Systematic Review of Total Wrist Arthroplasty and Arthrodesis in Wrist Arthritis

Background End-stage wrist arthritis has traditionally been treated with a total wrist fusion. There is a recent trend toward motion preserving surgery in the form of total wrist replacement. Questions Is there a functional benefit to performing a total wrist replacement instead of a total wrist fusion in patients with end-stage wrist arthritis? Is there any difference in secondary outcome measures including pain, grip strength, and range of motion? Does the risk of adverse events and treatment failure differ between the two techniques? Methods A systematic literature search was performed to identify studies reporting either total wrist arthrodesis or arthroplasty for end-stage wrist arthritis. Studies were systematically screened and assessed for risk of bias and quality. Data were extracted and reviewed. Results A total of 43 studies were included in the review: 17 on arthrodesis, 24 on arthroplasty, and 2 matched cohort studies. This represented 669 index arthrodesis operations in 603 patients, and 1,371 index arthroplasty operations in 1,295 patients. A significant improvement in functional outcome was seen with both interventions. Similar improvements were seen in pain scores, and modest improvements were seen in grip strength. Range of motion following arthroplasty improved to a functional level in two studies. Complication rates were higher after arthroplasty (range: 0.2–9.5%) than those after arthrodesis (range: 0.1–6.1%; p = 0.06). Fourth-generation implants (range 0.1–2.9%) performed better than earlier designs (range: 0.2–8.1%; p = 0.002). Implant revision rates ranged from 3.5 to 52.6%. Fourth-generation prostheses survival rates were 78% at 15 years (Universal 2), 86% at 10 years (Motec), 90% at 9 years (Re-Motion), and 95% at 8 years (Maestro). Conclusion The newer fourth-generation wrist implants appear to be performing better than earlier designs. Both wrist arthrodesis and wrist arthroplasty improve function, pain, and grip strength. The risk of complication following wrist replacements is higher than that after total wrist arthrodesis.

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Ulna Autograft for Wrist Arthrodesis: A Novel Approach in Failed Wrist Arthoplasty

The Open Orthopaedics Journal ◽

10.2174/1874325001711010768 ◽

2017 ◽

Vol 11 (1) ◽

pp. 768-776 ◽

Cited By ~ 1

Author(s):

Nastaran Sargazi ◽

M. Philpott ◽

A. Malik ◽

M. Waseem

Keyword(s):

Multidisciplinary Approach ◽

Surgical Intervention ◽

Salvage Surgery ◽

Wrist Arthrodesis ◽

Novel Approach ◽

Total Wrist Arthroplasty ◽

Stage Disease ◽

Wrist Function ◽

End Stage ◽

Wrist Arthroplasty

Rheumatoid arthritis is a polyarthropathy affecting approximately 1% of the population worldwide. Wrist involvement is observed around 75% of patients, resulting in substantial disability and morbidity. A multidisciplinary approach to management of such patients is undertaken to prevent disease progression, many go on to develop debilitating disease requiring surgical intervention. Total wrist arthroplasty and arthrodesis are the main options available for those with end-stage disease, with arthroplasty preferred due to its ability to preserve a good degree of wrist function. Where complications occur with total wrist arthroplasty, salvage surgery with arthrodesis can be considered, however this requires satisfactory bone stock to enable stable fusion of the joint following arthroplasty. We report our experience of Ulna strut allografts in wrist arthrodesis in the management of failed total wrist arthroplasty.

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Assessment of Wrist Function After Simulated Total Wrist Arthrodesis

Hand ◽

10.1177/1558944715626930 ◽

2016 ◽

Vol 11 (4) ◽

pp. 464-468 ◽

Cited By ~ 1

Author(s):

Richard M. Hinds ◽

Eitan Melamed ◽

April O’Connell ◽

Francoise Cherry ◽

Monica Seu ◽

...

