Total wrist arthroplasty in patients with rheumatoid arthritis

Titanium uptake, induction of RANK‐L expression, and enhanced proliferation of human T‐lymphocytes

“…10 Over 10% of patients suffer from the condition within 20 years of a primary hip arthroplasty, with the incidence continuing to increase. 17 Aseptic loosening is suggested to result from inflammatory and hypersensitivity responses to metals, which lead to increased osteolytic activity at the bone-implant interface and ultimately loss of fixation.…”

“…Activation of T-lymphocytes in peri-implant tissues can occur in the context of autoimmune diseases such as rheumatoid arthritis and infections. 10 Additionally, there is evidence that titanium itself may become antigenic and induce activation of specific T-lymphocytes. 33 In the presence of titanium ions that are released from an orthopedic implant, activated T-lymphocytes may be a major source of RANK-L, responsible for enhanced osteoclast activation, and resulting in aseptic loosening.…”

“…9 Pure titanium and titanium alloys are commonly used biomaterials in trauma and orthopedic surgery (wrist and acetabular prosthesis of a total hip arthroplasty). 10 Titanium provides the benefits of low water solubility at physiological pH, low inherent toxicity, and low reactivity with biomolecules in an aqueous environment. 11 Despite these relatively inert qualities, titanium has been shown to be released in its most stable Ti(IV) oxidation state at micromolar concentrations into the tissues surrounding metal implants by various mechanisms including wear, corrosion, and biological activity.…”

Review Article: Total Wrist Arthroplasty

“…14 of the studies reported pain relief, 6,[8][9][10][11][12][13]15,17,[19][20][21][22][23] but only 8 used validated scales, and the rest used ordinal scales, severity, and/or frequency to measure pain. Using the visual analogue scale (VAS) for pain, 2 studies reported improvement in the mean score from 8 to 2 (p<0.05) 9 and from 67 to 27 (p<0.001), 23 but one study reported no significant improvement.…”

“…extension, flexion, ulnar deviation, radial deviation, pronation, and supination) and grip strength, based on several wrist scoring systems. 6,[8][9][10][11][12][13][14][15][16][17][19][20][21][22][23] Eight studies used the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire or its shortened version. 9,12,[14][15][16][17]22,23 The DASH questionnaire consists of 30 items related to activities of daily living and symptoms.…”