Wrist arthroplasty--a systematic review.

Area of Science:

• Orthopedic surgery
• Biomaterials science

Background:

• Wrist reconstruction options include fusion, soft-tissue interposition, and arthroplasty.
• Total and partial wrist arthroplasty (T/PWA) has been utilized since the 1960s.
• Advancements in implant technology have led to multiple generations of T/PWA devices.

Purpose of the Study:

• To review the existing literature on second, third, and fourth-generation total and partial wrist arthroplasty (T/PWA) implants.
• To evaluate the efficacy and complications associated with contemporary T/PWA implants.

Main Methods:

• A systematic literature review was performed adhering to PRISMA guidelines.
• Searches were conducted in PubMed and the Cochrane Library using a protocolled strategy.
• Reference lists of relevant publications were also screened.

Main Results:

• 37 publications detailing 18 distinct implants were analyzed.
• Implant longevity data was available from 16 publications.
• Despite methodological limitations in source studies, a summary estimate of performance was achievable.

Conclusions:

• T/PWA demonstrates potential for improving wrist function via pain reduction and mobility preservation.
• Modern T/PWA implants present a low risk of severe complications like deep infection or instability.
• Implant survival rates of 90-100% at five years are common with second and third-generation implants, but decline between five and eight years.
• Periprosthetic osteolysis/radiolucency is a frequent finding, though its etiology and clinical significance remain unclear.