Wrist Replacement for Arthritis

Wrist replacement for arthritis is an operation that removes the damaged wrist joint and puts in an artificial one. Its main goal is to ease pain while keeping some wrist movement. It is usually considered when arthritis continues to limit daily activities despite nonsurgical care. It is not suitable for everyone, and wrist fusion—which stops movement but can relieve pain—is another option.

What is wrist replacement for arthritis?

Wrist replacement, also called total wrist arthroplasty, is a surgical procedure in which the damaged surfaces of the wrist joint are replaced with artificial components. These components are usually made of metal and include a plastic spacer that allows the joint to move. The aim is to reduce arthritis-related pain, improve function, and preserve some of the wrist's natural movement.

The wrist contains several small bones, supported by ligaments, tendons, and other soft tissues. Arthritis can damage the smooth cartilage that normally allows joint surfaces to glide against one another. As the joint becomes damaged, movement may become painful or restricted, affecting activities such as dressing, cooking, typing, opening containers, and lifting everyday objects.

Wrist replacement is less common than hip or knee replacement. The wrist has a complex structure, and an artificial wrist must cope with the many movements involved in using the hand. The operation is therefore generally considered for selected people rather than offered routinely for every case of wrist arthritis.

When is wrist replacement recommended?

Wrist replacement may be considered when arthritis causes persistent pain, stiffness, or loss of function that interferes with daily life. It is usually discussed after appropriate nonsurgical treatments have not provided enough relief. The decision depends on the type and extent of joint damage, the person's overall health, the condition of the surrounding tissues, and how much movement they need to preserve.

According to the Cleveland Clinic's guidance on wrist replacement, treatment before surgery may include changes to activities, wrist splints, pain-relieving medicines, physical or occupational therapy, and corticosteroid injections. These approaches may ease symptoms and help maintain function, although they cannot reverse established cartilage damage.

Wrist arthritis can occur for different reasons. Osteoarthritis may develop after a wrist fracture or other injury, while rheumatoid arthritis and other inflammatory conditions can also damage the joint. Examples of symptoms that may affect daily activities include:

• Pain when bending the wrist, gripping objects, or lifting items.
• Stiffness or reduced ability to bend the wrist up and down.
• Swelling or tenderness around the joint.
• Reduced grip strength or difficulty turning a handle or opening a jar.
• Difficulty performing work, household tasks, hobbies, or personal-care activities.

These symptoms can occur with different wrist conditions. A healthcare professional considers the pattern of symptoms, medical history, physical examination, and imaging findings when deciding whether arthritis is responsible and which treatment is appropriate.

Who may benefit from wrist replacement?

Wrist replacement may be an option for someone with advanced arthritis who wants to reduce pain while retaining some wrist movement. It may be particularly worth discussing when movement is important for everyday activities, including tasks that require positioning the hand to reach, dress, eat, or care for oneself. However, preserving movement does not mean that the wrist will return to normal or regain all its previous strength.

A hand and wrist surgeon will assess the bones, joint stability, tendons, soft tissues, existing movement, and the demands placed on the hand. The surgeon will also consider medical conditions that could affect surgery or recovery. A 2025 review published in the Journal of Hand Surgery: European Volume describes wrist replacement as a technically demanding procedure and highlights the importance of appropriate patient selection and surgical expertise.

High physical demands can make wrist replacement less suitable. Repeated heavy lifting, forceful manual work, hammering, or regularly putting body weight through the operated hand may increase concern about the artificial joint loosening or failing. A patient information guide from University Hospitals Dorset NHS Foundation Trust explains these restrictions and why expected hand use should be considered before surgery.

There is no single factor that determines suitability. The surgeon will weigh the likely pain relief and movement benefits against implant durability, possible complications, and the activities that matter most to the individual.

How is wrist replacement different from wrist fusion?

Wrist replacement and wrist fusion are two surgical options for arthritis that has not responded adequately to other treatments. They have different goals, so the preferred procedure depends on the person's needs and the condition of the wrist.

Wrist replacement

During wrist replacement, damaged joint surfaces are removed and artificial components are inserted. The procedure aims to relieve pain while allowing some movement to remain. This can be useful when the ability to bend the wrist is an important part of everyday function. The implant can, however, loosen, wear out, or fail over time, and further surgery may become necessary.

Wrist fusion

Wrist fusion, also called wrist arthrodesis, involves joining the bones so that they heal as one solid structure. This permanently stops movement at the fused wrist joint, but it can provide substantial pain relief. Movement of the fingers, thumb, elbow, and shoulder remains, although tasks that require bending the wrist may be more difficult. Fusion may be considered when long-term stability or higher physical demands are important priorities.

