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Medium Term Outcomes of the Universal-2 Total Wrist Arthroplasty for Rheumatoid Arthritis
K. Kailash, MCh, MRCS; A. Raza, MCh, MRCS; S. Mahalingam, MCh; SC Talwakar, FRCS; IA Trail, FRCS; R. Murali, FRCS; JK Stanley, FRCS
Wrightington Upper Limb Unit, Wrightington Hospital, Wigan, United Kingdom

Introduction: Total Wrist Arthroplasty (TWA) for Rheumatoid Arthritis (RA) of wrist allows pain relief and preservation of the movements. Revision still remains a major issue in Total Wrist Arthroplasty (TWA) for Rheumatoid Arthritis.

Aims: The primary aim was to evaluate medium term outcomes of Universal-2 TWA at a tertiary centre. The secondary aim was to follow complications and revision procedures performed in the series.

Methods: This was a retrospective review of case notes of 93 Universal-2 total wrist arthroplasty procedures performed from 2003 to 2009 at our institute. The five patients who were lost to follow-up and two patients died at two and four years following TWA, due to un-related causes. Therefore study included 87 TWA procedures.

Results: The indication was RA in 83 wrists, three had severe osteoarthritis and one had post-traumatic arthritis following scaphoid fracture. Ten patients had bilateral wrist replacements. Mean age of the patients was 60 years (26 to 86 years) and mean follow-up was of 51 months (13 to 94 months). Post-operatively pain relief was achieved in 70% within 6 months and patient satisfaction in 85% of wrists. Movements were preserved, at the final follow-up the mean dorsiflexion was of 23o and palmarflexion was of 21o. An earlier interim study of 39 patients showed VAS pain score improved from 5.4 to 1.7 and DASH score improvement of 14 points. The complications included; joint stiffness (10.5%, n=9), wrist pain (10.5%, n=9) and superficial infection 2.5% (n=2). Major complications were revision total wrist arthroplasty in 3.5% (n=3) and 3.5% (n=3) had salvage arthrodesis, as unable to proceed with revision arthroplasty. The Kaplan-Meier probability of survival was 91% at 7.8 years (95% CI:7%).

Conclusion: Pain relief and patient satisfaction following wrist arthroplasty procedures were consistently high in our series. The incidence of the major complications was 7% in this study, compared to the available literature which shows rates of up to 12% for Universal-2 TWA and up to 50% in earlier Universal implant.

Universal-2 Wrist Arthroplasty is recommended for pain relief and preservation of function. Further studies are required particularly focusing on carpal component loosening and long term outcomes.

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