Metal-on-metal disease in wrist arthroplasty: a systematic review and proposed management algorithm

Wrist arthroplasty is becoming increasingly popular. Metal-on-metal (MOM) articulations have been offered to diminish wear and increase range of motion. This systematic review aims to survey the literature for reports of MOM disease in the setting of wrist arthroplasty, identify patient characteristics that may predispose to its incidence and offer an algorithm for management of such patients.

An electronic database search of PubMed, Ovid Medline, Embase and CENTRAL was performed. Studies were included if they were published in English; reported original data following the implantation of a wrist replacement device; and commented on the presence of either intra-capsular metallosis or raised systemic metal ion levels. Studies were graded by the QUADAS-2 tool.

Nine studies with 124 patients were identified for inclusion. The mean age was 63 years (range 29-87). Complications included neurological symptoms, wrist pain, loss of range of motion and swelling. Time to revision surgery ranged from 12.5 to 72 months. The arc range of motion ranged from 112 to 140 degrees.

MOM disease is seen in patients with a retained arc of motion, particularly in females. A MOM articulation is not recommended when implanting a wrist arthroplasty. Close surveillance utilizing regular clinical, haematological and radiological review should be performed in patients who have previously undergone wrist arthroplasty with MOM articulation.

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