Total wrist arthroplasty with the Freedom® prosthesis: a short-term follow-up

Conversion of Total Wrist Arthrodesis to a Total Wrist Arthroplasty: Twelve Patients Followed for 7 (2-16) Years

PURPOSE

Total wrist arthroplasty has become a viable alternative to arthrodesis. Wrist arthrodesis is not necessarily the final surgery for many of the patients because some patients never accept the residual pain and reduced function that accompanies a stiff wrist. The purpose of this study was to evaluate the clinical performance (pain, function, and satisfaction) of rearticulation, as well as the complications and reoperations of the procedure in a prospective unselected case series of patients.

METHODS

Twelve (7 men) patients with a mean age of 53 (42-67) years were converted to a total wrist arthroplasty at a mean of 8 (3-17) years after wrist arthrodesis. The patients had undergone 53 wrist surgeries prior to rearticulation.

RESULTS

One wrist with a periprosthetic fracture of the ulna and a loose distal radioulnar joint arthroplasty that had been removed during the conversion was finally fused a second time. At follow-up 7 (2-16) years after conversion, increased wrist active range of motion (0°-98°), supination (75°-85°), reduced Patient-Rated Wrist Evaluation score (56-30), and reduced visual analog scale pain scores were found. All arthroplasties were radiologically stable, well-fixed and osseointegrated. None regretted the surgery knowing the outcome.

CONCLUSIONS

Conversion from total wrist arthrodesis to a modern wrist arthroplasty is feasible, yielding good functional results, significant pain relief, and stable implants.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Periprosthetic radiolucency in total wrist arthroplasty: a radiographic study

This retrospective study investigates the incidences of periprosthetic radiolucency and the position of the prosthesis in patients who underwent total wrist arthroplasty. A total of 50 patients with a mean age of 58 years (SD 11) were included. The available dorsopalmar and lateral radiographs were categorized into the following groups: immediately postoperative and 1, 2, 3, 5 and beyond 6 years postoperatively. The findings of this study indicate that periprosthetic radiolucency is a progressive phenomenon that originates at the bone adjacent to the joint line, possibly due to stress shielding. The size of the periprosthetic radiolucency showed no correlation with any clinical parameter, nor can its size be predicted by intraoperative implant positioning. However, a significant correlation was observed between a reduced implant-middle finger carpometacarpal distance and higher postoperative pain levels as well as patient dissatisfaction. Revision surgery after total wrist arthroplasty should not be solely guided by radiological signs of periprosthetic radiolucency. Instead, this study suggests that consideration for revision surgery should be reserved for symptomatic patients experiencing persistent pain and swelling accompanied by radiographic evidence of carpal implant subsidence.Level of evidence: IV.

Total wrist arthroplasty: commentary and opinions

Total wrist arthroplasty (TWA) is gaining interest as a management option for wrist arthritis. This review article summarizes the current evidence base for TWA, focusing on the performance and survivorship of fourth-generation implants. These appear to offer satisfactory patient-reported outcomes and survivorship over the medium term, but heterogeneity between implants and patient populations complicates data interpretation. We discuss issues facing TWA practice, including surgical competency, volume, implant development and stewardship. We acknowledge the need for further research on this topic and highlight a number of questions that need answering.