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Living with Psoriatic Arthritis (PsA)

Wrist replacement surgery

I’m faced with the prospect of wrist surgery to replace the joints in my right wrist, and just wondered if anyone else has had this kind of surgery, did it work, is it worth it etc.

I use my hands a lot - I’m an artist, crafter, writer, blogger, cook (with all that chopping, peeling, stirring etc) and I’m being restricted at the moment as I’m right handed and that’s my worst area for pain and immobility.

The prospect of being out of action for many weeks while the surgery heals is daunting, but if it’s worth it afterwards I guess it’s something I should go ahead with.

Any comments, advice etc?

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no advice–just sympathy. i had elbow surgery years ago and was stunned by how little I could accomplish with my elbow immobilized (and it was my left elbow and I’m right handed!). Thinking about whether it’s worth it is super smart but i guess you don’t really know the answer to that until it’s all said and done

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I think you are wise to make many inquiries and get all the advice you can before such an extensive surgery. Can I ask, is it confirmed that the PsA is the cause of the wrist deterioration?

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I have just had left shoulder replaced. Had my right one done 6yrs ago. Totally worth it! My husband had actually started being my sous chef! I’ve had both knees done also, both at same time.

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I am a little uncertain exactly what is going to happen in your surgery under consideration. Your description of replacing the bones of your wrist is what confuses me. In 2000, I had surgery on my left wrist to fuse the bones which were touching one another resulting in lots of pain. My orthopedic doc recommended that I choose this action to eliminate my wrist pain. He said that there was so much arthritis inside the wrist joint that it was the only way to eliminate the pain. He said I should have at least 75 % use of my wrist remaining without pain as I used it. For my surgery, a steel plate was attached at the base of my fingers and runs to just about equal to the outer wrist bone. The small bones which make up the wrist ( 8 if I remember correctly) were then anchored to the plate preventing movement of the bones which could cause pain. The surgery was successful, and the pain was controlled. I still have about 75% use of the wrist. I have some limitations, but overall it was a good choice for me. Just remember this is a permanent surgery. Hope this helps you make your decision. Good luck!

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The new wrist replacement surgery is amazing. It’s tough to come by in the US and is hampered by a lack of data to be a generalized procedure. The bulk of the work has been done in Australia. For reasons I still don’t understand. Treatment Data from Australia can’t be used in the USA (Its okay from India China etc but NOT Australia. Seenie and I listened to a lengthy presentation on the sharing of Data this week at the orphan disease conference though it was well presented, it was still as clear as mud. Had coffee with the FDA Guru and HE couldn’t explain it either. Something about privacy and integrity etc.

In regard to the wrist replacement, however, there are a few caveats to consider. Like all new joint replacements historically as they come to market, the life of the prosthesis is only about 10 years MUCH less if you try to use the joint “normally” Replacement of the replacement is a crapshoot, so really the only advantage at this point is pain management (granted it that’s a really big deal)

To me the issue is really how old one is and what 10 year window you want to choose for a functional wrist. In all likelihood what @schoonerbird schoonerbird experienced may be for many of us a better option. (the main difference in the two is the prosthetic plate articulates as opposed to being fixed. But as was stated it is a permanent surgery so limits future options. I would certainly have several opinions a bunch of discussion (mostly with my self) keeping in mind TIMING is everything.One certainly doesn’t want the best joints in the nursing home when to be blunt Quality of life (to me) when you are younger makes more sense… (although more independence when you are older has a lot of appeal too. There is a similar procedure in development for feet BTW so all you foot folks have something to look forward to…

Image result for wrist replacement surgery

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Yes it’s definitely bone erosion from PsA. X-rays have confirmed it. It’s my right wrist and that’s where the PsA started originally with massively high levels of inflammation.

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I’m a very active 68 year old, although slowing down now. I’ve done quite a bit of research into total wrist replacement as opposed to wrist fusion - both can manage pain, but I need flexibility and movement - I’m an artist and this is my dominant hand we’re talking about. I’m also a writer (often by hand) and use a keyboard a lot too. I’m a healthy eating blogger and cook a great deal, needing my hands for preparing and cooking food, chopping, whisking etc. So you could say I’m a heavy user when it comes to my hands. This is what I need to discuss with the surgeon when my appointment comes through. My Consultant Rheumatologist favours replacement rather than fusion for this reason. He’s all for preserving my movement.

The diagrams you show are what I’ve been shown. Quite a procedure with a long recovery period. Luckily my orthopaedic surgeon is an expert in hand surgery and my local hospital is one of the best in the world for pioneering procedures.

But yes, a lot to consider before heading into any kind of surgery.

10 years lifespan of prosthetics I can live with, at 78-80 I’m hoping my life will be gentler and I won’t need to use my hands so aggressively :joy:

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By the way, I’m in the UK not US

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Thank you. If you see my reply to @tntlamb it’s total replacement that’s being considered rather than fusion as you had. There have been great strides done in the UK with this type of surgery and there’s a 98% success rate for total wrist replacement. Lots to consider though.

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I wish you the very best. Hope it is a total success for you.

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Katie, that IS a big decision to make…there are always so many what ifs??? But, if you can’t fulfill your passions of drawing, crafts, writing, etc., if you don’t have the surgery, then what have you got to lose? Still a tough decision, no matter what!

@tntlamb, wow, I love the news about the foot procedure. Maybe there’s hope for us foot folks!

A what if for me is, will I have to stop my biologic temporarily for surgery?—what if I have to deal with PsA pain rebounding?—what if when I restart the biologic it doesn’t work anymore? Ugh, so many of those darn what ifs!!!

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@Grandma_J, you expressed a concern about stopping the biologic for surgery. I’ve had to stop for a number of reasons, including surgery. It hasn’t been an issue for me with Enbrel no longer working.

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@Stoney that’s good to hear…did you end up with PsA pain during the time you missed your injections? How many weeks did you have to stop Enbrel?

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With one surgery I did have a flare. But considering the number of times I’ve had to take a break that’s not bad. Other than that flare, no significant increase. In the last year alone I think I’ve been off Enbrel twice. Once for shoulder surgery, and once because of a bad cat bite.

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