Systematic Review of Total Wrist Arthroplasty and Arthrodesis in Wrist Arthritis

Abstract

Background End-stage wrist arthritis has traditionally been treated with a total wrist fusion. There is a recent trend toward motion preserving surgery in the form of total wrist replacement. Questions Is there a functional benefit to performing a total wrist replacement instead of a total wrist fusion in patients with end-stage wrist arthritis? Is there any difference in secondary outcome measures including pain, grip strength, and range of motion? Does the risk of adverse events and treatment failure differ between the two techniques? Methods A systematic literature search was performed to identify studies reporting either total wrist arthrodesis or arthroplasty for end-stage wrist arthritis. Studies were systematically screened and assessed for risk of bias and quality. Data were extracted and reviewed. Results A total of 43 studies were included in the review: 17 on arthrodesis, 24 on arthroplasty, and 2 matched cohort studies. This represented 669 index arthrodesis operations in 603 patients, and 1,371 index arthroplasty operations in 1,295 patients. A significant improvement in functional outcome was seen with both interventions. Similar improvements were seen in pain scores, and modest improvements were seen in grip strength. Range of motion following arthroplasty improved to a functional level in two studies. Complication rates were higher after arthroplasty (range: 0.2–9.5%) than those after arthrodesis (range: 0.1–6.1%; p = 0.06). Fourth-generation implants (range 0.1–2.9%) performed better than earlier designs (range: 0.2–8.1%; p = 0.002). Implant revision rates ranged from 3.5 to 52.6%. Fourth-generation prostheses survival rates were 78% at 15 years (Universal 2), 86% at 10 years (Motec), 90% at 9 years (Re-Motion), and 95% at 8 years (Maestro). Conclusion The newer fourth-generation wrist implants appear to be performing better than earlier designs. Both wrist arthrodesis and wrist arthroplasty improve function, pain, and grip strength. The risk of complication following wrist replacements is higher than that after total wrist arthrodesis.

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

“…(2018) showed complication incidences ranging from 0.1% to 2.9%. The discrepancy between our findings and those of Berber et al. (2018) is that their review considered arthroplasties for all aetiologies, including osteoarthritis, whereas isolating rheumatoid patients in this study produces a higher complication incidence, as the natural pathogenesis of rheumatism precludes definitive disease curation with arthroplasty.…”

“…The inclusion of newer 4th-generation prostheses in this review likely had an impact, as complications with this generation were lower than previous generations (11%). A recent systematic review of wrist arthroplasty by Berber et al. (2018) showed complication incidences ranging from 0.1% to 2.9%.…”

“…Since a systematic review published by Cavaliere and Chung (2008) , techniques have improved for wrist arthroplasty as demonstrated by a more recent review from Berber et al. (2018) .…”

Case Report of Customized Distal Radius Prosthesis Replacement: An Alternative Treatment for Post-traumatic Unreconstructable Intraarticular Distal Radius Malunion

“…The principle of arthroplasty is that it preserves the functional range of motion along with joint stability. One systematic review showed that TWA is associated with a 25% incidence of major complications [13]. Carpal component loosening has been reported as the major cause of revision [14].…”

Outcomes of Revision Total Wrist Arthroplasty

“…Despite the effectiveness of total wrist arthroplasty (TWA) in relieving pain and preserving motion, it has suffered from high rates of complications including instability and implant loosening. 1 2 3 4 5 6 7 8 9 10 11 In some instances, a revision or salvage procedure is necessary, with most reported revision rates falling in the range of 0% to approximately 20%, 2 , 5 6 7 8 9 , 12 although rates as high as 50% to 60% 4 , 10 after TWA have been reported.…”