CORR Insights^®: What Are the Risk Factors and Complications Associated With Intraoperative and Postoperative Fractures in Total Wrist Arthroplasty?

Excerpt

Patients who undergo successful total wrist arthroplasty (TWA) for advanced wrist degeneration report a better ability to perform certain daily living activities [4, 7], and cost-utility analyses suggest the intervention provides cost-effective value to patients [2]. Despite these benefits, TWA is less-frequently performed compared to total wrist arthrodesis [3, 5, 7]. In 2015, 1765 total wrist arthrodeses were billed to Medicare, compared with only 410 TWAs [3]—a number that actually is trending down [4]. Many hand surgeons are reluctant to recommend TWA due to concerns regarding high complication rates and limited survivorship [3, 5, 7]. I note that a major indication for TWA in the past, inflammatory arthritis, now is generally better managed medically. If symptoms persist despite disease-modifying drugs, some of these patients indeed will benefit from TWA, particularly if they have a sedentary or low-activity lifestyle. Likewise, patients with osteoarthritis (OA) or posttraumatic arthritis who are willing to forego heavy demands on at least one of their wrists may choose TWA in order to maintain the mobility necessary to perform activities of daily living that benefit from wrist motion. …