gms | German Medical Science

Objectives/Interrogation: The purpose of our study is to determine clinical and functional outcomes and analyze radiological evolution of total wrist arthroplasty (TWA) in patients with rheumatoid wrists, with a minimal follow up of 4 years.

Methods: We performed a retrospective study and included patients diagnosed with a rheumatoid wrist, submitted to TWA in our institution. Pain was assessed using visual analogic scale for pain (0-10). Active ROM and pinch and grip strength were obtained. Radiological assessment was performed at immediate postoperative period and at 1, 2 and 4 years to analyze alignment, osteolysis, loosening and heterotopic ossification. We also registered complications.

Results and Conclusions: 22 patients, with an average age of 56 years, were submitted to TWA with the same implant. No patient was submitted to revision surgery nor conversion to joint fusion. We had a superficial wound dehiscence that resolved without further procedures but evolved to a relevant stifness. Most of the patients experienced complete or very significant symptomatic relief (VAS - 1,14). ROM was 38º of extension, 36º of flexion, 7º of radial deviation, 15º of ulnar deviation, and 83º of pronation/supination arch. Grip and pinch strength was, at 4 years, 9,7 Kg and 4,1 Kg, respectively.

Radiological assessment demonstrated heterotopic ossifications in 5 patients. Peri implant osteolysis was found to be frequent, next to radial dome in 8 patients and adjacent to carpal component in 8 patients as well, remaining stable over the years. We did not find unequivocal sings of loosening.

Clinical and functional outcomes, with 4 years of follow-up, are extremely satisfactory. The procedure did not imply an increased risk of complications. It is important to recognize that heterotopic ossifications are frequent but they do not have correlation with clinical outcomes. Peri implant osteolysis is common but its significance remains unclarified and is not synonym of loosening.

Although represents a procedure with a notable learning curve, TWA is an excellent solution for rheumatoid wrists, allowing good clinical and functional results in the medium term.