Outcomes of radial-sided wrist hemiarthroplasty: A systematic review

Abstract

Purpose: Wrist hemiarthroplasty (WHA) has gained popularity as a motion-sparing alternative to either total wrist arthroplasty or wrist arthrodesis for a variety of pathologies, yet limited data currently supports its use. This systematic review was performed to evaluate the clinical outcomes and complications following WHA, regardless of indication.

Methods: A systematic review was performed using PubMed, Cochrane, and Embase databases to identify relevant studies published through January 2023. Articles describing outcomes following WHA with a distal radius prosthesis, for any indication, were included. Primary outcomes included Disabilities of the Arm, Shoulder, and Hand (DASH) scores, visual analog scale (VAS), grip strength, and range of motion (ROM). Secondary outcomes included clinical and radiographic complications, revisions, and other reoperations.

Results: Twelve studies with 207 patients were included. At follow-up times ranging from 7.7 to 52 months, mean postoperative DASH scores ranged from 18.2 to 58.6, VAS scores ranged from 1 to 3.8, and mean grip strengths were 8.6-33.5 kg, or 44.9-92 % of the contralateral hand. Mean ROM arcs ranged from 42 to 96.0° in flexion-extension, 74-163.6° in pronation-supination, and 22.9-46° in radial-ulnar deviation. Clinical complications occurred in 26.6 % of patients, while degenerative and implant-related radiographic findings were reported in 12.1 % and 3.0 % of patients, respectively. At least one revision was performed in 12.2 % of patients, and 8.2 % required an additional non-revision operation on the affected wrist.

Conclusions: The functional and clinical outcomes of WHA are considerably variable, which may be influenced by patient demographics and surgical indication in particular. While WHA appears to provide adequate preservation of wrist ROM, it carries a relatively high risk of complications, revision, and need for reoperation.

Level of evidence: Therapeutic V.

Keywords: Arthroplasty; Functional outcomes; Hemiarthroplasty; Resurfacing; Wrist.