Wrist Replacement Now Available

You probably know someone who has a hip or knee replacement. You may have heard there are also shoulder and elbow joint replacements. And now there are wrist replacements also known as total wrist arthroplasty or TWA. As with any new surgical procedure, one of the first things surgeons look for are those patients who can benefit the most from the new treatment.

In the case of wrist joint replacement, patients with wrist rheumatoid arthritis were the only candidates at first. Total wrist arthroplasty (TWA) makes it possible for these patients to avoid a wrist fusion or wrist bone removal (sometimes the only other surgical options). Even so, anyone with severe bone loss, infection, bone subluxation (partial dislocation), or who used a walking aid (cane, walker) was not considered a “good” candidate for this procedure.

Over time and with improvements in implant design, fixation, and surgical techniques, more patients have been included in the list of potential or good candidates for total wrist arthroplasty (TWA). For example, additional diagnoses considered for this procedure now include post-traumatic arthritis, Kienböck disease, gout, and osteoarthritis.

And today, with more than one type of wrist joint replacement on the market, studies are being done to determine which implant(s) work the best. In this study, surgeons from the Florida Orthopaedic Institute and the Foundation for Orthopaedic Research and Education evaluated the results of using the Maestro Total Wrist System.

They followed 22 patients for a total of 23 wrist implants over a period that ranged from four to 55 months (almost five years). Using measures of pain, motion, and grip strength, they evaluated the outcomes.

They also took X-rays and made note of any complications to help them track results. Other studies have reported complications like infection, failure of the wound to heal, loosening of the hardware, wrist dislocation, tendon rupture, and impingement. One of the biggest reasons complications develop is from implant malpositioning. Implant loosening tends to be another major cause of problems.

In this group, seven of the 23 wrists developed problems. That’s almost one-third of the group and is a fairly high rate of complications. Taking a closer look at the problems that developed in this group, there were wrist contractures (most common problem), deep (joint) infection, synovitis (inflammation of the synovium or fluid inside the joint), and loose screws. In one case, a patient had fallen causing wrist dislocation. Three patients with active rheumatoid arthritis inflammation had failed surgeries.

After reviewing the results of their own study, the authors made the following suggestions:

  • Patients with highly active disease may not be good candidates for total wrist arthroplasty (TWA).
  • Anyone with severe bone loss or carpal (wrist) subluxation should not be treated with TWA.
  • The Maestro system has a locking screw option that may decrease the risk of implant loosening.
  • To avoid wrist joint contracture (stiffness and loss of motion), a wrist splint that puts the wrist in 30-degrees of extension should be used after surgery.
  • TWA should not be used in young adults (younger than 50 years old), anyone using a walking aid, or who is unable to follow directions for activity restrictions.

    More long-term studies are needed before all aspects of TWA (and especially individual implant designs) are known. For now, it looks like the Maestro system can be used successfully with those who have rheumatoid arthritis as well as patients with other diagnoses. In fact, patients who don’t have rheumatoid arthritis often have better bone and better alignment making it possible to successfully treat with TWA.