REVIEW - A systematic review of total wrist arthroplasty (replacement) compared with total wrist arthrodesis (fusion) for RA

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Plast Reconstr Surg. 2008 Sep;122(3):813-25.

A systematic review of total wrist arthroplasty compared with total

wrist arthrodesis for rheumatoid arthritis.

Cavaliere CM, Chung KC

Section of Plastic Surgery, Department of Surgery, University of

Michigan Health System, Ann Arbor, Mich 48109-0340, USA

BACKGROUND: Management of the end-stage rheumatoid wrist is

controversial. The most common treatment is total wrist fusion. Total

wrist arthroplasty offers a motion-preserving alternative. Comparison

of outcomes for total wrist arthroplasty and total wrist fusion is

necessary for evidence-based decision making. The purpose of this

systematic review was to scientifically evaluate the existing

literature for outcomes of both procedures in rheumatoid arthritis.

METHODS: A MEDLINE database review was performed. Search included

" wrist and arthroplasty, " " wrist and arthrodesis, " and " wrist and

fusion. " Silicone arthroplasty was excluded. Data extraction included

demographic information, surgical technique, pain, and active arc of

motion. Complications and satisfaction were recorded.

RESULTS: Literature review identified 1750 citations that were

screened for inclusion criteria. Formal review identified 18 total

wrist arthroplasty studies representing approximately 500 procedures.

Data from 20 total wrist fusion studies represented over 800

procedures. Comparison of outcomes showed that total wrist fusion

provides more reliable relief than total wrist arthroplasty.

Complication and revision rates were higher for total wrist

arthroplasty. Satisfaction was high in both groups. Postoperative

motion was reviewed to evaluate whether arthroplasty provides a

functional active arc of motion. Of 14 studies reporting appropriate

data, three showed average active arc of motion within the functional

range.

CONCLUSIONS: In this systematic review, outcomes for total wrist

fusion were comparable and possibly better than those for total wrist

arthroplasty in rheumatoid patients. In this era of cost-conscious

medical care, expensive interventions must demonstrate superior

outcomes. Existing data do not support widespread application of total

wrist arthroplasty for the rheumatoid arthritis wrist.

PMID: 18766045

http://www.ncbi.nlm.nih.gov/pubmed/18766045

Not an MD