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Biaxial total-wrist arthroplasty
1Department of Orthopedics, Mayo Clinic, Rochester, MN 55905, USA.
The Journal of Hand Surgery
|November 1, 1996
Summary
Biaxial total wrist arthroplasty significantly improved pain and grip strength in rheumatoid arthritis patients, with an 83% survival rate free of revision after a mean of 6.5 years. Distal implant loosening was the primary failure cause.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
Background:
- Rheumatoid arthritis (RA) frequently affects the wrist, causing pain and functional limitation.
- Total wrist arthroplasty (TWA) is a surgical option for end-stage wrist arthritis.
Purpose of the Study:
- To evaluate the long-term outcomes of biaxial total wrist arthroplasty in patients with rheumatoid arthritis.
- To identify factors associated with implant survival and failure.
Main Methods:
- Retrospective review of 64 consecutive biaxial TWAs in 52 patients (March 1983-June 1988).
- Follow-up for a minimum of 5 years or until failure in 57 cases.
- Assessment of pain, range of motion, grip strength, and implant survival using Kaplan-Meier analysis.
Main Results:
- At a mean 6.5-year follow-up, 75% of patients reported no pain and 92% reported improvement.
- Mean grip strength improved from 4.1 kg to 5.9 kg.
- The Kaplan-Meier probability of survival free of revision was 83%; distal implant loosening occurred in 8 of 11 failures.
Conclusions:
- Biaxial total wrist arthroplasty provides significant pain relief and functional improvement in RA patients.
- Distal implant loosening is a major concern, and abnormal resting stance/subsidence at 1 year may predict failure.