Trends in the Utilization of Total Wrist Arthroplasty versus Wrist Fusion for Treatment of Advanced Wrist Arthritis
08 October 2015
04 January 2016
09 February 2016 (eFirst)
Background Total wrist arthroplasty (TWA) provides the requisite range of motion to accomplish activities of daily living, especially for low-demand patients with bilateral wrist arthritis. However, there are no large epidemiologic studies to evaluate nationwide trends of TWA and wrist fusion (WF).
Questions/Purposes To analyze data collected from the National Inpatient Sample (NIS) to compare utilization, demographic, and outcome data among patients undergoing TWA versus total WF. We hypothesized that utilization rates of TWA have significantly increased over the prior decade in the United States.
Methods NIS data from 2001 to 2010 were reviewed. Procedures were identified by ICD-9-CM codes 81.73 (TWA) and 81.25 (WF). Utilization rates, primary treatment diagnoses, patient demographic and medical comorbidity data, and procedure costs were compared between TWA and WF.
Results There was a decrease in the number of procedures per year for TWA, while the number of WF remained relatively unchanged. There was, however, a transient increase in the frequency of TWA procedures performed from 2005 to 2008, following a decline in 2005. Patients with traumatic arthritis were more likely to receive WF. Rheumatoid patients were more likely to receive TWA. Patients receiving TWA tended to be older, female, be insured by Medicare, have a greater comorbidity burden, and have rheumatologic disease.
Conclusion WF was performed nearly four times more frequently than TWA. A trend was demonstrated toward a decreasing number of TWA being implanted, and in patients with more underlying comorbidities. TWA was associated with a higher hospitalization charge, which may be expected given the higher implant costs associated with arthroplasty.
Level of Evidence Level II, prognostic study.
The study was performed entirely at NYU Hospital for Joint Diseases, New York.
- 1 Buckwalter JA, Saltzman C, Brown T. The impact of osteoarthritis: implications for research. Clin Orthop Relat Res 2004; (427, Suppl): S6-S15
- 2 Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am 1984; 9 (3) 358-365
- 3 Graham TJ. Total wrist arthrodesis and total wrist arthroplasty. In: Chhabra AB, Issacs J, eds. