Total Wrist Arthroplasty Versus Wrist Fusion in Rheumatoid Arthritis

Total wrist fusion (TWF) and total wrist arthroplasty (TWA) are viable treatment options for the rheumatic wrist. TWF fuses through the carpus to stabilize the wrist in 10° to 15° of extension and neutral coronal alignment. Although TWF can be performed with many implants, dorsal fusion plates are best supported. TWA has the advantage of preserving wrist motion but has historically had unacceptable complication rates. The current fourth and fifth generation implants represent significant improvements and have acceptable long-term survivorship and complication rates. Both TWF and TWA can improve quality of life and hand function in patients with rheumatoid arthritis.