Total wrist arthroplasty: a systematic review of the evidence from the last 5 years

Abstract

We reviewed evidence on total wrist replacement from the last 5 years. Eight articles met a minimum set standard. The results of 405 prostheses were available, including seven different manufacturers. The mean follow up was 2.3-7.3 years with an average age of 52-63. Rheumatoid arthritis was the indication in 42% of patients. Motec demonstrated the best post-operative DASH scores. Only Maestro achieved a defined functional range of motion post-operatively. Universal 2 displayed the highest survival rates (100% at 3-5 years), while Elos had the lowest (57% at 5 years). Biaxial had the highest complication rates (68.7%), while Remotion had the lowest (11%). Wrist arthroplasty preserves some range of motion. Functional scores improved and were maintained over the mid- to long-term. Complication rates were higher than wrist fusion, with reports of radiological loosening and osteolysis. The evidence does not support the widespread use of arthroplasty over arthrodesis, and careful patient selection is essential.

What Are the Risk Factors and Complications Associated With Intraoperative and Postoperative Fractures in Total Wrist Arthroplasty?

“…TWA has been associated with a relatively high rate of complications, with high rates of distal component loosening and joint instability with various types of implants [1,4,6,7,[9][10][11][14][15][16]. Although some studies mention the possibility of fracture associated with TWA [1, 2, 5, 6, 11], to our knowledge, nothing has been reported specifically regarding fractures related to this procedure.…”

“…Particularly in patients with bilateral disease, patients with a TWA on one side and arthrodesis on the other preferred the side with the arthroplasty [13]. However, historically TWA has been associated with a high number of complications and concerns regarding survivorship [1,4,6,7,[9][10][11][14][15][16].…”

“…Complications associated with TWA include carpal component loosening and joint instability [1,4,6,7,[9][10][11][14][15][16]. However, there have been few reports regarding intraoperative or postoperative periprosthetic fractures [1,2,5,6,11], with no reports, to our knowledge, examining the risk of these occurring, the risk factors associated with them, the outcomes of different treatments, or their effect on postoperative outcomes after TWA.…”

Proximal‐distal shift of the center of rotation in a total wrist arthroplasty is more than twice of the healthy wrist

“…Total wrist arthroplasty (TWA) has a history as long as total knee and hip joint replacements 1 ; however, it has not demonstrated the same high survival rates 2‐4 . Although current TWA designs 5‐8 have improved over the past decade and have started to become a reliable option for some patients, 6 high complication rates are still a major issue 9‐11 . While the reasons for the complications following a TWA are debated, studies evaluating total joint replacements of the knee, shoulder, spine, and hip have shown that kinematic differences between the healthy and replaced joint motion can lead to implant and bone‐implant interface failures 12‐16 .…”

About systematic reviews

“…In the systematic review on total wrist arthroplasty (Yeoh and Tourret, 2015), the search was restricted to the last 5 years. In the context of wrist arthroplasty, this is rational: there is no need to include articles of mainly historical value, starting with Themistocles Glück in 1890 and proceeding with implants that are no longer in use, or only have a short follow-up period.…”