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Published on December 14, 2018

A novel option for chronic wrist pain

A novel option for chronic wrist pain
The wrist pain bothered Robert Romano for six years. First, he had to quit playing guitar. Eventually it hurt to do something as simple as combing his hair.

When the pain finally became unbearable, he discussed options with his doctor, which led to a meeting with Brian Najarian, MD, a Hyannis orthopedic surgeon who specializes in hand surgery. The introduction finally led to some relief.

In August, Romano became one of the first people in Massachusetts to undergo a partial wrist replacement using the new WristMotion® implant. The result: “I feel like a million bucks,” said Romano, 67, of South Yarmouth.

The procedure resurfaces the capitate, the largest bone in the wrist, with two pieces: a cap made of cobalt chromium and a taper post made of titanium alloy.

“It’s definitely one of the more novel things I’ve been able to incorporate into my practice over the years,” said Dr. Najarian of Cape Cod Orthopaedics and Sports Medicine. “It’s allowed me to offer an option to patients that wasn’t available before and gets better results.”

First in Massachusetts

Dr. Najarian was the first doctor in Massachusetts to perform the procedure, according to a representative from Arthrosurface, the maker of the WristMotion® implant. He has performed the surgery seven times since January.

The procedure is intended for middle-aged and elderly people with wrist arthritis, he said. It helps relieve pain for people with SLAC (scaphoid lunate advanced collapse), a form of arthritis that results from an old ligament injury or wrist sprain.

“From their X-rays and their histories, we can see they had a wrist sprain maybe 15 or 20 years earlier that was never treated,” said Dr. Najarian. “It changed the wear patterns of the cartilage in the wrist and they eventually developed wrist arthritis.”

The implant changes the shape of the bone to mimic the natural anatomy of the bone that was there, he added.

“You’re not replacing the whole bone. You’re resurfacing the arthritic end of it, so it integrates with the bone and becomes part of it.”

For many patients, the best previous option was fusion, which has “challenges and complications,” according to Dr. Najarian.

“When you try to fuse bones together, it involves putting hardware into the wrist and trying to get the bones to grow together. Often that requires taking bone graft from other parts of the body, and there are some morbidity or pain problems associated with doing that.

“With this implant, the range of motion results that I’m seeing are better than they were after fusions. People want to maintain wrist motion but get rid of their arthritic wrist pain,” he said.

Outpatient Surgery

It takes under an hour to perform the outpatient surgery. Patients wear a splint for several weeks and then begin physical therapy while wearing a brace. They typically show great progress within three months of the surgery and have continued, gradual improvement for up to a year, said Dr. Najarian.

This type of implant is new, so there’s no long-term data yet, but he said implants for other procedures last 15 to 20 years.

“I would assume that this would last at least that long or longer possibly,” he said.

For Romano, who works as an oil burner technician, the surgery on his right hand has been life-changing.

“It got to the point where I couldn’t use my hand anymore,” he said. “The pain from the arthritis was just unbelievable. It would just shoot all the way up my arm.

“I played horseshoes five weeks after the surgery and played my guitar, which I couldn’t play in years, after six weeks. There’s no pain, so I think it worked out pretty good.”