Hi Lynn
Welcome to the forum. A great place to be for support and information; lots of folk, lots of knowledge and a wealth of tried and tested experiences! Glad you have found us and NRAS!
I'm Lyn, married to Mike, we have four children (well I call them children but perhaps it's time to stop!), Abby 23, Ian and Jake 17, and Louis 16. All four in various stages of education! We live in Thornton Cleveleys in north west Lancashire. I was diagnosed with RA 23 years ago and have since run the gamut of medication and had lots of surgical procedures along the way. Currently on Enbrel, Leflunomide, Big Dose of Prednisolone and Naproxen, and a wagon load of pain killers! Struggling at the moment after knee surgery last summer, a major flare in Cyprus of all places, two lots of knee aspirations and joint injections in 7 weeks, a depo injection that didn't work and basically RA that has not been controlled for the last 12 months! But heyho... no-one said life with RA would be easy
Like you Lynn, I too have extensive joint damage mainly down to years of poor disease control at the outset. Back then there just weren't the wonderful drugs that are now available. I have had extensive surgery to both feet to remove the metatarsal heads, couple of knee ops and countless aspirations and joint injections, surgery on my left hand to fuse the thumb joint, a total wrist replacement on my right hand, both lenses replaced due to steroid damage and a few other bits and bats along the way! Currently awaiting a call from orthopaedics about knee replacement. Great fun to be dropping to bits slowly but surely!
I had a lot of problems with my wrist and eventually went ahead with total replacement in May 2003 after much deliberation. My consultant considered three possible options;
1. Fusion, but as I'm right handed and he felt the left wrist would need surgery at some point he decided against this due to lack of functionality. The idea being if the right wrist is replaced the left one could be fused.
2. Partial replacement, some of the bones of the carpus are removed and a fibrous joint is created. Good at relieving pain but patients may take a long time to recover following surgery and have a very weak grip and poor function. He also decided against this because should it become necessary to do further surgery on the wrist, which would be inevitable, bone grafts may be needed when the 'partial' prosthesis is removed. This procedure seems quite uncommon these days.
3.Total replacement, provides better functionality, a longer lasting prosthesis, and improved outlook for further surgery when the replacement needs replacing. Shelf life 10-15 years!
Different materials are used for different joints and many of the more modern combinations are superior to those used in the first hip and knee replacements. Usually for wrists it seems to be a metal stem and polyethylene spacer/liner. I'm not sure whether Titanium is ever used in hand/wrist surgery as it is not a weight bearing joint and doesn't require anything like the same strength but it does need an element of flexibility.
I found after surgery I managed, not well, but I managed. It's up to you really and how well you can get by using your other hand! It's a case of adapting really and the first six weeks or so it will be in a cast so much like having a broken wrist. After that the physio starts and that's when it gets hard building up the weakened muscles and re-learning things like rotation! Enbrel has to be stopped for at least two weeks before surgery and cannot be restarted until the wound has healed adequately. The recommendation is two weeks after surgery providing there is no evidence of infection and the wound has healed. This does mean the cast has to come off and some surgeons are not best pleased and will suggest that you do not restart meds until the cast is removed after 6 weeks. It's a difficult call and each surgeon has there own opinion on this. After 4 weeks the Enbrel will start to lose its efficacy and after 6 weeks it's like starting all over again (happened to me last summer!).
Perhaps this all sounds rather negative, it isn't meant to, but there is a lot to consider. Our hands are important and they need to be right. Often that requires major corrective surgery to ensure a satisfactory long term outcome. It took me the best part of 12 months to get over the wrist replacement and regain function. But it has been good and pain free. What more can I ask?
Sorry this is such a lot to take in ... didn't want to miss anything! Hope you will be able to make a decision that is right for you.
Lyn x
