gms | German Medical Science

Objectives/Interrogation: To report the long-term follow-up outcomes of 43 total wrist arthroplasty (TWA) in rheumatoid and post traumatic wrists.

Methods: From 2003 to 2018 8 men and 35 women, aged 32 to 74 (mean 62) years underwent 43 total wrist arthroplasties for rheumatoid arthritis (n=29) and post-traumatic arthritis (n=14) using the Universal 2 wrist prosthesis in 24 Patients, Integra Freedom Wrist System in 6 Patients, ReMotion in 11 Patients and Emi-Prosthesis in 2 cases. The mean follow-up was a mean follow-up was 82.3 months (range: 2-12 years). Pre and post-operative Visual Analogue Scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (DASH) score and the Patient-Rated Wrist Evaluation (PRWE) score were performed. The Authors also evaluated: Range of motion, neurovascular and tendon status, stability, dislocation rate. The X-Ray views was performed to evaluated implant and screws alignment and fit and loosening.

Results and Conclusions: All patients had good or complete pain relief, the mean visual analogue scale pain score was 1,0 (pre-op 9,0). The mean grip strength improved and postoperatively was 11kg (Jamar). The mean total active motion (AROM) of flexion-extension was 73.4°; radial-ulnar deviation 25.7°. The mean QuickDASH score was 32 and PRWE was 40,3. Revision surgical procedures were performed in 7 cases (18,6%): 6 carpal components were revised (polyethylene inserts wear and/or carpal ulnar screw loosening secondary to intra-operative malalignment) and 1 radial component, in 4 cases total implant failed, Swanson's silicone spacer was applied (n=3) or wrist joint fusion (n=1).

Long term results in TWA suggest a pain relief and improves function both in rheumatoid and post traumatic arthritis. Nowadays the wrist arthroplasty can be considered as a predictable functional option to managing wrist joint arthritis in selected cases and patients.