Nydick and colleagues’ study compared patient outcomes between two groups patients of whom 15 underwent wrist arthrodesis and seven had arthroplasty.¹ Mean Disabilities of the Arm, Shoulder, and Hand (DASH) Visual Analog Scale (VAS) scores were not statistically different between groups. However, mean Patient‐Rated Wrist Evaluation (PRWE) was statistically significant: 31 versus 73 for TWA and arthrodesis, respectively. These questions from the PRWE were statistically significant and supportive of TWA: cut meat using a knife, fasten buttons, pushing up from a chair, personal care activities, and household work (p = 0.01). There was one complication of fixed wrist contracture in the arthroplasty group, two patients in the arthrodesis group had delayed union, and one required symptomatic screw removal.

In a retrospective review of 56 patients with a mean age of 52 years, who had undergone uncemented Motec wrist arthroplasty, Reigstad and colleagues found that the patients had greater ROM and grip strength at a mean of eight years following surgery.² Compared to preoperative values grip strength had increased by 3 kg (p <0.05) and ROM had increased from 97 to 126° (p <0.05). At final follow‐up, 27 of 56 patients were working. The 10‐year Kaplan–Meier survival of the implants was 86%.

In retrospective review of 23 wrists in 22 patients with the Maestro TWA, Nydick et al. noted that patients had a statistically significant reduction in pain from 8 to 2 (p <0.05) at mean follow‐up of 28 months.³ Complications occurred in seven of the 23 patients: four wrist contractures, one implant failure, one deep infection, and one instability.

In a multicenter registry of the Remotion TWA implant, Boeckstyns reported a significant reduction in pain scores by 42 points at a mean two‐year follow‐up (p <0.01).⁴ The revision rate in this series was 3.7% with an estimated survival rate of 90% at four years.

Total wrist fusion (TWF) of the wrist has been used effectively for pain relief in the past. Weiss et al. reported being able to achieve pain relief in all of their 28 patients who underwent TWF for post‐traumatic arthritis and enabled 13 of patients to return to full‐time work, without restriction.⁵ Four patients required re‐operation due to discomfort of the extensor tendons following the surgery. In another study of 23 patients with TWF by Weiss and colleagues, 15 were able to return to full‐time work at the average follow‐up of 54 months.⁶

Results are not universally favorable. De Smet et al. found that many patients continued to have ongoing pain following fusions. Only six of 36 patients were pain free with activity at the time of follow‐up of four years.⁷ Many complications were seen in this study; 21 patients required re‐operation following TWF where 18 required removal of metalwork and three required revision.