Abstract
Introduction
Total Wrist Arthroplasty (TWA) for Rheumatoid Arthritis (RA) of wrist allows pain relief and preservation of the movements.
Aims
The aims of current study were to evaluate outcomes of Universal-2® TWA at a tertiary centre.
Methods
This was a retrospective review of case notes of 92 Universal-2® wrist replacements performed from 2003 to 2009. There were 63 female and 14 male patients. Ten patients had bilateral wrist replacements. There were 5 patients lost to follow-up and 2 patients died at 2 and 4 years following TWA, due to un-related causes. The available literature related to Universal implant was also reviewed.
Results
The indication was RA in 83 wrists, 3 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 91.2% and patient satisfaction was 86%. Movements were preserved with mean dorsiflexion of 23o and palmarflexion of 21o. An interim study of 34 patients showed VAS pain score improved from 5.4 to 1.7 and DASH score improvement of 14 points. Radiologically, intercarpal fusion was noted in 85% of the cases. Minor complications included; joint stiffness (10%, n=14), wrist pain (9%, n=8) and superficial infection in 2 cases (2.3%). Major complications were revision of wrist arthroplasty in 4.7% (n=4) and 3.5% salvage arthrodesis (n=3).
Conclusion
Pain relief and patient satisfaction following wrist arthroplasty was 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. Further studies are required particularly focusing on Carpal component loosening and long term outcomes.
