Total Wrist Replacement: A Retrospective Comparative Study

Abstract

Total wrist arthroplasty (TWA) can provide the motion, strength, and the stability needed to perform activities of daily living. 1-3 Clinical series reporting on total wrist arthroplasty, however, have been limited. Problems related to implant loosening and instability have limited the clinical application of TWA. [3][4][5][6][7] Wrist arthroplasty provides the potential of improving hand strength secondary to maximizing resting muscle tension as well as better positioning the hand for functional use in daily activities. Total wrist arthroplasty has traditionally required large bone resection from the carpus and distal radius, and the results have been fraught with difficulties including proximal and distal component prosthetic loosening and instability 4-11 New designs for TWA that are lower profile and more anatomic and utilize minimal bone resection and a resurfacing arthroplasty concept are now available. Comparative studies of older-generation AbstractPurpose Total wrist arthroplasty (TWA) is an evolving procedure for the treatment of arthritis of the wrist joint. The purpose of this study is to compare outcomes of three different total wrist implants. Methods A retrospective review of the Biaxial, Universal 2, and Re-Motion total wrist arthroplasties was performed. Patients were evaluated for clinical outcome, radiographic analysis, review of complications (incidence and type), and conversion to wrist fusion. Patient function measures included: the Mayo wrist score, the Patient Related Wrist Evaluation, and Disabilities of Arm, Shoulder, and Hand (DASH) score. Results Forty-six wrist implants were performed in 39 patients. There were 36 rheumatoid and 10 posttraumatic cases. The average follow-up was 6 years (3.5 to 15). The total wrist inserted included 16 resectional arthroplasties (Biaxial) and 30 resurfacing designs (Universal 2 and Re-Motion). Nine implant failures were noted. Causes for arthroplasty failure included distal component implant loosening and wrist instability. Salvage procedures included revision TWA or wrist fusion. In successful cases, flexion and extension motion averaged 30 and 38 degrees, respectively, and grip strength improved by 3 kg. Mayo wrist scores, in successful cases, increased from 40 (preoperative) to 76 (postoperative). The Mayo wrist scores for posttraumatic conditions averaged 87 points versus 71 points for rheumatoid arthritis. The average DASH score for the two resurfacing designs were 20 and 37, and 48 for the resectional arthroplasty design. Discussion Total wrist replacement maintains itself and provides good pain relief and functional motion in over 80% of all cases and in 97% of resurfacing implants. Better results were correlated with improved distal component fixation and minimal resection of the distal radius. Level of Evidence Level 3 Case Control

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.…”

“…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. These fractures have the potential to compromise implant fixation, joint stability, wrist motion, and implant survivorship.…”

Folk Medicine in the Therapeutics of Rheumatoid Arthritis

“…Its affects is approximately 1% of the world population, and the prevalence is three times more in men than in woman [1][2][3][4]. However, the incidence of rheumatoid arthritis increases with ageing, and at this age differences between genders became equal.…”