Total wrist arthroplasty for rheumatoid arthritis

Total wrist arthroplasty cannot duplicate the complex mechanics of the normal wrist which involves multiple articulations among the radius, ulna, and carpal bones. However, newer implant designs attempt to simplify this intricate system while producing a stable, pain-free joint with a functional range of motion. A motion-preserving alternative to wrist arthrodesis is of particular importance when treating patients who are debilitated by arthritis afflicting multiple joints. Total wrist arthroplasty enhances the performance of daily activities and is preferred to arthrodesis by rheumatoid patients [M.J. Goodman, et al., Arthroplasty of the rheumatoid wrist with silicone rubber: an early evaluation. J. Hand Surg. [Am.] 5 (2) (1980) 114–121; A.J. Vicar, R.I. Burton, Surgical management of the rheumatoid wrist-fusion or arthroplasty. J. Hand Surg. [Am.] 11 (6) (1986) 790–797]. Other patients may also choose arthroplasty over arthrodesis to better maintain their ability to perform vocational and avocational activities. Regardless of the need or desire for arthroplasty, the patient must accept and commit to a lifetime of restricted activities imposed by an artificial wrist. The patient must also recognize the risk of implant failure with the consequent need for revision surgery. This article discusses the history, technique, and outcomes of total wrist arthroplasty with emphases on new implant designs and strategies to minimize risks and manage complications.