Total Wrist Arthroplasty Using the Universal 2 Prosthesis

Abstract

purpose. To report outcomes of 21 total wrist arthroplasties (TWA) using the Universal 2 prosthesis. Methods. Five men and 14 women aged 44 to 82 (mean, 62) years underwent 21 total wrist arthroplasties for rheumatoid arthritis (n=19) and post-traumatic arthritis (n=2) by a single surgeon using the Universal 2 prosthesis. Pre-and post-operative pain and function were assessed by a single surgeon using the Disabilities of the Arm, Shoulder and Hand (DASH) score and the patient-rated wrist evaluation (PRWE) score. Range of motion, stability, dislocation rate, and neurovascular status were also assessed. Radiographs were evaluated for implant alignment and fit, screw positioning, and implant loosening. results. The mean time to assessment of the range of motion was 3.1 (range, 1.8-3.9) years, and the mean time to assessment of the PRWE score was 4.8 (range, 2.1-7.3) years. The range of motion in each direction and the mean DASH and PRWE scores improved significantly following TWA. Two patients Total wrist arthroplasty using the Universal 2 prosthesis 2012;20(3):365-8 had restricted range of motion, which was treated by manipulation under anaesthetic (after 6 months in one and 8 weeks in the other). One patient underwent excision of a palmar bony bridge. One patient endured extensor pollicis longus rupture and underwent tendon transfer after 5 months. Radiographs revealed no evidence of implant loosening, migration, or malalignment. There was no sign of osteonecrosis in the remaining carpals or metacarpals. conclusion. The Universal 2 TWA achieved significant improvement in range of motion and functional outcome of the wrist, with reduced rates of early joint instability, dislocation, and implant loosening, compared to previous implants. The small implant size and cementless design reduce bone loss and osteonecrosis. Journal of Orthopaedic Surgery

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.…”

“…Using the patient-rated wrist evaluation (PRWE) questionnaire, one study reported improvement in the mean pain scores from 43.0 to 18.2 (p<0.001), 12 and another reported just a mean postoperative score of 11 (standard deviation, 10). 13 One study used the pain component of the Hospital for Special Surgery system and reported a mean postoperative score of 0.4 out of 10.…”

“…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.…”

“…11 In 2 studies using the shortened version with 11-items, 22,23 only one reported an improvement from 58 to 42 (p<0.001). 23 Two studies used the PRWE questionnaire, 12,13 but only one reported improvement of function score from 38.4 to 17.6 (p<0.001) and total score from 81.4 to 35.8 (p<0.001). 12 Two studies reported improvements in the Mueli system score.…”

“…23 Two studies used the PRWE questionnaire, 12,13 but only one reported improvement of function score from 38.4 to 17.6 (p<0.001) and total score from 81.4 to 35.8 (p<0.001). 12 Two studies reported improvements in the Mueli system score. 8,19 One study reported improvements in the Hospital for Special Surgery score and Wrightington activities of daily living score.…”