Wrist & Hand

How reliable is wrist arthroplasty?

We are familiar with the excellent and durable results for many designs of hip and knee replacement, yet the metal-on-metal saga reminds us that implant surgery can be at best unreliable, if not catastrophic. When even elbow and ankle replacements are starting to get their share of good long-term follow-up series, it does beg the question: why does wrist arthroplasty not have such a good pedigree? The orthopaedic literature is riddled with fairly encouraging small series of short-term results, however, some designs have been withdrawn. With a niche operation with currently limited indications and little evidence to support its outcomes, it is tricky to formulate an opinion on the likely success of such a procedure – particularly so when many reports are written by early adopters or designing surgeons, which introduces a certain bias into the proceedings. A group from Thomas Jefferson University Hospital, Philadelphia (USA) is to be applauded for their candour in reporting the rather miserable results from their large series of 105 total and partial wrist replacements.² With a mean follow-up of just 35 +/- 28 months, the surgical team reported 51% of patients suffered a complication and 39% required a revision procedure. Stiffness and component failure were the most common reasons. Hand surgeons would be wise to make their patients aware that wrist arthroplasty, although an appealing concept, remains experimental.