Download PDF
J Wrist Surg 2017; 06(03): 206-215
DOI: 10.1055/s-0037-1598637
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Universal 2 Wrist Arthroplasty in Rheumatoid Arthritis

Sandra Pfanner
1   Unit of Surgery and Reconstructive Microsurgery of the Hand, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
,
Giovanni Munz
1   Unit of Surgery and Reconstructive Microsurgery of the Hand, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
,
Giulia Guidi
2   Guidi Hand Rehabilitation Center, Florence, Italy
,
Massimo Ceruso
1   Unit of Surgery and Reconstructive Microsurgery of the Hand, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
› Author Affiliations
Further Information

Publication History

25 October 2016

06 January 2017

Publication Date:
17 February 2017 (online)

    Permissions and Reprints

Abstract

Purpose The aim of this study was to evaluate the mid- to long-term outcomes and complications in patients affected by rheumatic diseases treated with the Universal 2 (U2) total wrist arthroplasty (TWA).

Methods We reviewed, in a retrospective, noncontrolled cohort study, 22 patients affected by rheumatoid arthritis (RA), who underwent U2 total wrist replacement between March 2003 and January 2014 for the treatment of 23 rheumatoid wrists with the aim of obtaining the remission of pain and a range of motion (ROM) useful for daily activities, according to the patients' demands, as an alternative to total wrist arthrodesis. The cohort of patients included 20 females and 2 males, with a mean age of 54.9 years. Residual pain, preoperative ROM, postoperative ROM increases, grip strength, radiographic changes, long-term complications, and reasons for revision or failures were evaluated.

Results In this study, 22 patients were evaluated at a mean follow-up of 82.3 months (range: 2–12 years). All patients had good or complete pain relief, the mean visual analogue scale pain score was 0.82. The mean grip strength improved and postoperatively was 11 kg (Jamar). The mean total ROM of flexion–extension was 72.3 degrees; radial–ulnar deviation 24.9 degrees. The mean QuickDASH score of 49 and patient rate wrist/hand evaluation of 41.7 a revision surgical procedure in six cases (26%): in two cases, a carpal component revision procedure and in four cases, total implant failures requiring either conversion to a Swanson spacer or wrist joint fusion.

Conclusion TWA provides pain relief, preserves motion, and improves function in severe degenerative RA. Our results at a mid- to long-term follow-up with the U2 prosthesis were encouraging and represent, when indicated, a valid alternative to fusion which is less appealing for RA patients.

Level of Evidence Level of evidence is therapeutic IV.

