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Trends in the Utilization of Total Wrist Arthroplasty versus Wrist Fusion for Treatment of Advanced Wrist Arthritis
Eitan Melamed, MD1; Bryan Marascalchi, MD1; Richard M. Hinds, MD1; Marco Rizzo, MD2; John T. Capo, MD1
1NYU Hospital for Joint Diseases, New York, NY; 2Mayo Clinic, Rochester, MN

Introduction: The purpose of this study was to analyze data collected from the Nationwide Inpatient Sample (NIS) regarding Total Wrist Arthoplasty (TWA) versus Total Wrist Fusion (WF). We hypothesized that over a 10 year period utilization rates of TWA have increased.
Methods: NIS data from 2001 to 2010 was reviewed. Procedures were identified by searching for ICD-9-CM codes 81.73 (TWA) and 81.25 (WF). Patient demographic, comorbidity, and hospital charge data was compared using chi-squared tests and t tests for categorical and continuous variables, respectively. Linear regression modeling was used to determine national trends.
Results: NIS analysis identified 199 TWA and 738 WF cases that were extrapolated to a national prevalence of approximately 995 TWA cases and 3960 WF procedures. There was a decrease in the number of TWA cases per year (p<0.05), while the annual number of WF procedures remained relatively constant (p=0.13). There was, however, a steady increase in the frequency of TWA procedures observed from 2005 to 2007 following a decline from 2002 to 2005. Patients with malunion or traumatic arthritis were more likely to have underwent WF (malunion: 12% vs 3%, p<0.001; traumatic arthritis: 12% vs 3%, p<0.001). Rheumatoid patients were more likely to undergo TWA than WF (51% vs 16%, p<0.001). Patients receiving TWA tended to be older, female, and have rheumatologic disease. TWA patients also demonstrated a higher comorbidity burden and were more often insured by Medicare. Hospital charges were greater for TWA compared to WF ($34,055 vs. $27,079, p<0.01), though patients receiving WF had a higher percentage of perioperative device-related complications (6% vs. 3%, p<0.001) and respiratory complications (0.54%% vs. 0%, p<0.05). LOS was similar between the 2 groups. Linear regression modeling demonstrated an increase in LOS from 1.7 days in 2001 to 2.9 days in 2010 (p<0.05) for WF.
Conclusions: Despite improvements in TWA ingrowth strategies, bearing surfaces, and the potential for preservation of wrist movement, WF was performed nearly four times more frequently. Overall TWA utilization decreased over the 10 year period despite being utilized more often in patients with underlying comorbidities. WF was associated with a higher risk of complications when compared to TWA during the index hospitalization period. Although LOS was similar between the 2 groups, TWA was associated with a higher hospitalization charge.

Figure 1. National trends of volume of total wrist arthroplasty (TWA) and wrist fusion (WF) from 2001 to 2010.

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