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

Abstract

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

Complications after total wrist arthroplasty

“…(2018), there were no cases of CRPS among the 651 TWAs. This is also reflected in more recent publications, where there is no mention of this complication (Gendera et al., 2020; Martinez Vilen and Rodriguez Nogue, 2021; Newton et al., 2023; Zijlker et al., 2019). However, in a multicentre study on Remotion implants, Herzberg et al.…”

Total wrist arthroplasty: commentary and opinions

“…It is important to question whether the evidence can be extrapolated across these different groups of patients. There are data to support the use of certain TWA implants in inflammatory arthropathy, including the Freedom TWA, which is the successor to the third-generation Universal 2 (Brown et al., 2023; Newton et al., 2023). Meanwhile, the Universal 2 performs less well in patients with osteoarthritis, with 10-year survival rates as low as 35% (Gendera et al., 2020).…”

“…It should be borne in mind that the Universal 2 implant (Integra Life Sciences, Plainsboro, NJ, USA), the Freedom’s predecessor, also had a high rate of lucency. The Universal 2 implant has 10-year survival rates in the region of 70%–80% at 10 years, with a deteriorating survival curve over time (Newton et al., 2023). In theory, the Freedom has an improved bearing surface comprising UHMWPE, which has been highly cross-linked on the carpal component, with improved geometry on the radial component.…”