Aetna considers total wrist arthroplasty medically necessary for rheumatoid arthritis affecting the wrist in persons who have radiographic evidence of wrist joint destruction with demonstrated resistance or failure to conservative medical treatment (3 or more months of nonsteroidal antiinflammatory drugs (NSAIDS), disease modifying antirheumatic drugs (DMARDs), and/or glucocorticoids, as appropriate). Total wrist arthroplasty is considered experimental and investigational for diagnoses other than rheumatoid arthritis because there is inadequate evidence in the peer-reviewed published clinical literature regarding its effectiveness.

Total wrist arthroplasty involves the implantation of a prosthetic joint, with the goals of reducing pain and preserving or increasing wrist mobility. The procedure is almost always performed to relieve the symptoms of severe arthritis. These components come in extra-small, small, medium, and large sizes to match patient anatomy. To enable movement and prevent dislocation, the polyethylene spacer has a convex end that slides on the surface of a concave plate on the radial component. 

Several wrist implants have been developed since the early 1970s. First-generation were silicone implants, such as those designed by Swanson in the 1980s. Second-generation implants typically included two metal components that articulated by means of a ball-and-socket or a hemispheric design. Many of these early implants were taken off the market because of problems with joint imbalance and dislocation. The third generation of wrist prostheses were developed in an effort to better approximate the center of motion to prevent imbalance and dislocation. Examples include the revised Meuli design (MWP III), as well as the Trispherical, the Universal, and the Biaxial designs, the latter of which has been discontinued.