Current status of total wrist arthroplasty in patients with rheumatoid arthritis: A literature review

The joints of the hand are most frequently involved in pathological process in rheumatoid arthritis (RA). This is the cause of future functional impairment, inability to perform professional activities, significant difficulties in activities of daily living, and worsening of life quality. The goal of surgical treatment of hand involvement is to achieve a balance between minimal pain and maximal preservation of function. Joint-preserving surgical techniques are applied; however, in cases of severe wrist joint destruction, total wrist fusion (arthrodesis) (TWF) or total wrist arthroplasty (TWA) remain the treatment options of choice.
TWF is a reliable, safe, cost-effective, and technically availability procedure with predictable long-term outcomes; however, it causes complete loss of ROM (range of motion) in wrist joint, which represents a major drawback and following search for alternative surgical options. In the early 2000s, fourth-generation TWA implants were introduced, that characterized by improved anatomical design, greater preservation of bone stock during implantation, higher survivorship rates, the usage of specialized coatings to enhance osseointegration, biomechanical stability, and applicability for revision when required.
The main advantages of TWA over TWF include preservation of wrist motion and, in some cases, an increase in ROM, which are vitally important for patients’ daily and professional activities. Accordingly, to published reports with 10–15 years of follow-up, survivorship rates have increased and the incidence of complications and revisions following TWA has decreased; nevertheless, TWA procedure is currently considered less reliable than TWF. To achieve long-term outcomes of TWA in patients with RA comparable to those of total knee and hip arthroplasty – appropriate patient selection, consideration of disease-specific characteristics, and continuous improvement of preoperative planning and surgical technique based on annually published reports and registry data are required.

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