stratidis

    Hi,
    I am a 54 yo male that is currently taking antibiotics to kill a infection I have in my wrist that has dissolved most of the carpal wrist bones in my right wrist. My surgeon has said he cannot operate until the infection is gone and that the wrist will likely fuse itself. As the bones are now missing my hand is closer to the ulna and radius bones and making a fist or trying to grip something is very painful . The tendons that connect to my fingers seem to long to make a proper fist.
    If the wrist is fused will I loose the use of my hand and will the pain continue?
    What treatment would you reccomend.
    Regards,
    Steve Australia.

    1. Regenexx Team Post author

      Steve,

      You describe a very complicated situation for which we’d need to see MRI’s, get a full medical history etc. to offer an opinion. Clearing up the infection, however is crucial. Please submit the Candidate form if you’d like us to weigh in. This is another situation in which infection played an important role: http://www.regenexx.com/blog/knee-surgery-is-a-risk-even-with-the-best-surgeons/ Here is our Australia Regenexx Provider: http://www.nssm.com.au/

  7. Hassan Abdelnaby

    I had TFCC surgery and iam told based on my first MRI there was no tear. Now iam being told i have a full thickness tear, Would PRP help this?

    1. Regenexx Team

      Hi Hassan,
      The decision about what the appropriate treatment is in any individual situation is a crucial one. Please see: https://regenexx.com/blog/regenexx-flexible-lab-platform/ and https://regenexx.com/conditions-treated/hand-and-wrist/tfcc-tear/ and
      https://regenexx.com/blog/avoid-ulnar-shortening-surgery-whats-causing-pain-not-long-ulna-bone/ We’d need more information through the candidacy process. To do that, please submit the Candidate form here: http://www.regenexx.com or give us a call at 855 622 7838

  8. Tracy

    I sustained a wrist fracture @ the age of 19 when I was hit by a car. I seem to remember being told it was a chauffeurs fracture, but I may be wrong. Now @ age 54 my wrist is starting to swell between the base of my thumb and the head of the radius, range of motion is becoming severely limited, & some activities are just imposable due to pain. For instance, there are times when I need to start my car with my left hand because it is just too painful to do so with my “bad” wrist. I use hot wax treatments & capsaicin cream regularly & take NSAIDS when the pain is bad. Is it too late for me to try the injections you described above? How often are these injections needed, and what are side effects/long term effects?

    1. Regenexx Team

      Hi Tracy,
      We’d need more information through a Candidacy review to answer your questions about your specific case. To do that, please submit the Candidate form here: https://regenexx.com/conditions-treated/hand-and-wrist/

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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