Total wrist arthroplasty: a quantitative review of the last 30 years.

OBJECTIVE

To investigate the suitability of design of 3 generations of wrist prostheses.

METHODS

A comparative review was performed on the Swanson, Volz, Meuli, Trispherical, Biaxial, and MWP III total wrist prostheses.

RESULTS

The review revealed a sharp rise in fracture and revision rates for the Swanson prosthesis after 55 months followup, with the most likely site for fracture at the junction of the distal stem and barrel. The Volz prosthesis had initial problems with a postoperative resting stance of ulnar deviation, due to the radial shift of the axis of the prosthesis to that of the normal wrist. A modified prosthesis corrected the problem of ulnar deviation; however, problems with bone resorption under the collar of the radial component and metacarpal loosening were seen. The majority of complications occurred in patients with post-traumatic degenerative joint disease. The remaining prostheses have had only a few clinical studies, and are presented to illustrate the different design concepts adopted.

CONCLUSION

Total wrist arthroplasty has less satisfactory clinical outcomes compared to hip and knee arthroplasty. The changes in design from the first to the third generation, with closer approximation to the wrist joint's center of rotation, have led to encouraging results. The comparison of the clinical outcome of different prostheses has been difficult due to the lack of uniformity of outcome measures used.