01 March 2017
More than a million Britons have sought treatment for osteoarthritis in the wrist.
Clive Moore, 58, a transport planning manager from Shoeburyness, Essex, had a new device implanted in each wrist, as he tells Roger Dobson.
For years I suffered from niggling pains in my right wrist, but I wasn’t too worried as they would come and go. The real problems started after I was in a car crash in 2012. I collided with another car but my airbag failed to inflate. I was gripping the steering wheel very hard at the time and the impact really jolted my wrists. My right wrist became very painful. Movement in any direction, especially rotation, was agony.
So a few weeks later, still in pain and with my wrist swollen, I used my private health insurance to see orthopaedic surgeon Greg Packer.
An X-ray revealed I had not only fractured my wrist but there was damage due to wear and tear: bone was rubbing on bone, causing pain. I was told that the conventional treatment was to fuse the bones in the wrist together so the ends don’t rub. But while this deals with the pain, it leaves you with little movement in the joint. I’ve always been a keen motorcyclist and I wanted to go biking and be active with my son William, now 18, so a fusion was not ideal.
Mr Packer then told me about a new implant which would replace my joint and give me a greater movement than fusion. I had the op a few weeks later, in November 2012.
The procedure took about one-and-a-half hours under general anaesthetic. When I woke up, there was a large dressing on my wrist. The joint was swollen and stiff but I could move it. I started physiotherapy once a week and did exercises every day. After six weeks I could confidently hold a cup of tea, and today I have almost full rotation and no pain.
In the past few years my left wrist has begun to deteriorate and become painful so a month ago I had the same procedure on that one. I’ve been told I’m only the tenth person worldwide to have this implant in both wrists. It is still swollen but I can now open a jar, wash my motorbike and do gardening and DIY.
Greg Packer is a consultant orthopaedic surgeon at the Spire Wellesley Hospital and Southend University Hospital.
The wrist is very complex, as it is made up of lots of small bones and a series of joints. It is formed where the two bones of the forearm — the radius (the larger bone on the thumb side of the arm) and the ulna (on the little finger side) — meet the eight small bones (the carpal bones) in the wrist. Normal joints are lined with cartilage and lubricated with a little bit of fluid that is continually renewed. But wear and tear can cause the lining of the joint to thin, leading to bone rubbing on bone, which can be painful.
Until recently, patients who developed arthritis of the wrist were faced with having the bones fused together or having a total wrist replacement. In a replacement, the bones in the hand are permanently bonded with a metal plate to the inner bone of the forearm. While this helps pain, a wrist replacement — like fusion — vastly restricts movement.
Recently, however, we started offering a new implant, called Motec. Developed in Sweden, it is designed to give patients a stable, mobile, pain-free wrist and a wide range of movement.
It’s basically a ball-and-socket joint to replace the original one, and is coated with a biologically active material that encourages the surface of the metal implant and the wrist bones to bond.
This is to ensure that the implant is held firmly in place. The ball-and-socket joint has two ‘arms’ radiating out on opposite sides. The longer one goes up into the hand, the other down into the forearm.
These arms ensure that the ball-and-socket joint remains in the right spot. Each of them also has a thread to ensure a secure connection with bone. There are several sizes available — we use scans to select the right one.
In the procedure, an incision 8cm to 10cm long is made in the wrist. This exposes some of the eight carpal bones. Three of these — those nearest the forearm — are removed. We then drill holes into the capitate, the largest carpal bone, at the base of the palm, and the metacarpal, the long bone of the little finger. Another hole is drilled into the radius — the larger of the two long bones of the forearm.
A guide wire is used to find the way down the centre of the bones. A screw is inserted into each of these holes and they are connected together by the ball-and-socket device. Once everything is in place, the incision is closed with stitches.
Patients stay in hospital for one or two nights and need to rest the joint for about a week while it heals. They should be able to return to normal activities, including driving, after a fortnight. The wrist stays in plaster for about ten days.
Source: By Roger Dobson for the Daily Mail.Published: 3 January 2017