Medium-term results of total wrist arthroplasty with ceramic implants

Abstract

Objective. Arthritis of the wrist joint can cause significant pain and decreased motion, resulting in a significant impact on quality of life. Total wrist Arthroplasty can provide pain relief and motion in these patients. Ceramic implants can be used in arthroplasty, but their longer-term performance in the wrist remains unknown. The purpose of the study was to review outcomes utilizing a ceramic total wrist arthroplasty.Material and Methods. А consistent ceramic arthroplasty technique and postoperative regimen was performed. The number of observations subjected to preoperative analysis at Novosibirsk Research Institute for Traumatology and Orthopedics is 63. The results of the study and the nature of the changes determine the indications for wrist arthroplasty. The average observation period was 8 years. Medium-term results were evaluated in 35 patients operated on between 2010 and 2017. The article evaluated three main time points: before the operational intervention, 2017 and 2019. Comparable results of objective and subjective evaluation of the intervention are indicated. X-ray methods and questionnaires were used to analyze the material: the Visual Analogue Pain Syndrome Scale (VAS), the Mayo Clinic Wrist Function Scale (MWS), and the Disability of the Arm, Shoulder and Hand (DASH). All patients underwent total wrist arthroplasty with ceramic endoprosthesis. In one patient, total arthroplasty of both wrists were performed, which corresponds to two clinical cases, in all other cases surgical treatment was carried out on one wrist joint.Results. At the preoperative stage, according to the DASH scale, the result was from 15.8 to 86.2 points, the median was 69.2 (56.2; 76.5) points. Performance characteristics and subjective sensations in the joint according to the MWS questionnaire ranged from 0 to 70, median 30 (15; 45) points. The assessment of the initial state of patients according to the Mayo clinic scale corresponded to very poor results of adaptation and functional activity. The value of the pain scale had indicators from 0 to 10 points, the median was 7 (5; 8) points.In 2017 (second time point), the mean VAS pain score decreased by 2.35 times (by 3.9 points, p < 0.0001), the mean DASH score decreased by 2.64 times (by 40.9 points, p < 0.0001), the average score of the MWS questionnaire increased 1.84 times (by 25.4 points, p < 0.0001). In 2019 (third time point), the average pain syndrome score on the VAS scale decreased by 2.19 times (by 3.7 points, p < 0.0001) compared to the first point; the average score on the DASH scale decreased by 2.25 times (by 36.6 points, p < 0.0001) compared to the first point; the mean score of the MWS questionnaire increased by 1.99 times (by 29.8 points, p < 0.0001) compared to the first point.Conclusions. 1. In the vast majority of cases, there is an increase in the volume of movements in the wrist joint compared to the original condition. 2. According to the results of a midterm study, stability and positive dynamics are noted. 3. Pain syndrome decreases or disappears completely. 4. Preservation of physiological mobility of bones of distal row of wrist contributes to redistribution of force action (damping) and stabilization of components in long period of time. 5. We divide the postoperative period for orthopedic pathology into the nearest (in the hospital), early (up to 2 years), medium-term (2-8 years) and long-term (more than 8 years).