High Survivorship and Few Complications With Cementless Total Wrist Arthroplasty at a Mean Followup of 9 Years
Joseph A. Gil, MD; Robin N. Kamal, MD; Eugene Cone, MD; Arnold Peter C. Weiss, MD
Brown University / Rhode Island Hospital, Providence, RI
Background The purpose of this investigation is: (1) to report ROM and pain scores after wrist reconstruction with cementless fourth-generation TWA at a mean followup of 9 years (range, 4.8-14.7 years). (2) To report complications of a cementless fourth-generation TWA and the cumulative probability of not undergoing a revision at a mean followup of 9 years.
Methods This is a retrospective case series of 69 patients who were treat for pancarpal wrist arthritis between 2002 and 2014 (Figure 1). The mean age of the 39 patients who had TWA was 56 ± 8.9 years (range: 31-78) at the time of surgery; 36 were women and three were men. The patients who underwent TWA were seen at a minimum of 4 years (mean, 9 years; range, 4-15 years). Pain and ROM were gathered before surgery as part of clinical care, and were measured again at latest followup; at latest followup, radiographs were analyzed (also by the senior author) for evidence of loosening, defined as any implant migration compared with any previous radiograph with evidence of peri-implant osteolysis and bone resorption. Subjective pain score was assessed by a verbal pain scale (0-10) and ROM was measured with a goniometer. Complications were determined by chart review and final examination. Kaplan Meier survival analysis was performed to estimate the cumulative probability of not undergoing a revision.
Results The mean preoperative active ROM was 34o±18¡ flexion and 36±18¡ extension. Postoperatively, the mean active ROM was 37¡ ± 14¡ flexion and 29¡ ± 13¡ extension. The mean difference between the preoperative pain score (8.6 ± 1.2) and postoperative pain score (0.4 ± 0.8) was 8.1 ± 1.9 (p < 0.001). Implant loosening occurred in three (7.7%) patients. No other complications occurred in this series. Kaplan-Meier survivorship analysis estimated the cumulative probability of remaining free from revision as 78% (95% CI, 62%-91%) at 15 years (Figure 2).
Conclusion Cementless fourth-generation TWA improves pain while generally preserving the preoperative arc of motion. The cumulative probability of remaining free from revision at 14.7 years after the index procedure is 77.7% (95% CI, 62.0%-91.4%). Future studies should compare alternative approaches for patients with endstage wrist arthritis; such evaluations which might compare TWA implants, or TWAs with arthrodesis will almost certainly need to be multicentered, as the problem is relatively uncommon.
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