Wrist & Hand

Wrist arthroplasty in rheumatoid arthritis

Wrist arthroplasties are a bit of a mixed bag. Although clearly indicated in some patients, the reliable and long-term results of wrist fusion have served as the main reason why wrist arthroplasties are still very much a niche operation. There are few sufficiently large series of patients from which to calculate any reliable estimates of survival and complication rates from wrist arthroplasty. Consequently, we were delighted to see this study of 95 Universal-2 total wrist arthroplasties (TWA) reported with both survival and complications at around five years of follow-up.

The authors from Wigan (UK) report a series of 95 Universal-2 TWAs, of whom eight either died or were lost to follow-up.⁹ The authors therefore report 85 TWAs in 75 patients. Outcomes were assessed with VAS, DASH and range of motion assessments in addition to the Wrightington Wrist Score. The authors also took radiographs at regular intervals in the first year and then annually to monitor for failure or loosening. Total wrist arthroplasty had a marked effect on reported pain scores, improving from 8.1 pre-operatively to 5.4 post-operatively. During the follow-up period there was a 7% major complication rate, with failures equally split between revision arthroplasty and fusion. With revision surgery as an endpoint, the authors were able to report a survival of 91% at 7.8 years (95% CI 84 to 91). While TWA is far from the mature technology offered by almost any other joint arthroplasty, the clinical and survivorship results presented in this study do seem to suggest that, all things being equal, rheumatoid patients will do well with a wrist replacement.