Abstract
The Swanson silicone prosthesis was one of the first devices to realize total wrist arthroplasty (TWA). It has been used regularly since the early 1960s. This systematic review of the literature evaluated the status quos of TWA. The present study was conducted according to the PRISMA guidelines. A literature search was made in Medline, PubMed, Google Scholar, and the Cochrane Library databases. The focus of the present study was on implant survivorship and related functional outcomes. Data from 2286 TWA (53 studies) were collected. Fifteen studies were included for the analysis of implant survivorship. Fifteen studies were included for the analysis of pain. Twenty-eight studies were included for the analysis of the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Grip strength was tracked in 16 studies. The range of motion (RoM) was evaluated in 46 studies. For supination and pronation, 18 articles were available. Despite some methodological heterogeneities, TWA may be effective and safe in pain reduction and improving function and motion. There is still a range for a future improvement of the procedure.
Highlights
Total wrist arthroplasty (TWA) is still a controversial issue but it has become a challenge to total- and sometimes partial-wrist arthrodesis (TWAD/PWAD)
TWA has been shown to be effective in improving quality of life in patients with wrist rheumatoid and osteoarthritis (RA/OA) [4–7]
That the results of TWA in terms of prosthesis survival have generally been poor compared to most other prostheses [26], the purpose of this study was to elongate the knowledge about TWA, doing a systematical review about the available evidence and to compare clinical and surgical outcomes among patients undergoing a TWA
Summary
Total wrist arthroplasty (TWA) is still a controversial issue but it has become a challenge to total- and sometimes partial-wrist arthrodesis (TWAD/PWAD). TWA has not found widespread acceptance, and most surgeons prefer to recommend a TWAD to their patients [1]. For patients who present with advanced joint degeneration and painful wrist, TWA and TWAD/PWAD are appropriate options for reconstruction [2,3]. TWA has been shown to be effective in improving quality of life in patients with wrist rheumatoid and osteoarthritis (RA/OA) [4–7]. In this case, conservative means have not provided adequate pain relief, and other motion-preserving procedures are impossible, hopeless, or have failed [3]. Patients eligible for TWA should report chronic pain (RA/OA, or posttraumatic arthritis), low-activity lifestyle, and the desire to preserve wrist motion and have adequate bone stock and good quality of the soft tissue [7,8]. TWA has been considered an option only for certain individuals with specific needs and desires for motion who clearly understand the risks and benefits (Adams, 2001)
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