title: Trends in the Utilization of Total Wrist Arthroplasty versus Wrist Fusion for Treatment of Advanced Wrist Arthritis.
abstract: BACKGROUND
  Total wrist arthroplasty (TWA) provides the requisite range of motion to accomplish activities of daily living, especially for low-demand patients with bilateral wrist arthritis. However, there are no large epidemiologic studies to evaluate nationwide trends of TWA and wrist fusion (WF).
  
  
  OBJECTIVE
  To analyze data collected from the National Inpatient Sample (NIS) to compare utilization, demographic, and outcome data among patients undergoing TWA versus total WF. We hypothesized that utilization rates of TWA have significantly increased over the prior decade in the United States.
  
  
  METHODS
  NIS data from 2001 to 2010 were reviewed. Procedures were identified by ICD-9-CM codes 81.73 (TWA) and 81.25 (WF). Utilization rates, primary treatment diagnoses, patient demographic and medical comorbidity data, and procedure costs were compared between TWA and WF.
  
  
  RESULTS
  There was a decrease in the number of procedures per year for TWA, while the number of WF remained relatively unchanged. There was, however, a transient increase in the frequency of TWA procedures performed from 2005 to 2008, following a decline in 2005. Patients with traumatic arthritis were more likely to receive WF. Rheumatoid patients were more likely to receive TWA. Patients receiving TWA tended to be older, female, be insured by Medicare, have a greater comorbidity burden, and have rheumatologic disease.
  
  
  CONCLUSIONS
  WF was performed nearly four times more frequently than TWA. A trend was demonstrated toward a decreasing number of TWA being implanted, and in patients with more underlying comorbidities. TWA was associated with a higher hospitalization charge, which may be expected given the higher implant costs associated with arthroplasty.
  
  
  METHODS
  Level II, prognostic study.
authors.affiliation: Division of Hand Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: Eitan
authors.initials: E
authors.lastname: Melamed
authors.affiliation: Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, New York, New York.
authors.forename: Bryan
authors.initials: B
authors.lastname: Marascalchi
authors.affiliation: Division of Hand Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Hinds
authors.affiliation: Division of Hand Surgery, Department of Orthopedics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Marco
authors.initials: M
authors.lastname: Rizzo
authors.affiliation: Division of Hand Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: John T
authors.initials: JT
authors.lastname: Capo
keywords: National Inpatient Sample; arthritis; total wrist arthroplasty; wrist fusion