There is evidence that total wrist replacement relieves pain, but this is based on small numbers of patients and there is insufficient evidence of its efficacy in the long term. The procedure is associated with a risk of the recognised complications of prosthetic joint replacement. Therefore, total wrist replacement should only be used with special arrangements for clinical governance, consent and audit or research.
Clinicians wishing to undertake total wrist replacement should take the following actions.
Inform the clinical governance leads in their Trusts.
Ensure that patients understand the possible alternatives to total wrist replacement and the uncertainty about its efficacy in the long term, such that further surgery may be required, including fusion of the wrist joint. They should provide them with clear written information. In addition, the use of NICE's information for the public is recommended.
Audit and review clinical outcomes of all patients having total wrist replacement (see section 3.1).
This procedure should be undertaken only on carefully selected patients, by surgeons with special expertise in interventions for the hand and wrist.
Further publication of safety and efficacy outcomes will be useful. NICE may review the procedure on publication of further evidence.