The last time I saw the hand surgeon, she said wrist replacements were improving but she still couldn’t recommend one for me in good conscience. Faced with the alternative of a wrist fusion for severe rheumatoid arthritis, shouldn’t this be my decision to make?

Of course, each patient must come to terms with the best way to treat their orthopedic problems. But on the flip side, the surgeon must educate the patients and provide the most realistic picture possible. A successful fusion is far better than a failed surgery to replace the joint.

Some information we gathered from recent studies might help put this into perspective for you. Surgeons are still reporting a pretty high complication and failure rate. In a study from the University of Iowa, the failure rate was 50 per cent. And those were early failures — not after the patient had the wrist implant for years and years.

You might think that was just one place but reviewing other similar studies, we found the same type of results. The biggest problem appears to be loosening of the implant on the hand side (as opposed to the component part on the forearm side).

The second most common problem was something called subsidence — the implant literally sinks down into the bone. Most of the patients who have complications or failures end up having another surgery. The surgeon either removes and replaces the implant or removes the implant and fuses the joint.

You may wonder what about the other half who had good results? Well, they gained enough motion to regain considerable function. And it didn’t take that much increased motion to be considered a success. Even a few degrees of wrist motion can position the fingers in such a way to allow patients to complete many previously impossible tasks.

The problem is surgeons don’t know yet how to predict who will have good results and who will be a failure from the outset. Those kind of predictive factors may be determined eventually — but we don’t have that information yet.