gms | German Medical Science

Introduction: Total Wrist Arthroplasty(TWA) in painful panarthritis is to establish a stable, painfree wrist to cope with daily life. Even with newer designs the procedure's prognosis would remain uncertain. Numbers of implants in the US would not differ between 2008 and 2016. Progressively older patients preferably with rheumatoid arthritis are operated on. Aim of the study was the comparison of revision free post-OP time and total implant survival between the two entities.

Material and Method: Between 2002 and 2018 31 patients received UNI 2 total wrist arthroplasty KMI. 18 of these were included. 9 Cases in either group with rheumatoid or post traumatic arthritis. Rheumatoid patients: n=8 (1M, 7F - 1 operated on both wrists) age at surgery 65,5 years, with Carpus Simmen Stadium 1+2, 6 with long lasting Cortisol. In the Group of posttraumatic patients: n=9 (6M, 3F; mostly SLAC Wrist) age at index surgery was 64 years.

Results and Conclusions: In the rheumatoid patients group first revision n=5 (Changing of polyethylene (PE) alone or together with carpal plate) was done at an average of 47 months. Arthrodesis either as immediate and final solution or as secondary or even tertiary revision was undertaken after 85 months n=6. In the post traumatic group revision meant exclusively changing of the polyethylene layer after a period of 112 months. None of the bony implants was loose. In only one female patient with demand of walking aids arising after index surgery arthrodesis was done 36 months after implantation. 4 other implants stay symptomless with a follow up of 75,5 months. The difference is statistically significant.

Early results of TWA were encouraging. Midterm results in mixed indications showed 90% survival rate. An own FU showed 50% failure rate in rheumatoid patients after 5 years. Initial symptoms of PE wear are reported to be carpal tunnel syndrome due to synovitis and metallosis later on. In the literature recommendation is given for TWA in older patients and rheumatoids although TWA and arthrodesis will not differ markedly in quality of life. Our data let entertain grave doubts about TWA in rheumatoid arthritic patients. We now prefer arthrodesis over TWA in this group. Numbers of implantation in post traumatic wrists growing in adverse.