Keyword(s):

Grip Strength ◽

Functional Limitation ◽

Test Duration ◽

Fusion Model ◽

Optimal Position ◽

Wrist Arthrodesis ◽

Ulnar Deviation ◽

Radial Deviation ◽

Wrist Fusion ◽

Wrist Function

Background: There is poor consensus in the literature regarding associated functional limitation and the preferred wrist position for total wrist arthrodesis. The purpose of the current investigation was twofold: (1) to assess the functional limitations of wrist arthrodesis and (2) to determine the optimal position for wrist arthrodesis using a simulated wrist fusion model. Methods: Twenty healthy volunteers underwent simulated wrist arthrodesis in 6 different positions using custom-molded wrist splints: 15° extension with 0° radio-ulnar deviation, 15° extension with 10° ulnar deviation, 15° extension with 10° radial deviation, 0° extension with 0° radio-ulnar deviation, 0° extension with 10° ulnar deviation, and 0° extension with 10° radial deviation. Each volunteer was independently assessed for wrist function using the Jebsen-Taylor hand function test, grip strength, and satisfaction in the simulated wrist fusion positions. Comparisons between all simulated fusion wrists and the baseline unsplinted wrist as well as among the 6 simulated fusion positions were performed. Results: Turning over a card (5.1 vs 4.3 seconds), picking up small objects (7.1 vs 5.8 seconds), and simulated feeding (8.3 vs 7.1 seconds) as well as total Jebsen-Taylor test duration (41.8 vs 37.9 seconds) was significantly longer in simulated fusion wrists. Both grip strength (55.9 vs 80.7 kg) and satisfaction scores (6.4 vs 9.6) were lower in simulated fusion wrists. Wrists in 0° extension also demonstrated significantly shorter durations in stacking checkers than wrists in 15° extension. Conclusion: Our findings suggest that wrist arthrodesis may only compromise select wrist functions. Among the tested wrist fusion positions, wrists fused in neutral may demonstrate better function than wrist fused in slight extension. However, grip strength and satisfaction seem to be unaffected by wrist fusion position.

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Total wrist arthroplasty: a systematic review of the evidence from the last 5 years

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193414539796 ◽

2014 ◽

Vol 40 (5) ◽

pp. 458-468 ◽

Cited By ~ 37

Author(s):

D. Yeoh ◽

L. Tourret

Keyword(s):

Range Of Motion ◽

Survival Rates ◽

Complication Rates ◽

Level Of Evidence ◽

Total Wrist Arthroplasty ◽

Functional Scores ◽

Wrist Fusion ◽

Wrist Arthroplasty

We reviewed evidence on total wrist replacement from the last 5 years. Eight articles met a minimum set standard. The results of 405 prostheses were available, including seven different manufacturers. The mean follow up was 2.3–7.3 years with an average age of 52–63. Rheumatoid arthritis was the indication in 42% of patients. Motec demonstrated the best post-operative DASH scores. Only Maestro achieved a defined functional range of motion post-operatively. Universal 2 displayed the highest survival rates (100% at 3–5 years), while Elos had the lowest (57% at 5 years). Biaxial had the highest complication rates (68.7%), while Remotion had the lowest (11%). Wrist arthroplasty preserves some range of motion. Functional scores improved and were maintained over the mid- to long-term. Complication rates were higher than wrist fusion, with reports of radiological loosening and osteolysis. The evidence does not support the widespread use of arthroplasty over arthrodesis, and careful patient selection is essential. Level of Evidence: III

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A Comparative Study of Efficacy and Functionality of Ten Commercially Available Wrist-Hand Orthoses in Healthy Females: Wrist Range of Motion and Grip Strength Analysis

Frontiers in Rehabilitation Sciences ◽

10.3389/fresc.2021.687554 ◽

2021 ◽

Vol 2 ◽

Author(s):

Alejandra Aranceta-Garza ◽

Karyn Ross

Keyword(s):

