Prosthetic Design in Total Wrist Arthroplasty

Total wrist arthroplasty (TWA) provides a motion-preserving alternative to total wrist arthrodesis for low-demand patients with debilitating pancarpal arthritis. The earlier generation total wrist implants had high complication and failure rates. Advances in prosthetic design have contributed to improved clinical outcomes and implant survivorship. The current fourth-generation implants allow for expansion of indications for TWA. Careful patient selection remains critical; patients with high-demand lifestyles and poor bone stock may not be candidates. Long-term studies on implant survival and patient outcomes are critical for the current generation total wrist implants in assessing their long-term value compared with total wrist arthrodesis.

Key points

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Total wrist arthroplasty provides a motion-preserving alternative to wrist arthrodesis for low-demand patients with debilitating, painful pancarpal arthritis.
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Technical advancement in implant design promotes osteointegration and preserves motion with the goal of reducing torque transmission to the carpal component.
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Current generation implants have reduced rates of dislocation and instability but reoperation rates remain high and further long-term evaluation of survivability and complications are necessary.
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Long-term, prospective, randomized trials comparing total wrist arthroplasty with wrist arthrodesis are needed to understand which patients receive the greatest benefit with the lowest failure and complications.