Neither operation is automatically better for everyone. The Cleveland Clinic's comparison of wrist replacement and fusion explains the central trade-off: replacement preserves some wrist movement, while fusion removes movement at that joint. A surgeon can also discuss other procedures, such as partial wrist fusion or removal of selected wrist bones, when the pattern of arthritis makes these options appropriate.

How is the operation performed?

Before surgery, the surgeon reviews symptoms, previous treatments, medical history, medications, and the demands placed on the affected hand. The wrist is examined for movement, stability, and strength. X-rays help show the bones and the pattern of joint damage. Additional tests may be needed depending on the clinical assessment and the person's general health.

Wrist replacement is usually performed under general anaesthesia, sometimes with a nerve block to provide additional pain relief. The surgeon makes an incision, usually on the back of the wrist, and removes the damaged joint surfaces. Artificial components are then fitted to the bones on either side of the joint, with a spacer between them to allow movement. The surgeon checks the position and stability of the implant before closing the wound and protecting the wrist with a dressing, cast, or splint.

The exact technique, implant design, and need for additional procedures depend on the individual wrist. Some people may need treatment for associated tendon or soft-tissue problems at the same time. The operating team will explain the planned procedure and its specific risks before surgery.

What is recovery like after wrist replacement?

Recovery takes time because the operated wrist needs protection while the wound heals and the surrounding tissues recover. The wrist is commonly kept in a cast or splint for several weeks. Follow-up appointments allow the surgical team to check the wound, monitor progress, and decide when it is safe to begin or advance rehabilitation.

Hand therapy is an important part of recovery. A hand therapist may guide exercises to reduce stiffness, maintain movement in the fingers, manage swelling, and gradually improve the use of the hand. The timing and type of exercises depend on the operation and the surgeon's instructions. Moving too forcefully or loading the implant too soon may put the replacement at risk.

Light activities may become easier over the following weeks, but recovery can extend over several months. During the early period, everyday tasks such as dressing, preparing meals, washing, and carrying objects may require help or adjustments. Planning for assistance at home is particularly useful when the operated wrist is in the dominant hand.

Return to driving, work, exercise, and heavier tasks should be guided by the surgeon and hand therapist rather than a fixed date. Even after recovery, some activities may need to be modified to protect the artificial joint. Long-term restrictions on lifting and repetitive loading depend on the implant and the surgeon's recommendations.

What are the risks of wrist replacement?

Wrist replacement may reduce pain and improve function, but it is a complex procedure with risks both around the time of surgery and over the longer term. Possible complications include:

• Wound problems, bleeding, or infection.
• Stiffness, swelling, or pain that persists after surgery.
• Injury to nearby nerves, tendons, or blood vessels.
• A fracture in a bone near the implant.
• Dislocation or instability of the artificial joint.
• Loosening, wear, or failure of the implant.
• The need for further surgery to revise or remove the replacement, or to fuse the wrist.

A 2024 review in the Journal of Hand Surgery: European Volume found that later complications, including bone changes around the implant and loosening, remain important concerns with total wrist arthroplasty. Implant survival at 10 years was reported in the range of 70% to 80% in most publications reviewed, although results varied across studies and implant designs.

More recent evidence also highlights the need to discuss complications and the possibility of further surgery before making a decision. A 2026 systematic review available through the US National Library of Medicine's PubMed database analysed 2,503 wrists across 62 studies. It reported complications in 36.9% of wrists, revision surgery in 16.3%, and additional surgical interventions for complications in 18.4%. These study findings include a range of outcomes and do not predict what will happen to any one person.

How successful is wrist replacement for arthritis?

Many people experience less pain and better daily function after wrist replacement. Some gain useful movement that would not be possible after complete wrist fusion. However, the amount of movement, grip strength, and pain relief achieved varies. The purpose of surgery is to improve useful function and comfort, not necessarily to restore a completely normal wrist.

Long-term results depend on factors such as the type of implant, the condition of the bones and surrounding tissues, the activities performed after surgery, and whether complications occur. An artificial wrist may last for many years, but it cannot be expected to last indefinitely. Implant loosening or failure may require another operation, which can be more complex than the original replacement.

Before deciding, it is useful to discuss the expected benefits and limitations for the specific wrist, the surgeon's experience with the procedure, the restrictions on lifting and other activities, and what options would remain if the implant failed. A clear understanding of both the movement benefits and the possibility of future surgery can help people make an informed choice.

What should you ask your hand surgeon?

An appointment with an orthopaedic surgeon who has experience in hand and wrist surgery is an opportunity to compare options. Useful questions include whether the arthritis pattern is suitable for replacement, how much movement might realistically remain, and whether wrist fusion or another procedure may provide a better balance of pain relief and function.

It is also worth asking how long the wrist will need protection, which activities will be restricted, how hand therapy will be arranged, and when driving or work may be possible. People who use a walking aid, perform manual work, or rely heavily on the operated hand should discuss these needs before selecting a procedure.