Range Of Motion ◽

Grip Strength ◽

Evidence Base ◽

Secondary Outcome ◽

Functional Study ◽

Strength Analysis ◽

Hand Position ◽

Ulnar Deviation ◽

Flexion Extension ◽

The Impact

Objective: Wrist-hand orthoses (WHOs) are prescribed for a range of musculoskeletal/neurological conditions to optimise wrist/hand position at rest and enhance performance by controlling its range of motion (ROM), improving alignment, reducing pain, and optimising grip strength. The objective of this research was to study the efficacy and functionality of ten commercially available WHOs on wrist ROM and grip strength.Design: Randomised comparative functional study of the wrist/hand with and without WHOs.Participants: Ten right-handed female participants presenting with no underlying condition nor pain affecting the wrist/hand which could influence motion or grip strength. Each participant randomly tested ten WHOs; one per week, for 10 weeks.Main outcome measures: The primary outcome was to ascertain the impact of WHOs on wrist resting position and flexion, extension, radial, and ulnar deviation. A secondary outcome was the impact of the WHOs on maximum grip strength and associated wrist position when this was attained.Results: From the 2,400 tests performed it was clear that no WHO performed effectively or consistently across participants. The optimally performing WHO for flexion control was #3 restricting 86.7%, #4 restricting 76.7% of extension, #9 restricting 83.5% of radial deviation, and #4 maximally restricting ulnar deviation. A grip strength reduction was observed with all WHOs, and ranged from 1.7% (#6) to 34.2% (#4).Conclusion: WHOs did not limit movement sufficiently to successfully manage any condition requiring motion restriction associated with pain relief. The array of motion control recorded might be a contributing factor for the current conflicting evidence of efficacy for WHOs. Any detrimental impact on grip strength will influence the types of activities undertaken by the wearer. The design aspects impacting wrist motion and grip strength are multifactorial, including: WHO geometry; the presence of a volar bar; material of construction; strap design; and quality of fit. This study raises questions regarding the efficacy of current designs of prefabricated WHOs which have remained unchanged for several decades but continue to be used globally without a robust evidence-base to inform clinical practise and the prescription of these devices. These findings justify the need to re-design WHOs with the goal of meeting users' needs.

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PATIENT RELATED FUNCTIONAL OUTCOME AFTER TOTAL WRIST ARTHROPLASTY: A SINGLE CENTER STUDY OF 206 CASES

Hand Surgery ◽

10.1142/s0218810415500112 ◽

2015 ◽

Vol 20 (01) ◽

pp. 81-87 ◽

Cited By ~ 15

Author(s):

Marcus Sagerfors ◽

Anil Gupta ◽

Ole Brus ◽

Marco Rizzo ◽

Kurt Pettersson

Keyword(s):

Range Of Motion ◽

Grip Strength ◽

Outcome Measures ◽

Performance Measure ◽

Hand Grip Strength ◽

Ulnar Deviation ◽

Hand Grip ◽

Total Wrist Arthroplasty ◽

Patient Related Outcome ◽

Wrist Arthroplasty

Objectives: To prospectively evaluate patient related outcome measures after total wrist arthroplasty (TWA) using four different total wrist implants operated at a single referral center in Sweden. Methods: 206 primary TWAs were assessed preoperatively and after one year postoperatively with respect to the following eight outcome measures: Range of motion (flexion/extension, radial/ulnar deviation, pronation/supination), hand grip strength, Canadian Occupational Performance Measure (COPM), performance and satisfaction, Visual Analog Scale (VAS) pain scores at rest and in activity. Results: The Maestro TWA had a significantly greater improvement of radial/ulnar deviation than the Biax and Remotion TWAs. COPM performance and satisfaction improved more for the Maestro and Universal 2 prostheses than the Biax and Remotion. Conclusions: All four TWAs offer reduced VAS-scores and improved COPM-scores with preserved hand grip strength and somewhat improved range of motion. The Maestro TWA performed favorably compared to the Remotion TWA. Implant design may affect patient related outcome.

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Effect of static wrist position on grip strength

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699481 ◽

2011 ◽

Vol 44 (01) ◽

pp. 055-058 ◽

Cited By ~ 4

Author(s):

Praveen Bhardwaj ◽

Saumyakumar S. Nayak ◽

Asif M. Kiswar ◽

S. Raja Sabapathy

Keyword(s):

Grip Strength ◽

Wrist Flexion ◽

Wrist Extension ◽

Wrist Arthrodesis ◽

Left Hand ◽

Hand Grip ◽

Ideal Position ◽

Wrist Fusion ◽

The Difference ◽

The Ideal

ABSTRACT Background: Grip strength after wrist arthrodesis is reported to be significantly less than normal. One of the reasons suggested for this decrease in grip strength is that the arthrodesis was performed in a suboptimal position. However, there is no consensus on the ideal position of wrist fusion. There is a paucity of studies evaluating the effect of various fixed positions of the wrist on grip strength and therefore, there is no guide regarding the ideal position of wrist fusion. The authors’ aim was to determine the grip strength in various fixed positions of the wrist and subsequently to find out in which position of wrist fusion the grip strength would be maximal. Materials and Methods: One hundred healthy adults participated in the study. For the purpose of this study, the authors constructed splints to hold the wrist in five different fixed positions: 45, 30 and 15 degrees of wrist extension, neutral and 30 degrees of wrist flexion. The grip strength in all the participants was measured bilaterally, first without a splint and then with each splint sequentially. Results: The average grip strength without the splint was 34.3 kg for right and 32.3 kg for the left hand. Grip strength decreased by 19–25% when the wrist was splinted. The maximum average grip strength with a splint on was recorded at 45 degrees of extension (27.9 kg for right and 26.3 kg for left side). There was a gradual increase in the grip strength with increase in wrist extension but the difference was not statistically significant (P = 0.29). The grip strength was significantly less in flexed position of the wrist (P < 0.001).

