title: Medium-term outcomes of the Universal-2 total wrist arthroplasty in patients with rheumatoid arthritis.
abstract: OBJECTIVE
  The aims of this study were to evaluate the clinical and radiological outcomes of the Universal-2 total wrist arthroplasty (TWA) in patients with rheumatoid arthritis.
  
  
  METHODS
  This was a retrospective review of all 95 Universal-2 TWAs which were performed in our institution between 2003 to 2012 in patients with rheumatoid arthritis. A total of six patients were lost to follow-up and two died of unrelated causes. A total of ten patients had bilateral procedures. Accordingly, 75 patients (85 TWAs) were included in the study. There were 59 women and 16 men with a mean age of 59 years (26 to 86). The mean follow-up was 53 months (24 to 120). Clinical assessment involved recording pain on a visual analogue score, range of movement, grip strength, the Quick Disabilities of the Arm, Shoulder and Hand (DASH) and Wrightington wrist scores. Any adverse effects were documented with particular emphasis on residual pain, limitation of movement, infection, dislocation and the need for revision surgery. Radiographic assessment was performed pre-operatively and at three, six and 12 months post-operatively, and annually thereafter. Arthroplasties were assessed for distal row intercarpal fusion and loosening. Radiolucent zones around the components were documented according to a system developed at our institution.
  
  
  RESULTS
  The mean worst pain was 8.1 (3 to 10) pre-operatively and 5.4 (0 to 10) at latest follow-up (p < 0.001). Movements were preserved with mean dorsiflexion of 29o(0oto 70o) and palmar flexion of 21o(0oto 50o). The mean grip strength was 4.8 kg (1.7 to 11.5) pre-operatively and 10 kg (0 to 28) at final follow-up (p < 0.001). The mean QuickDASH and Wrightington wrist scores improved from 61 (16 to 91) to 46 (0 to 89) and 7.9 (1.8 to 10) to 5.7 (0 to 7.8) (p < 0.001). A total of six patients (7%) had major complications; three required revision arthroplasty and three an arthrodesis. The Kaplan-Meier probability of survival using removal of the components as the endpoint was 91% at 7.8 years (95% confidence interval 84 to 91).
  
  
  CONCLUSIONS
  The Universal-2 TWA is recommended for use in patients with rheumatoid arthritis. Cite this article: Bone Joint J 2016;98-B:1642-7.
authors.affiliation: Wrightington Hospital NHS Trust, Hall Lane, Appley Bridge, Wigan, Lancashire, WN6 9EP, UK.
authors.forename: R
authors.initials: R
authors.lastname: Badge
authors.affiliation: Trauma and Orthopaedics, University Hospital Crosshouse, Kilmarnock, KA2 0BE, UK.
authors.forename: K
authors.initials: K
authors.lastname: Kailash
authors.affiliation: Wrightington Hospital NHS Trust, Hall Lane, Appley Bridge, Wigan, Lancashire, WN6 9EP, UK.
authors.forename: D R
authors.initials: DR
authors.lastname: Dickson
authors.affiliation: Hairmyres Hospital, Eaglesham Rd, East Kilbride, Glasgow, G75 8RG, UK.
authors.forename: S
authors.initials: S
authors.lastname: Mahalingam
authors.affiliation: James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK.
authors.forename: A
authors.initials: A
authors.lastname: Raza
authors.affiliation: Wrightington Hospital NHS Trust, Hall Lane, Appley Bridge, Wigan, Lancashire, WN6 9EP, UK.
authors.forename: A
authors.initials: A
authors.lastname: Birch
authors.affiliation: Wrightington Hospital NHS Trust, Hall Lane, Appley Bridge, Wigan, Lancashire, WN6 9EP, UK.
authors.forename: D
authors.initials: D
authors.lastname: Nuttall
authors.affiliation: Wrightington Hospital NHS Trust, Hall Lane, Appley Bridge, Wigan, Lancashire, WN6 9EP, UK.
authors.forename: S R
authors.initials: SR
authors.lastname: Murali
authors.affiliation: Wrightington Hospital NHS Trust, Hall Lane, Appley Bridge, Wigan, Lancashire, WN6 9EP, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Hayton
authors.affiliation: Wrightington Hospital NHS Trust, Hall Lane, Appley Bridge, Wigan, Lancashire, WN6 9EP, UK.
authors.forename: S
authors.initials: S
authors.lastname: Talwalkar
authors.affiliation: Wrightington Hospital NHS Trust, Hall Lane, Appley Bridge, Wigan, Lancashire, WN6 9EP, UK.
authors.forename: A C
authors.initials: AC
authors.lastname: Watts
authors.affiliation: Wrightington Hospital NHS Trust, Hall Lane, Appley Bridge, Wigan, Lancashire, WN6 9EP, UK.
authors.forename: I A
authors.initials: IA
authors.lastname: Trail
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D019643:Arthroplasty, Replacement / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength; D006801:Humans; D007595:Joint Prosthesis / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain; D011474:Prosthesis Design; D011475:Prosthesis Failure / Q000209:etiology; D016459:Prosthesis-Related Infections / Q000209:etiology; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*
keywords: Medium-term outcomes; Total wrist arthroplasty