Wrist arthroplasty--a systematic review

INTRODUCTION: Severely painful or dysfunctional destroyed wrists can be reconstructed by fusion, interposition of soft-tissue or by arthroplasty using artificial materials. Total and partial wrist arthroplasty (T/PWA) has been used on a regular basis since the 1960's. The objective of this study was to review the literature on second, third and fourth generation implants.

METHODS: The review was conducted according to the PRISMA-guidelines. A search was made using a protocolled strategy and well-defined criteria in PubMed, in the Cochrane Library and by screening reference lists.

RESULTS: 37 publications describing a total of 18 implants were selected for analysis. 16 of the publications were useful for the evaluation of implant longevity. Despite methodological shortcomings in many of the source documents, a summary estimate was possible.

CONCLUSION: It seems that T/PWA has a good potential to improve function through pain reduction and preservation of mobility. The risk of severe complications - deep infection and instability problems - is small with the available implants. Implant survival of 90-100% at five years are reported in most series - if not all - using newer second generation and third generation implants, but declines from five to eight years. Periprosthetic osteolysis/radiolucency is frequently reported. Its causes and consequences are not clarified.