Current Concepts in Total Wrist Arthroplasty: A Review

Abstract

Introduction: Total wrist arthroplasty was envisioned to give patients with severe and debilitating pain the opportunity to regain independence. Prior to the first generation of implants, the standard of care for patients suffering from end-stage arthritis of the wrist was total wrist fusion which provided significant pain improvement at the expense of wrist movement. Current Techniques: The first three generations of wrist implants showed promise of restored wrist function but were unfortunately plagued with poor long-term outcomes and significantly higher revisionist rates due to joint instability and peri/post-operative fractures. The current fourth generation of implants have shown the most promise in both preserving/restoring wrist motion and providing pain relief on par with the total wrist fusion. Complications Associated with Total Wrist Arthroplasty: The current generation of implants still face complications of lower long-term survival rates and increased revisionist surgeries as compared to total wrist fusions. Future Innovations in Surgical Wrist Interventions: Future innovations will focus on less bone resection and greater bone integration on a molecular level. Also, the relatively novel technique of wrist hemiarthroplasty shows promise as an acceptable alternative to total wrist arthroplasty. Conclusions: Though the current generation of TWAs still have a lower survival rate and higher complication rate vs TWF, the functional gains associated with current models and the novel implants and techniques currently in development make TWA still a promising option.