Total wrist replacements performed in Örebro University Hospital between 2002-2010

Background

There are several different anatomically designed total wrist systems available. Some implants are no longer on the market (BIAX) and some are new with very little documentation (Maestro).
The aim of this study was to evaluate our results from 4 different wrist prostheses that we followed up for up to 8 years.

Material and Methods

A consecutive series of 199-wrist prosthesis (60 BIAX, 76 Remotion, 17 Uni II, and 46 Maestro) were studied for a mean follow-up time of 60 (6-90) months.
Preoperatively, and at follow-up AROM, handgrip strength, 2-pinch and key pinch force, pain at rest and in activity (Visual analogue scores, 0-10), COPM, DASH and x-ray of the wrist were performed. Patients were classified as Wrightington grade 2-4.
The distal component of the BIAX wrist prosthesis was cemented but all other prostheses were un-cemented.

Results

9 (4.5%) prostheses had to be revised (6 BIAX, 1 Remotion and 2 Uni II). Pain at rest (VAS 0.3 - 2.9) and in activity (1.8 - 6.4) and handgrip strength (9.8 - 13.9 kg) improved significantly except for handgrip strength in Uni II (ns).
COPM satisfaction and performance score and DASH improved significantly in all prosthesis.
The Remotion prosthesis showed non-significant improvement in ROM. BIAX and Maestro showed most improvement in ROM.

Discussion

Excellent patient satisfaction and pain reduction at rest and in activity was found in all prosthesis. The best range of motion was reported in BIAX and Maestro.
6/60 BIAX prostheses loosened but these patients also had the longest follow-up time.
Remotion wrist prosthesis showed no loosening but also a non-significant ROM.
All prostheses performed well functionally and showed a very high patient satisfaction. In order to further evaluate the wrist prostheses, it is essential to analyse a larger series of patients during a long follow-up time