Active Population Drives Arthroscopic Wrist Reconstruction

Market for Wrist Surgery Up; Hand and upper limb orthopedic surgeon Dr. Alejandro Badia Offers Prevention Tips

March 12, 2020 – Musculoskeletal joints do not age well, particularly in the wrist, a highly complex joint susceptible to injury, wear-and-tear and disease. “Wrist injury occurs in active people as well as those with arthritis and osteoporosis and is helping drive demand for procedures that can maintain motion and restore function to the hand and wrist,” states Dr. Badia, a specialist in treating disorders of the upper limb.

That’s why the field of orthopedics is currently replete with studies of new techniques in wrist surgery, wrist partial arthrodesis (joint fusion), ligament transfer, and wrist cartilage repair, and why companies are vying to develop improved full or partial prosthetic replacement systems for severely damaged wrist joints, says Dr. Badia

But he emphasizes that advancements in arthroscopy are what have made this therapeutic approach, by far, the gold standard for wrist reconstruction when surgery is required.

“Arthroscopy is minimally invasive and results in less pain and quicker recovery time for the patient,” says Dr. Badia, who is founder and chief medical officer of Florida-based Badia Hand to Shoulder Center and OrthoNOW®. The procedure is performed by inserting surgical instruments and a small magnifying camera through tiny cuts in the wrist.

Dr. Badia adds that arthroscopy is also a highly effective diagnostic procedure, allowing the surgeon to pinpoint a wrist problem when a patient fails to respond to more conservative treatments for resolving debilitating joint pain or when the wrist is so badly damaged that surgery is the only option.  “Arthroscopy is especially useful in diagnosing intercarpal ligament tears and tears of the wrist’s triangular fibrocartilage complex, a ring of cartilage similar to the meniscus of the knee,” he says

“Too often, primary care or urgent care physicians order MRI images of a patient’s painful wrist.  MRIs are expensive and not nearly as accurate as arthroscopy in diagnosing a joint problem,” he says.

The wrist is composed of a complex of eight irregularly shaped “carpal” bones, joined by ligaments, with cartilage at the ends of bones providing the “oil” that allows them to glide around each other. “The wrist is an engineering marvel whose motion is critical to the ability of the hand and fingers to grab, grasp, and pick up objects,” Dr. Badia says.

The term “wrist reconstruction” applies to everything from simple repairs of structures in the joint, including the wrist’s small bones and ligaments affected by disease or injured in falls, sports, work injuries (read also: Preventing Injuries at Your Worksite) or other trauma, to much more complicated, technical procedures that can involve joint replacement, bone grafts, and transfer of tissue from other parts of the body to reconstruct torn or ruptured wrist ligaments.

Osteoporosis is responsible for some 8.9 million fractures worldwide

In addition to osteoporosis and various forms of arthritis, like osteoarthritis or rheumatoid arthritis, which wear away joint cartilage, disorders impacting the wrist include fractures and soft tissue injuries often caused by trauma (typically falls, industrial or motor vehicle accidents). Other disorders of the wrist include the common carpal tunnel syndrome, Kienbock’s disease (avascular necrosis where a bone essentially dies) and late manifestations of prior remote wrist injury.

A global market report from Mordor Intelligence for 2020-2025 indicates that “increasing prevalence of rheumatoid and osteoarthritis” due to aging will result in a compound annual market growth rate of 3.5 percent in total wrist-joint replacement.

That figure is supported by numbers from the International Osteoporosis Foundation, indicating osteoporosis is responsible for some 8.9 million fractures worldwide, according to the Mordor report.  Distal radius fractures (Colles fractures) is one of the most common fractures affecting osteoporotic adults and typically requires insertion of a metal plate/screws in order to restore anatomy and function. Children often break the distal radius (wrist) in playground or sports injuries, but the vast majority can be treated with simple casting.

Other key statistics show 1.5 million adults in the United States are living with rheumatoid arthritis, which leads to problems in hand and wrist joints in up to 70 percent of cases, and another three million have been diagnosed with gout, a form of arthritis. Report authors foresee a 47 percent increase in total wrist replacement procedures in the U.S. between now and 2025 as technology improves.

Arthroscopic surgery

Dr. Badia says long-term evidence from ongoing clinical studies and continuing advancements in prosthetic devices may prompt more physicians to undertake partial fusion or total joint replacement procedures in order to maintain or restore near-normal movement to a severely damaged wrist joint.  But he quickly adds that, in most instances, arthroscopic surgery remains a much more effective – and commonly performed – procedure.

“Arthrodesis is a process in which small bones of the wrist are fused to the forearm in order to stabilize the joint and eliminate pain by preventing motion among the wrist’s worn bones.  Although effective, it may not necessarily be the optimal solution for patients who want to return to a more active lifestyle,” Dr. Badia states.

Meanwhile, to protect hand and wrist joints, Dr. Badia offers this advice, especially for seniors struggling with joints already compromised by osteoporosis, inflammation of arthritis and tendonitis, or chronic pain due to years of wear and tear:

• First and foremost, if wrist pain persists or is disabling, the patient MUST seek care with a hand surgeon since primary care or emergency medicine physicians do not focus on joints, and wrist arthroscopy may be the only way to make an accurate diagnosis.
• Use wrist guards when engaging in particular sports.
• Keep active; talk to an orthopedic specialist about recommended exercises for forearm strengthening which will help protect the wrist and hand, such as using a gripper, and the Xtensor device, as well as doing wrist circles and “windshield-wiper” movements.
• Take breaks in-between tasks. Get off the computer keyboard every 15-20 minutes and stretch fingers, wrists and arms.
• Avoid putting too much stress on joints. Use a jar-lid opener, for example, rather than fingers and wrists to open a tightly closed lid. Whenever possible, push open heavy doors or move other large objects out of the way with the arm and shoulder rather than with hands and wrists.
• Maintain body weight and body mass index appropriate to height.

By Alejandro Badia, M.D, F.A.C.S.

Orthopedic Hand Surgeon

Upper Extremity Specialist of Hand, Thumb, Wrist, Elbow & Shoulder
Badia Hand to Shoulder Center
Founder, OrthoNOW Orthopedic Immediate Care Center
Doral, Florida