A Systematic Review of Total Wrist Arthroplasty Compared with Total Wrist Arthrodesis for Rheumatoid Arthritis

Author(s): Cavaliere CM, and Chung KC

Source: J Plast Reconstr Surg 122: 813-25, 2008

Summary:

The authors performed a systematic MEDLINE database review with the aim of scientifically evaluating the existing literature for outcomes of total wrist arthroplasty and arthrodesis for rheumatoid arthritis.  Eighteen total wrist arthroplasty studies and 20 total wrist fusion studies were identified.  Comparison of the outcomes revealed that wrist arthrodesis resulted in more reliable pain relief and carried less complication and revision rates.  Both groups showed high satisfaction rates.  The authors conclude that based on this systematic review, the outcomes for total wrist arthrodesis were comparable or possibly better than for wrist arthroplasty.

Controversy exists regarding the best operative management strategy for the painful rheumatoid wrist. To this end, this study attempts to compare the available data for total wrist arthroplasty versus total wrist fusion so that hand surgeons, rheumatologists, and patients can make informed choices about the most appropriate treatment.  The conclusion that arthrodesis may potentially carry better results should; however, be balanced with specific patient preferences.  For example, for some patients, preserving even a limited amount of wrist motion may be acceptable, even with a higher likelihood of major complications.

The limitation of this well thought out investigation is that it is a literature review and relies on the quality of the published studies.  Nevertheless, rigorous attempts were made to minimize bias. For now, this systematic review presents the best possible summary of outcomes from available information until the time where multicenter prospective randomized studies definitively settle the debate.