title: Total Wrist Arthroplasty: A Single-Center Study of 219 Cases With 5-Year Follow-up.
abstract: OBJECTIVE
  To assess implant survival and radiographic loosening after total wrist arthroplasty (TWA) operated at a single tertiary referral center in Sweden.
  
  
  METHODS
  In a prospective cohort study, we evaluated 189 consecutive patients with a TWA (219 wrists). The wrists were implanted between 2002 and 2013. The primary end point was revision for any reason. The mean follow-up period was 7 years (range, 2-13 years). In addition, radiological examination was done for evidence of prosthetic loosening 5 years postoperatively. Implant survival was estimated using the Kaplan-Meier method. Secondary outcome measures included range of motion, visual analog scale pain scores, hand grip strength, and patient-related outcome measures.
  
  
  RESULTS
  Cumulative implant survival after 8 years was 81% for Biax, 94% for Remotion, and 95% for Maestro implants. Radiographic loosening was present in 26% of wrists with the Biax design, 18% of those with Remotion, and 2% of those with Maestro. Visual analog scale pain scores and patient-related outcome scores improved significantly for all TWAs. Improved hand grip strength was noted for all TWAs except for the Universal 2. Range of motion improved somewhat, especially for the Biax and Maestro TWAs.
  
  
  CONCLUSIONS
  Good midterm to long-term results were achieved in patients undergoing TWA. Radiographic loosening did not necessarily correlate with implant survival rates, but rather to severe arthritic destruction of the wrist preoperatively. All TWA implants studied offered a high level of patient satisfaction.
  
  
  METHODS
  Therapeutic III.
authors.affiliation: Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. Electronic address: marcus.sagerfors@regionorebrolan.se.
authors.forename: Marcus
authors.initials: M
authors.lastname: Sagerfors
authors.affiliation: Department of Anesthesiology and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Anil
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Clinical Epidemiology and Biostatistics Unit, Örebro University, Örebro, Sweden.
authors.forename: Ole
authors.initials: O
authors.lastname: Brus
authors.affiliation: Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
authors.forename: Kurt
authors.initials: K
authors.lastname: Pettersson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D016059:Range of Motion, Articular; D013548:Sweden; D016896:Treatment Outcome; D014955:Wrist Joint / Q000601:surgery*
keywords: Osteoarthritis; rheumatoid arthritis; total wrist arthroplasty