Clinical Outcomes of Total Wrist Arthroplasty in Patients With Rheumatoid Arthritis: Minimum 10-Year Follow-Up Study

Yuichiro Matsui; Akio Minami; Makoto Kondo; Jyunichi Ishikawa; Makoto Motomiya; Daisuke Kawamura; Norimasa Iwasaki

doi:10.1016/j.jhsa.2024.03.002

Clinical Outcomes of Total Wrist Arthroplasty in Patients With Rheumatoid Arthritis: Minimum 10-Year Follow-Up Study

J Hand Surg Am. 2024 Apr 9:S0363-5023(24)00098-4. doi: 10.1016/j.jhsa.2024.03.002. Online ahead of print.

Authors

Yuichiro Matsui¹, Akio Minami², Makoto Kondo³, Jyunichi Ishikawa⁴, Makoto Motomiya⁵, Daisuke Kawamura⁶, Norimasa Iwasaki⁷

Affiliations

¹ Section for Clinical Education, Faculty of Dental Medicine, Hokkaido University, Sapporo, Hokkaido, Japan; Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.
² Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan.
³ Department of Orthopaedic Surgery, Hokkaido Orthopaedic Memorial Hospital, Sapporo, Hokkaido, Japan.
⁴ Utsukushigaoka Orthopedics, Sapporo, Hokkaido, Japan.
⁵ Department of Orthopaedic Surgery, Obihiro Kosei Hospital Hand Center, Obihiro, Hokkaido, Japan.
⁶ Department of Orthopaedic Surgery, NTT Medical Center Sapporo, Sapporo, Hokkaido, Japan.
⁷ Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan. Electronic address: niwasaki@med.hokudai.ac.jp.

PMID: 38597835
DOI: 10.1016/j.jhsa.2024.03.002

Abstract

Purpose: We developed a semiconstrained total wrist prosthesis that was used in a series of patients with rheumatoid arthritis. We previously reported favorable clinical outcomes for up to 5 years after surgery; however, the longer-term outcomes remain unclear. The objective of this study was to evaluate the clinical outcomes of this wrist prosthesis for the treatment of severe wrist rheumatoid arthritis during a minimum 10 years of follow-up.

Methods: From 2010 through 2012, total wrist arthroplasty using the semiconstrained total wrist arthroplasty device was performed in 20 wrists in 20 patients with rheumatoid arthritis (five men and 15 women). The mean patient age was 64 years (range, 50-84 years). Preoperative radiographs showed Larsen grade IV changes in 16 wrists and grade V changes in four wrists. Patients were evaluated clinically and radiologically before surgery, 5 years after surgery, and 10 years or more after surgery. Evaluated parameters were the visual analog scale for pain, range of motion, Figgie score, and Disabilities of the Arm, Shoulder, and Hand score.

Results: The minimum 10-year follow-up clinical results (mean, 11.3 years) were available for all 14 surviving patients (three men and 11 women). Significant improvements in the mean visual analog scale for pain, Figgie score, and Disabilities of the Arm, Shoulder, and Hand score, compared with those before surgery, were maintained from 5 years after surgery to the final follow-up. The mean wrist flexion angle tended to slightly decrease at 5 years after surgery compared with that before surgery but remained similar from 5 years after surgery to the final follow-up. The increase in the mean wrist extension angle, compared with that before surgery, was maintained from 5 years after surgery to the final follow-up. Radiographic evaluation had already revealed implant loosening in five of the 19 wrists at 5 years after surgery, but there were no new cases of component loosening identified at the final follow-up.

Conclusions: Total wrist arthroplasty using the semiconstrained arthroplasty system achieves favorable clinical outcomes with no serious complications requiring revision for 10 years after surgery.

Type of study/level of evidence: Therapeutic IV.

Keywords: Rheumatoid arthritis; total wrist arthroplasty.