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[Total wrist arthroplasty--indications and state of the art].

BACKGROUND
For decades design and development of TWA has been accompanied by quite a few failures, so that it has been rejected by most surgeons until today. The difficult and complex anatomy of the wrist led to different ways of development and often ended in an impasse. Compared to knee and hip arthroplasties which could be conceived and developed further, a consistent method could not be applied. But in the last years some new concepts have established themselves, so that TWA is now not only applied in individual cases. The indications could be expanded and standardised.


PATIENTS/MATERIAL AND METHODS
At the Hand-Center Lingen more than 400 TWAs have been performed since 2005. This article describes the mid-term results (5 years since operation) of TWA in 162 patients. 41 % suffered from rheumatoid arthritis, the remaining diseases consisted of osteoarthritis, post-traumatic arthritis and osteoarthritis following distal radius fracture, scaphoid non-union, scapholunate dissociation and Kienböck's disease.


RESULTS
Three different types of TWA have been applied and their benefits and disadvantages were examined. In the follow-up we found an improvement in the Quick-Dash of 34 points and 5.8 points on the VAS. The range of motion decreased in patients with RA, but it increased in patients with other diseases. In both groups of patients we found an increase of force. On the whole there was a rate of complications in an average rate of holding time of 3.7 %. There was no necessity for TWA removal and secondary wrist arthrodesis.


CONCLUSIONS
Our own very positive experience corresponds with the international comparison and it further encourages a standardised indication in TWA as an equivalent treatment.