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Scapho-Trapezio-Trapezoid Arthrodesis.

Hand Surgery ◽

10.1142/s0218810497000239 ◽

1997 ◽

Vol 02 (02) ◽

pp. 135-140 ◽

Cited By ~ 1

Author(s):

Andrew Kaines ◽

Hugh Chissell ◽

Michael Hayes ◽

Andrew Saies

Keyword(s):

Pain Relief ◽

Postoperative Complications ◽

Range Of Motion ◽

Grip Strength ◽

Common Procedure ◽

Wrist Arthrodesis ◽

Scapholunate Instability ◽

Results Of Surgery ◽

Stt Arthrodesis ◽

Kienbock’S Disease

Scapho-trapezio-trapezoid (STT) arthrodesis is a relatively common procedure performed for severe STT arthritis, scapholunate instability and Kienböck's disease. Twenty-eight of 31 patients who had undergone this procedure were reviewed at a mean of 65 months following surgery (range 24 to 97 months). Four patients underwent wrist arthrodesis; two for failed STT fusion; and two for uncontrolled pain related to pre-existing carpal osteoarthritis. Ninety-two percent of patients who had a successful STT arthrodesis achieved good or excellent pain relief and 79% were satisfied with the results of surgery. Pain relief was best in patients with a pre-operative diagnosis of STT arthritis. Wrist range of motion and strength were well preserved. No patients developed isolated arthrosis in the radiocarpal, intercarpal or adjacent joints. STT provides excellent pain relief with an acceptable reduction in grip strength and range of motion. However, the benefits of this procedure must be balanced against the potentially serious postoperative complications and the possibility of arthrosis.

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Wrist tuberculosis-experience from eighteen cases: a retrospective study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02198-0 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Longfei Zou ◽

Xing Guo ◽

Hao Xue ◽

Denghua Huang ◽

Hui Lv ◽

...

Keyword(s):

Retrospective Study ◽

Range Of Motion ◽

Grip Strength ◽

Wrist Joint ◽

Kirschner Wire ◽

Clinical Manifestations ◽

Postoperative Recovery ◽

Dash Score ◽

Wrist Fusion

Abstract Background Wrist tuberculosis is a rare disease, which is easy to be misdiagnosed, leading to delayed treatment and poor prognosis. In this study, the clinical manifestations, diagnosis, treatment, and prognosis of 18 cases of wrist tuberculosis were analyzed retrospectively. Methods A retrospective study was conducted, investigating tuberculosis of the wrist, diagnosed in 18 patients from August 2013 to November 2018. Puncture biopsy confirmed the diagnosis. The study includes 11 males and 7 females, and 8 left and 10 right wrists. The average age was 53.5 ± 18.3 years and ranged from 15 to 81 years. The disease course was 1 to 42 months, with an average of 15.1 ± 11.3 months. Eighteen patients were underwent surgery and chemotherapy, 3 patients with severe bone defects were treated with wrist fusion, and 15 patients were underwent focus removal. The Gartland and Werley score, DASH score, the range of motion (ROM), grip strength, and imaging examinations were used to evaluate the postoperative recovery of the patients. Results Eighteen patients were followed up for 15 to 77 months, with an average follow up of 39.7 ± 15.3 months. The ESR and CRP levels were normal for all patients after chemotherapy. No recurrence of tuberculosis was observed in any of the patients. Among the 15 focus removals, the Gartland and Werley scores at admission, two weeks of chemotherapy, 1 month after surgery, and the last follow-up were 21.73 ± 4.33, 18.60 ± 3.16,11.27 ± 2.79, and 5.07 ± 2.28, respectively; and the DASH scores were 45.87 ± 5.58, 39.47 ± 4.72, 22.67 ± 6.54, and 6.73 ± 2.94, respectively. The range of motion (ROM) of the wrist and grip strength improved significantly when compared to those at admission. Among the three cases of wrist fusion, 2 were fixed with a steel plate and the fixation position of wrist joint was good. One case was fixed with Kirschner wire and resulted in a slightly deformed wrist joint. Conclusion For patients with wrist tuberculosis, early diagnosis, preoperative and postoperative chemotherapy, thorough focus removal, and appropriate fixation of the affected limb can help restore the function of the affected wrist, reduce the recurrence rate, and improve the quality of life.

