Total wrist arthroplasty: Review and update

Abstract

Abstract The first articulated total wrist prosthesis in the United States was designed and implanted at the Arizona Health Sciences Center in 1974. Based on the original concepts of Charnley's total hip implant, the prosthesis was intended for cement fixation. However, early concern over the long-term durability of cement in the small bones of the wrist led to a natural reluctance of surgeons to use such an approach to treatment. Instead, most surgeons preferred to use a Silastic wrist spacer. Unfortunately, time has proven that use of such a device has led to two serious problems, ie, implant breakage and the production of erosive changes in adjacent bone caused by Silastic detritus and its resultant synovitis. Concerned that similar changes would arise from the use of cement, the author of this report has elected to press-fit the metacarpal component since 1978, continuing to cement only the radial component. His experience has been that gross lossening of the radial component with erosive changes to bone has been observed infrequently. Migration of the press-fitted metacarpal component has been observed especially in poorly balanced wrists and in patients with poor quality bone. More recently a newer modular design of a total wrist prosthesis, which is secured to both radial and metacarpal bone beds by a precision press-fit, has shown promise of pain-free function without the concerns of loosening or bone lysis. However, efforts in designing a more durable long-lasting wrist implant need to be continued because the preservation of a certain pain-free arc of motion is critical for many patients, especially in patients with advanced rheumatoid arthritis of the hand and wrist and in certain individuals whose occupation or vocation demands the preservation of wrist motion.