2 The condition, current treatments and procedure
2.2 Treatments include analgesics, non-steroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs and corticosteroid injections. If these do not work well enough, surgical treatments can be used. These include proximal row carpectomy, limited or partial carpal fusion, total wrist arthrodesis or total wrist arthroplasty.
2.3 The procedure is done using general or regional anaesthesia, with a tourniquet applied to the upper arm. A radiographic template is created preoperatively to determine the implant size. An incision is made over the wrist, in line with the third metacarpal. The joint is exposed, and the first row of carpal bones and the radial articular cartilage are removed. A trial implant is put into position, the carpus is reduced onto the bearing surface and the implant size, range of motion and stability are assessed. The final implant is then put in place and fully seated on the contoured subchondral plate.
2.4 Strengthening exercises are started 4 to 6 weeks after surgery and full activity can start several weeks after that. The aim is to relieve pain while keeping the midcarpal articulation and the anatomic centre of wrist rotation.