A systematic review of outcomes of wrist arthrodesis and wrist arthroplasty in patients with rheumatoid arthritis

Zhu, Xi; Perera, Edward; Gohal, Chetan; Dennis, Brittany B.; Khan, Moin; Alolabi, Bashar

doi:10.1177/1753193420953683

Cited by 18 publications

(17 citation statements)

References 48 publications

(104 reference statements)

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“…The results showed higher rates of major complication and lower rates of patient satisfaction following arthroplasty compared with arthrodesis. These findings were concordant with the review by Zhu et al 4 who reported higher rates of complication in TWF compared with TWA in rheumatoid arthritis (RA) patients.…”

supporting

confidence: 92%

A Dual Center Experience with a Locking Intramedullary Nail for Wrist Fusion

Heifner,

Rowland,

Gomez

et al. 2023

J Wrist Surg

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Background In aggregate, there is varied efficacy for total wrist fusion (TWF) with a locking intramedullary (IM) nail which indicates the need for further investigation. It remains unclear whether preparation of the third carpometacarpal joint (CMCJ) will reduce the risk of complications including distal screw loosening. Purpose Our objectives were (a) to report clinical outcomes for wrist arthrodesis using a locking IM nail and (b) to determine whether maintenance of the native third CMCJ articulation would contribute to short-term complications. Patients and Methods A chart review from 2010 to 2022 was performed at two institutions for cases of TWF fixed with the IMPLATE locking nail (Skeletal Dynamics, Miami, FL). Clinical and radiographic outcomes were collected. Results Radiographic union was achieved in 93.8% of cases, including one case of delayed union. The mean patient-rated wrist evaluation score was 30.4, the mean visual analog scale score for pain at rest was 1.7, and the mean visual analog scale score during activities of daily living was 3.2. There were seven cases of distal screw loosening (21.8%), and three cases of revision surgery (9.4%) which included two implant removals. A long radial nail was used in 24 (75%) of cases and a short metacarpal nail was used in 3 (9%) cases. Conclusion The current series demonstrated satisfactory function with low rates of revision surgery following IM nail TWF without inclusion of the third CMCJ into the fusion mass. Cases with distal screw loosening had variable clinical presentation and our current practice is to offer outpatient screw removal for cases which reach the threshold for intervention. Level of Evidence IV retrospective series.

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supporting

confidence: 92%

A Dual Center Experience with a Locking Intramedullary Nail for Wrist Fusion

Heifner,

Rowland,

Gomez

et al. 2023

J Wrist Surg

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“…The rate of 12% of revision in our study remained lower than some rates reported for TWF and TWA. [31][32][33] Herzberg et al 34 reported, in his series of TWA using ReMotion 6% of revision.…”

Section: Discussionmentioning

confidence: 99%

Medium-Term Outcomes for Amandys Implant: A 5-Year Minimum Follow-Up of 63 Cases

et al. 2021

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Background Amandys is a pyrocarbon interposition implant used as a therapeutic alternative to total wrist fusion (TWF) or total wrist arthroplasty (TWA) in painful and disabling extensive destruction of the wrist. Objective To review mid-term outcomes in a continuous prospective series of patients who underwent wrist arthroplasty Amandys with a minimum follow-up of 5 years. Methods Clinical evaluation included a satisfaction survey, pain, two functional scores, the short version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and the Patient-Rated Wrist Evaluation (PRWE), active wrist mobility, and grip strength compared with the contralateral side. Radiological evaluation was used to detect implant subsidence, carpal migration, bone lysis, or implant malposition. All per- and postoperative complications were collected. Results Fifty-nine patients (63 procedures) were evaluated with a mean follow-up of 7 years; 57% of the patients were males, and the mean age was 58 years. Among the patients, 90% were satisfied or very satisfied. Pain was significantly improved, with a gain of 4/10 (p < 0.001). Functional outcomes also improved between the second and fifth year of follow-up. Active mobility was preserved and grip strength was significantly improved by 7 kg (p < 0.001). No implant subsidence or carpal migration was observed. Ten patients (11.9%) underwent revision surgery for conflict (1%), rotation (6%), or implant dislocation (5%). All complications and revisions occurred early with no new events after 1 year of follow-up. Discussion Mid-term clinical and radiological outcomes were stable with improvement of functional scores. The survival rate was comparable to that reported for TWF with conserved mobility. We report fewer complications compared with those reported for TWA or TWF. Early instability of the implant was the main etiology of the revisions. Repositioning of the implant was successful. No conversion to TWA or TWF was necessary. Conclusions Mid-term outcomes of the Amandys implants were encouraging. Patients conserved good wrist motion with improved strength and functional scores. The implant was well tolerated. Functional outcomes continue to improve with the follow-up. The survival rate remains stable after 2 years. The level of evidence of this study is IV (therapeutic case series).

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“…Compared with arthrodesis, arthroplasty carries the risk of longer-term loosening and failure, with the potential need for further procedures. Interest in arthroplasty persists due to the potential increase in function, and evidence supports both operations (Zhu et al., 2021). The question of which option is ‘better’ remains a point of debate, and it is likely to vary depending on the patient’s disease pattern and expectations.…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes of the Universal 2 total wrist replacement: revision and loosening at 10 years and beyond

Newton

Kandemir

Joyce

et al. 2023

J Hand Surg Eur Vol

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The aim of this study was to ascertain the long-term revision rates of the Universal 2 wrist prosthesis in a previously published cohort of patients with rheumatoid arthritis. The time to, and reasons for revision were determined. Radiographs were analysed to determine whether loosening had occurred in the long-term according to the Wrightington zonal classification of loosening. Seventy-eight wrists from the original cohort of 85 wrists could be identified for analysis. The longest follow-up was 16 years and 29 wrists had follow-up beyond 10 years. Seventeen wrists had been revised or were on the waiting list for revision, an overall revision rate of 22%. The 10-year survivorship was 78%. Long-term revision was commonly for periprosthetic loosening with pain and component subsidence. In those with more than 10-year follow-up, significant lucency was seen in 16 carpal components and 15 radial components. Explant analysis showed significant polyethylene wear and we postulate this is the principal reason for component loosening. Level of evidence: IV

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A systematic review of outcomes of wrist arthrodesis and wrist arthroplasty in patients with rheumatoid arthritis

Cited by 18 publications

References 48 publications

A Dual Center Experience with a Locking Intramedullary Nail for Wrist Fusion

A Dual Center Experience with a Locking Intramedullary Nail for Wrist Fusion

Medium-Term Outcomes for Amandys Implant: A 5-Year Minimum Follow-Up of 63 Cases

Long-term outcomes of the Universal 2 total wrist replacement: revision and loosening at 10 years and beyond

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