Total wrist arthroplasty efficacy and safety: a systematic review.

Abstract

Wrist arthrosis is a clinically relevant condition with considerable impact on patients' daily lives. While total wrist arthroplasty (TWA) has emerged as a motion-preserving alternative to arthrodesis, evidence regarding its long-term effectiveness and safety remains heterogeneous. Therefore, this study systematically reviews clinical outcomes of TWA, including patient-reported outcome measures (PROMs), functional performance, and surgical safety endpoints such as complications, revisions, and reoperations. The present systematic review followed the guidelines defined in the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. PubMed, Web of Science, and Embase were accessed in January 2025 without additional filters or temporal constraints. All clinical studies investigating the clinical outcomes of TWA were included. Data concerning the visual analogue scale (VAS), disability of arm, shoulder, and hand (DASH), patient-reported wrist evaluation (PRWE) score, grip strength and ROM were collected at baseline and at last follow-up. Data on complications, reoperation and revision rates were collected postoperatively. Only studies with a minimum of one year of follow-up were included. The methodological quality of the included studies was assessed using the ROBINS-I tool for non-randomised studies. Data on 2503 wrists from 2362 patients across 62 studies were retrieved. All PROMs and functional tests showed a statistically significant improvement from baseline to the last follow-up (p < 0.001 for each parameter). A total of 924 postoperative complications were reported over 2503 operated wrists (36.9%). 16.3% (408 of 2503) wrists underwent revision, and 18.4% (461 of 2503) needed further surgical interventions because of complications. TWA appears to be effective in improving pain and disability scores for patients affected by wrist arthrosis. However, some uncertainty persists regarding the safety profile of the surgical procedure. Future studies should focus on reducing postoperative complications. Level II.