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A systematic review of outcomes of wrist arthrodesis and wrist arthroplasty in patients with rheumatoid arthritis

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193420953683 ◽

2020 ◽

pp. 175319342095368

Author(s):

Xi Ming Zhu ◽

Edward Perera ◽

Chetan Gohal ◽

Brittany Dennis ◽

Moin Khan ◽

...

Keyword(s):

Systematic Review ◽

Functional Improvement ◽

Complication Rates ◽

Wrist Arthrodesis ◽

Wrist Motion ◽

Long Term Follow Up ◽

End Stage ◽

Wrist Arthroplasty

Surgical management of end-stage rheumatoid wrists is a contentious topic. The standard surgical treatment has traditionally been wrist arthrodesis. Wrist arthroplasty, however, offers an alternative that preserves some wrist motion. A systematic review of MEDLINE, EMBASE and CENTRAL databases was conducted. Data from 23 studies representing 343 cases of wrist arthrodesis and 618 cases of wrist arthroplasty were included. Complication rates were 17% for arthrodesis and 19% for arthroplasty, and both procedures were effective at alleviating pain and improving grip strength. Functional assessment by Disabilities of the Arm, Shoulder, and Hand and Patient-Related Wrist Evaluation of arthroplasty patients revealed clinically meaningful functional improvement compared with preoperative measurements. In contrast to previously published findings both procedures demonstrated comparable complication rates. While this can be speculated to be from advancements in prosthetics, robust long-term follow-up data on wrist arthroplasty are not available yet.

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Wrist Tuberculosis-experience From Eighteen Cases: A Retrospective Study

10.21203/rs.3.rs-42568/v1 ◽

2020 ◽

Author(s):

longfei zou ◽

meiyun tan ◽

xing guo ◽

jiang guo ◽

hao xue ◽

...

Keyword(s):

Retrospective Study ◽

Range Of Motion ◽

Grip Strength ◽

Wrist Joint ◽

Kirschner Wire ◽

Clinical Manifestations ◽

Postoperative Recovery ◽

Dash Score ◽

Wrist Fusion

Abstract Background Wrist tuberculosis is a rare disease, easy to cause misdiagnosis, delay treatment and lead to poor prognosis. In this study, the clinical manifestations, diagnosis, treatment and prognosis of 18 cases of wrist tuberculosis were analyzed retrospectively. Methods We conducted a retrospective study investigating tuberculosis of the wrist, diagnosed in 18 patients from August 2013 to November 2018. Puncture biopsy confirmed the diagnosis. The study includes 11 males and 7 females, and 8 left and 10 right wrists. The average age was 53.5 ± 18.3 years and ranged from 15 to 81 years. The disease course was 1 to 42 months, with an average of 15.1 ± 11.3 months. Eighteen patients were treated with surgery and chemotherapy, 3 patients with severe bone defect were treated with wrist fusion, and 15 patients were treated with focus removal. The Gartland and Werley score, DASH score, the range of motion (ROM), grip strength, and imaging examinations were used to evaluate the postoperative recovery of the patients. Results Eighteen patients were followed up for 15 to 77 months, with an average follow up of 39.7 ± 15.3 months. The ESR and CRP levels were normal for all patients after chemotherapy. No recurrence of tuberculosis was observed in any of the patients. Among the 15 focus removal, the Gartland and Werley scores at admission, two weeks of chemotherapy, 1 month after surgery, and the last follow-up were 21.73 ± 4.33, 18.60 ± 3.16,11.27 ± 2.79, and 5.07 ± 2.28, respectively; and DASH scores were 45.87 ± 5.58, 39.47 ± 4.72,22.67 ± 6.54, and 6.73 ± 2.94, respectively. The wrist range of motion (ROM) and grip strength improved significantly compared to those at admission. Among the three cases of wrist fusion, 2 were fixed with a steel plate and the fixation position of wrist joint was good. One case was fixed with Kirschner wire and resulted in a slightly deformed wrist joint. Conclusion For the patients with wrist tuberculosis, early diagnosis, preoperative and postoperative chemotherapy, thorough focus removal, and appropriate fixation of the affected limb can help restore the function of the affected wrist, reduce the recurrence rate, and improve the quality of life.

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