Total Wrist Replacement: A Retrospective Comparative Study

Abstract

Purpose 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

Keywords

arthroplasty - rheumatoid - total wrist - joint

• References

• 1 Swanson AB. Flexible implant arthroplasty for arthritic disabilities of the radiocarpal joint. A silicone rubber intramedullary stemmed flexible hinge implant for the wrist joint. Orthop Clin North Am 1973; Apr; 4 (2) 383-394
• 2 Adams BD. Total wrist arthroplasty. Orthopedics 2004; 27 (3) 278-284
• 3 Meuli HC. Arthroplasty of the wrist. Clin Orthop Relat Res 1980; 149 (149) 118-125
• 4 Meuli HC, Fernandez DL. Uncemented total wrist arthroplasty. J Hand Surg Am 1995; 20 (1) 115-122
• 5 Volz RG. Total wrist arthroplasty: a new approach to wrist disability. Clin Orthop Relat Res 1977; 128 (128) 180-189
• 6 Figgie III HE, Ranawat CS, Inglis AE, Straub LR, Mow C. Preliminary results of total wrist arthroplasty in rheumatoid arthritis using the Trispherical total wrist arthroplasty. J Arthroplasty 1988; 3 (1) 9-15
• 7 Cooney III WP, Beckenbaugh RD, Linscheid RL. Total wrist arthroplasty. Problems with implant failures. Clin Orthop Relat Res 1984; 187 (187) 121-128
• 8 Vogelin E, Nagy L. Fate of failed Meuli total wrist arthroplasty. J Hand Surg [Br] 2003; 28 (1) 61-68
• 9 Alnot JY. Guepar's total arthroplasty of the wrist in rheumatoid polyarthritis. [in French]. Acta Orthop Belg 1988; 54 (2) 178-184
• 10 Rahimtoola ZO, Hubach P. Total modular wrist prosthesis: a new design. Scand J Plast Reconstr Surg Hand Surg 2004; 38 (3) 160-165
• 11 Rahimtoola ZO, Rozing PM. Preliminary results of total wrist arthroplasty using the RWS Prosthesis. J Hand Surg [Br] 2003; 28 (1) 54-60
• 12 Adams BD. Total Wrist Arthroplasty. J Am Soc Surg Hand 2001; 1: 236-249
• 13 Cooney WP, Bussey R, Dobyns JH, Linscheid RL. Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clin Orthop Relat Res 1987; (214) 136-147
• 14 Rettig ME, Beckenbaugh RD. Revision total wrist arthroplasty. J Hand Surg Am 1993; 18 (5) 798-804
• 15 Cobb TK, Beckenbaugh RD. Biaxial total-wrist arthroplasty. J Hand Surg Am 1996; Nov 21 (6) 1011-1021
• 16 Takwale VJ, Nuttall D, Trail IA, Stanley JK. Biaxial total wrist replacement in patients with rheumatoid arthritis. Clinical review, survivorship and radiological analysis. J Bone Joint Surg Br 2002; 84 (5) 692-699
• 17 Hudak PL, Amadio PC, Bombardier C. The Upper Extremity Collaborative Group (UECG). Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. Am J Ind Med 1996; 29 (6) 602-608
• 18 MacDermid JC, Stratford P. Applying evidence on outcome measures to hand therapy practice. J Hand Ther 2004; 17 (2) 165-173
• 19 MacDermid JC, Turgeon T, Richards RS, Beadle M, Roth JH. Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma 1998; 12 (8) 577-586
• 20 Hodgson SP, Stanley JK, Muirhead A. The Wrightington classification of rheumatoid wrist x-rays: a guide to surgical management. J Hand Surg [Br] 1989; 14 (4) 451-455
• 21 Lorei MP, Figgie MP, Ranawat CS, Inglis AE. Failed total wrist arthroplasty. Analysis of failures and results of operative management. Clin Orthop Relat Res 1997; 342 (342) 84-93
• 22 Bosco III JA, Bynum DK, Bowers WH. Long-term outcome of Volz total wrist arthroplasties. J Arthroplasty 1994; 9 (1) 25-31
• 23 Beckanbaugh RD. Arthroplasty of the wrist. In: Morrey BF, et al, eds. Joint Replacement Arthroplasty. New York: Churchill-Livingstone; 1993: 143-187
• 24 Rizzo M, Beckenbaugh RD. Results of biaxial total wrist arthroplasty with a modified (long) metacarpal stem. J Hand Surg Am 2003; 28 (4) 577-584
• 25 Menon J. Universal Total Wrist Implant: experience with a carpal component fixed with three screws. J Arthroplasty 1998; 13 (5) 515-523
• 26 Divelbiss BJ, Sollerman C, Adams BD. Early results of the Universal total wrist arthroplasty in rheumatoid arthritis. J Hand Surg Am 2002; 27 (2) 195-204
• 27 van Winterswijk PJ, Bakx PA. Promising clinical results of the universal total wrist prosthesis in rheumatoid arthritis. Open Orthop J 2010; 4: 67-70
• 28 Ryu JY, Cooney III WP, Askew LJ, An KN, Chao EY. Functional ranges of motion of the wrist joint. J Hand Surg Am 1991; 16 (3) 409-419