Total Wrist Arthroplasty Versus Wrist Fusion in Rheumatoid Arthritis

Area of Science:

• Orthopedic surgery
• Rheumatology
• Biomedical engineering

Background:

• Rheumatic wrist conditions significantly impair hand function and quality of life.
• Surgical interventions like Total Wrist Fusion (TWF) and Total Wrist Arthroplasty (TWA) are considered for management.
• Historically, TWA had high complication rates, while TWF provided stability but sacrificed motion.

Purpose of the Study:

• To compare the efficacy and outcomes of Total Wrist Fusion (TWF) and Total Wrist Arthroplasty (TWA) for treating the rheumatoid wrist.
• To evaluate the advancements in current generation TWA implants regarding survivorship and complication rates.
• To assess the impact of both procedures on patient quality of life and hand function.

Main Methods:

• Review of surgical techniques for TWF, emphasizing dorsal fusion plates for optimal support.
• Analysis of long-term survivorship and complication data for fourth and fifth generation TWA implants.
• Assessment of functional outcomes and quality of life improvements in patients undergoing TWF or TWA.

Main Results:

• TWF stabilizes the wrist in a functional position (10°-15° extension, neutral alignment).
• Current TWA implants demonstrate acceptable long-term survivorship and reduced complication rates compared to historical designs.
• Both TWF and TWA procedures lead to significant improvements in quality of life and hand function for rheumatoid arthritis patients.

Conclusions:

• Total Wrist Fusion (TWF) and Total Wrist Arthroplasty (TWA) are effective surgical options for the rheumatoid wrist.
• Advancements in TWA implant technology have made it a more viable alternative with acceptable outcomes.
• Both procedures can restore function and enhance the quality of life for individuals suffering from rheumatoid arthritis affecting the wrist.