Total Wrist Arthroplasty with Integra Freedom® Implants: A Pilot Study with a New Evaluation System

Total wrist arthroplasty (TWA) is gaining interest as a management option for wrist arthritis. This review article summarizes the current evidence base for TWA, focusing on the performance and survivorship of fourth-generation implants. These appear to offer satisfactory patient-reported outcomes and survivorship over the medium term, but heterogeneity between implants and patient populations complicates data interpretation. We discuss issues facing TWA practice, including surgical competency, volume, implant development and stewardship. We acknowledge the need for further research on this topic and highlight a number of questions that need answering.

Section: Introductionsupporting

confidence: 52%

Total wrist arthroplasty: commentary and opinions

Smith,

Maling,

Williamson

2023

“…The search yielded 1858 results. After screening and full-text review, 12 studies met the inclusion criteria (Figure 1) (Badge et al, 2016;Boeckstyns et al, 2013;Brinkhorst et al, 2018;Ferreres et al, 2011;Harlingen et al, 2011;Holm-Glad et al, 2022;Holzbauer et al, 2022;Honecker et al, 2019;Matsui et al, 2020;Reigstad et al, 2012Reigstad et al, , 2017Rossello et al, 2022). Reigstad et al (2012Reigstad et al ( , 2017 presented their initial results in 2012, followed by a follow-up report in 2017; only data from the 2017 analysis were included in our analysis.…”

Section: Resultsmentioning

confidence: 99%

A systematic review and network meta-analysis of outcomes after total wrist arthroplasty in inflammatory and non-inflammatory arthritis

Chong,

Zabaglo,

Asif

et al. 2023

This systematic review analysed the available evidence on the clinical outcomes of total wrist arthroplasty (TWA) in patients with inflammatory and non-inflammatory arthritis. After screening, 12 studies met the inclusion criteria. They involved 359 patients with 378 TWA implants. The results showed that TWA significantly improved Disabilities of the Arm, Shoulder and Hand (DASH)/Quick-DASH scores and pain visual analogue scale scores in both arthritis groups compared with preoperative values. However, there was no statistically significant difference in the outcome scores between the two groups. Three studies reported Patient-Rated Wrist Evaluation (PRWE) scores, and TWA significantly improved PRWE scores in non-inflammatory arthritis but not in inflammatory arthritis, with no significant difference in postoperative outcome scores between the two groups. Although the included studies have limitations, the review suggests that TWA may be a successful treatment for wrist pain in individuals with either inflammatory or non-inflammatory arthritis. However, further high-quality trials are needed to confirm these findings.

“…In the systematic review by Zijlker et al ( 2021) there were no articles describing PROMs or survivorship of the Freedom V R prosthesis available for inclusion. Rosello et al ( 2022) subsequently published clinical outcomes in 12 patients undergoing Freedom V R TWA and demonstrated significant improvements in pain scores, wrist range of motion, and Mayo Wrist and PRWE scores (Rossello et al, 2022). Their mean follow-up was 48 months (range 24-72), and there were no reported complications and no revisions.…”

Section: Discussionmentioning

confidence: 99%

“…Rosello et al. (2022) subsequently published clinical outcomes in 12 patients undergoing Freedom® TWA and demonstrated significant improvements in pain scores, wrist range of motion, and Mayo Wrist and PRWE scores (Rossello et al., 2022). Their mean follow-up was 48 months (range 24–72), and there were no reported complications and no revisions.…”

Section: Discussionmentioning

confidence: 99%

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Total wrist arthroplasty with the Freedom® prosthesis: a short-term follow-up

Brown,

Wharton,

Begum

et al. 2023

We retrospectively reviewed our series of primary total wrist arthroplasty with the Freedom® prosthesis. The primary outcome measure was revision, and secondary measures included radiographic loosening, pain, complications, movement range, grip strength and patient-reported measures. We reviewed 12 implants in 11 patients (mean age 59 years, range 45–80) with a mean radiological and clinical follow-up of 2.7 and 3 years, respectively. One radial component failed to integrate and was revised at Day 84. Four carpal components demonstrated areas of lucency. There was a statistically significant reduction in pain, and total flexion–extension increased. Despite high patient satisfaction on a ten-point visual analogue scale score (mean 8.7 out of 10), the mean patient-rated wrist evaluation, Quick Disabilities of the Arm, Shoulder and Hand and Patient Evaluation Measure scores were 52, 55 and 53, respectively. The Freedom® implant reduced pain and preserved wrist movement in our patients; however, annual surveillance is recommended due to the high incidence of early carpal component lucency. Level of evidence: IV