Keywords

wrist joint - total wrist arthroplasty - rheumatoid arthritis - Universal 2
 

  • References

  • 1 Swanson AB. Flexible implant arthroplasty for arthritic disabilities of the radiocarpal joint. A silicone rubber intramedullary stemmed flexible hinge implant for the wrist joint. Orthop Clin North Am 1973; 4 (02) 383-394
    CrossrefPubMedGoogle Scholar
  • 2 Brase DW, Millender LH. Failure of silicone rubber wrist arthroplasty in rheumatoid arthritis. J Hand Surg Am 1986; 11 (02) 175-183
    PubMedGoogle Scholar
  • 3 Jolly SL, Ferlic DC, Clayton ML, Dennis DA, Stringer EA. Swanson silicone arthroplasty of the wrist in rheumatoid arthritis: a long-term follow-up. J Hand Surg Am 1992; 17 (01) 142-149
    CrossrefPubMedGoogle Scholar
  • 4 Stanley JK, Tolat AR. Long-term results of Swanson silastic arthroplasty in the rheumatoid wrist. J Hand Surg Am 1993; 18B: 381-388
    PubMedGoogle Scholar
  • 5 Meuli HC. Meuli total wrist arthroplasty. Clin Orthop Relat Res 1984; (187) 107-111
    PubMedGoogle Scholar
  • 6 Volz RG. The development of a total wrist arthroplasty. Clin Orthop Relat Res 1976; (116) 209-214
    PubMedGoogle Scholar
  • 7 Cobb TK, Beckenbaugh RD. Biaxial total-wrist arthroplasty. J Hand Surg Am 1996; 21 (06) 1011-1021
    CrossrefPubMedGoogle Scholar
  • 8 Menon J. Universal total wrist implant: experience with a carpal component fixed with three screws. J Arthroplasty 1998; 13 (05) 515-523
    CrossrefPubMedGoogle Scholar
  • 9 Pfanner S, Ceruso M. Artrite reumatoide: artrodesi, protesi articolari. In: Landi A, Catalano F, Luchetti R. , eds. Trattato di chirurgia della mano. Vol. 2. Roma: Verduci; 2007: 1199-1224
    Google Scholar
  • 10 Divelbiss BJ, Sollerman C, Adams BD. Early results of the Universal total wrist arthroplasty in rheumatoid arthritis. J Hand Surg Am 2002; 27 (02) 195-204
    CrossrefPubMedGoogle Scholar
  • 11 Yeoh D, Tourret L. Total wrist arthroplasty: a systematic review of the evidence from the last 5 years. J Hand Surg Eur Vol 2015; 40 (05) 458-468
    CrossrefPubMedGoogle Scholar
  • 12 Larsen A, Dale K, Eek M. Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radiol Diagn (Stockh) 1977; 18 (04) 481-491
    PubMedGoogle Scholar
  • 13 Flury MP, Herren DB, Simmen BR. Rheumatoid arthritis of the wrist. Classification related to the natural course. Clin Orthop Relat Res 1999; (366) 72-77
    PubMedGoogle Scholar
  • 14 Menon J. Universal Total Wrist Implant: experience with a carpal component fixed with three screws. J Arthroplasty 1998; 13 (05) 515-523
    CrossrefPubMedGoogle Scholar
  • 15 Adams BD. Total wrist arthroplasty. Tech Hand Up Extrem Surg 2004; 8 (03) 130-137
    CrossrefPubMedGoogle Scholar
  • 16 Bienfait M. La fascia. Anatomia, topografia, fisiologia, patologia. Il “Pompage”. Trattamento della fascia. Roma: Marrapese; 1995
    Google Scholar
  • 17 Ferreres A, Lluch A, Del Valle M. Universal total wrist arthroplasty: midterm follow-up study. J Hand Surg Am 2011; 36 (06) 967-973
    CrossrefPubMedGoogle Scholar
  • 18 Sagerfors M, Gupta A, Brus O, Pettersson K. Total wrist arthroplasty: a single-center study of 219 cases with 5-year follow-up. J Hand Surg Am 2015; 40 (12) 2380-2387
    CrossrefPubMedGoogle Scholar
  • 19 Murphy DM, Khoury JG, Imbriglia JE, Adams BD. Comparison of arthroplasty and arthrodesis for the rheumatoid wrist. J Hand Surg Am 2003; 28 (04) 570-576
    CrossrefPubMedGoogle Scholar
  • 20 Vicar AJ, Burton RI. Surgical management of the rheumatoid wrist--fusion or arthroplasty. J Hand Surg Am 1986; 11 (06) 790-797
    CrossrefPubMedGoogle Scholar
  • 21 Takwale VJ, Nuttall D, Trail IA, Stanley JK. Biaxial total wrist replacement in patients with rheumatoid arthritis. Clinical review, survivorship and radiological analysis. J Bone Joint Surg Br 2002; 84 (05) 692-699
    CrossrefPubMedGoogle Scholar
  • 22 Nydick JA, Greenberg SM, Stone JD, Williams B, Polikandriotis JA, Hess AV. Clinical outcomes of total wrist arthroplasty. J Hand Surg Am 2012; 37 (08) 1580-1584
    CrossrefPubMedGoogle Scholar
  • 23 Adams BD. Complications of wrist arthroplasty. Hand Clin 2010; 26 (02) 213-220
    CrossrefPubMedGoogle Scholar
  • 24 Morapudi SP, Marlow WJ, Withers D, Ralte P, Gabr A, Waseem M. Total wrist arthroplasty using the Universal 2 prosthesis. J Orthop Surg (Hong Kong) 2012; 20 (03) 365-368
    CrossrefPubMedGoogle Scholar
  • 25 Cooney W, Manuel J, Froelich J, Rizzo M. Total wrist replacement: a retrospective comparative study. J Wrist Surg 2012; 1 (02) 165-172
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Sagerfors M, Gupta A, Brus O, Rizzo M, Pettersson K. Patient related functional outcome after total wrist arthroplasty: a single center study of 206 cases. Hand Surg 2015; 20 (01) 81-87
    CrossrefPubMedGoogle Scholar
  • 27 Chevrollier J, Strugarek-Lecoanet C, Dap F, Dautel G. Results of a unicentric series of 15 wrist prosthesis implantations at a 5.2.  year follow-up. Acta Orthop Belg 2016; 82 (01) 31-42
    PubMedGoogle Scholar