Wrist Arthroplasty Techniques and Outcomes
Summary
A range of surgical techniques has evolved to address end-stage wrist arthrosis, spanning soft-tissue interposition, segmental excision and prosthetic replacement. Proximal row carpectomy (PRC) and its variants create a functional neo-joint by excising the scaphoid, lunate and triquetrum; four-corner arthrodesis stabilises midcarpal facets while preserving partial motion; and total wrist arthroplasty (TWA) offers an implant-based solution for diverse pathologies from rheumatoid arthritis to post-traumatic osteoarthritis. Contemporary TWA designs employ modular stems, advanced surface coatings and novel biomaterials to mitigate loosening and optimise joint kinematics. Outcome measures across these approaches emphasise pain relief, range of motion, grip strength, complication and revision rates, and patient-reported functional scores. Long-term data indicate that while fusion techniques deliver durable stability, they may restrict motion; conversely, arthroplasty preserves movement but carries risks of implant wear, loosening and potential revision. Recent advancements in interposition grafts, bioabsorbable and shape-memory alloy fixation, and pyrocarbon hemiarthroplasty have refined the balance between stability and mobility, enabling tailored interventions based on pathology and patient demand.
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Wrist Arthroplasty Techniques and Outcomes publication trend
The graph below shows the total number of articles in wrist arthroplasty techniques and outcomes across all publications each year (not limited to Nature Index journals).
Technical terms
Proximal row carpectomy (PRC): Surgical excision of the scaphoid, lunate and triquetrum to create a neo-joint between the capitate and radius.
Four-corner arthrodesis: Fusion of the capitate, lunate, triquetrum and hamate bones following scaphoid excision to stabilise the midcarpal joint.
Interposition arthroplasty: Reconstruction of a joint surface gap using soft-tissue grafts or biomaterials to preserve motion and cushion articulations.
Total wrist arthroplasty (TWA): Replacement of the radiocarpal joint with a prosthetic implant designed to restore movement and unload arthritic surfaces.
Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC): Patterns of degenerative wrist arthritis characterised by progressive cartilage loss secondary to ligament injury or scaphoid nonunion.
References
- Proximal row carpectomy with interposition arthroplasty using both capsular flap and acellular human dermal matrix. BMC Musculoskeletal Disorders (2024).
- Clinical efficacy of Ni-Ti memory alloy four-corner arthrodesis concentrator in the treatment of scaphoid nonunion advanced collapse: a follow-up of over 10 years.. Journal of Plastic Surgery and Hand Surgery (2024).
- Lunate-capitate arthrodesis for scaphoid nonunion: a comparative study. BMC Musculoskeletal Disorders (2024).
- Four-corner fusion method using a bioabsorbable plate for scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists: a case series study. BMC Musculoskeletal Disorders (2020).
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