Total wrist arthroplasty: commentary and opinions

Area of Science:

• Orthopedic surgery
• Biomaterials science
• Rheumatology

Background:

• Total wrist arthroplasty (TWA) is an emerging surgical option for managing debilitating wrist arthritis.
• This review critically examines the evidence for fourth-generation TWA implants, focusing on patient outcomes and implant longevity.
• Current data suggests TWA provides satisfactory medium-term results for many patients.

Discussion:

• Significant heterogeneity exists across different TWA implants and patient cohorts, complicating direct comparisons and data interpretation.
• Key challenges in TWA practice include ensuring surgical expertise, optimizing patient selection, and responsible implant stewardship.
• The review addresses the complexities of implant design evolution and long-term performance monitoring.

Key Insights:

• Fourth-generation TWA implants demonstrate acceptable survivorship and patient-reported outcomes in the medium term.
• Variability in implant design and patient factors influences TWA success rates.
• Standardization of surgical techniques and implant evaluation is crucial for advancing TWA.

Outlook:

• Further high-quality research is essential to refine TWA indications and improve patient selection criteria.
• Addressing the identified challenges in surgical competency and implant stewardship is critical for the future of TWA.
• Future studies should focus on long-term survivorship data and comparative analyses of different TWA systems.