The concept of total wrist arthroplasty was first introduced by a German/Austrian Surgeon, Mr Themistocles Gluck in 1890. He implanted an ivory device to salvage a wrist destroyed by tuberculosis in a 19-year-old patient. Since then wrist prosthetic design and surgical technique have evolved to provide us with a range of prostheses for the treatment of radiocarpal arthritis. The first-generation prosthesis developed by Swanson consisted of a silastic flexible implant.
Themistocles
Gluck 1890
It provided initial good results but resulted in early failure due to implant fracture and/or foreign body reaction to silicone particles. The second-generation prostheses such as the Volz, the Meuli and the Guepar were introduced in the 1970s and consisted of separate radial and carpal components.
Development of Total Wrist Arthroplasty:
Fracturing, loosening and soft-tissue imbalance have all reduced the success of these implants and explain why total wrist arthroplasty remains controversial in comparison to other total joint replacements. An improved understanding of the biomechanical principles of the wrist joint has resulted in new third-generation designs (see pictures below) which attempt to maintain the normal function of the wrist. Zulfi Rahimtoola has been involved with the design of two Dutch wrist implants in the past and received the annual Dutch registrar prize in 2003 for their publications.
Rozing Wrist System, Total Modular Wrist and X-ray of wrist implant
Indications:
Total wrist arthroplasty should be considered for the rheumatoid wrist when there is severe wrist destruction and partial fusions no longer appropriate. Patients who are candidates for a total wrist fusion, but in whom the loss of wrist motion would increase their functional disability, should be offered the option of a total wrist implant. A few degrees of wrist motion greatly increases the reach of fingers in space and may have enormous functional consequences. Rheumatoid patients are suitable candidates for arthroplasty because of their low demands and low levels of activity. It remains very questionable whether patients with osteoarthritic or post-traumatic arthritic wrists are good candidates for an artificial joint as their demands may cause early failure of the prosthesis. Certainly, wrist arthrodesis may be the preferred choice patients engaged in heavy manual labour. When bilateral wrist disease exists, arthroplasty of the dominant side would seem an appropriate choice and has been favoured by other surgeons. Arthrodesis of the wrist is an effective surgical procedure, but only provides a compromise of pain relief for loss of motion and is not without complication.
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