Background Total Wrist Arthroplasty (TWA) for Rheumatoid Arthritis (RA) involving the wrist joint allows pain relief and preservation of the movements, when compared to the fusion. Universal-2® Total Wrist Arthroplasty is a 3rd Generation of wrist implants designed to improve on the issues faced with pervious implants.
Objectives The aims of the current study were to evaluate the outcomes of patients with RA who underwent Universal-2® TWA at a tertiary centre.
Methods This was a retrospective study of 92 wrist replacements with Universal-2® implant, performed from 2003 to 2009. There were 59 female and 16 male patients. Ten female patients had bilateral wrist replacements. There were five patients lost to follow-up and two patients died at 2 years and 4 years following TWA, due to un-related causes.
Results The indication for arthroplasty in 83 cases was RA, three had severe osteoarthritis and one had post-traumatic arthritis following scaphoid fracture. Mean age was 60 years (26 to 86 years) and mean follow-up of 51 months (13 to 94 months). Post-operatively pain relief was achieved in 72% within 6 months and patient satisfaction in 86% of the cases. The mean dorsiflexion of 23° and palmarflexion of 21° was recorded on final follow-up. The VAS pain score improved from 5.4 to 1.7 and DASH score improvement of 14 points (n=15). Major complications requiring further surgical interventions were revision with wrist arthroplasty in 3.5% (n=3), salvage arthrodesis in 3.5% (n=3) and one patient had removal of implant secondary to chronic synovitis (1.1%). The cumulative survival was 91% at 7.8years (95%CI: 7%) for the combined revision procedures (n=6).
Conclusions Pain relief and patient satisfaction following wrist arthroplasty were consistently high in our series. The incidence of major complications was 8.1% in this study, compared to the literature review which shows rates of 12% for Universal-2® TWA and up to 50% in earlier Universal® implant.
Universal-2® Wrist Arthroplasty is recommended for pain relief and preservation of function, as patients fail to respond to the medications. Further studies are required particularly focusing on Carpal component loosening and long term outcomes.
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Disclosure of Interest None Declared
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