Evaluation of Functional Outcome and Complications in Wrist Surgery by Total Wrist Arthroplasty and Arthrodesis

Abstract

Aim: To review and estimate the outcomes and complications of these two orthopedic techniques. Background: Advanced wrist disorders such as degenerative osteoarthritis or rheumatoid arthritis (RA), can be severely debilitating. Total wrist arthroplasty (TWA) and arthrodesis (AD) have been used for wrist rehabilitation in such cases. Methodology: This study was designed as a literature review including 14 articles, accessed via PubMed Central (PMC). Functional outcome of TWA and AD were assessed by evaluating the mean postoperative DASH (Disability of the Arm, Shoulder and Hand) scores and by confirming subjective improvement of wrist pain. Operative complications were also compared between the two procedures. SPSS-23 was used for data analysis while p<0.05 was considered significant. Other complications are beyond the scope of this study. Results: A total of 447 wrists (TWA=203 and AD=244) were operated in various settings. TWA was mostly performed for cases of RA while arthrodesis was more likely to be carried out for wrist trauma. There was no statistically significant difference between the mean postoperative DASH scores attained by the two different wrist surgeries. Both procedures resulted in a marked pain reduction however, no significant variation in postoperative pain scores was found between TWA and AD. Total arthroplasty carried a significantly higher risk of operative complications (p<0.001) and was also associated with a relatively higher rate of revision surgeries (OR=1.63). Conclusion: Both TWA and AD can be efficiently used for addressing wrist disorders, but the former carries a higher potential for operative complications. The specific procedure utilized mainly depends upon the specific patient history.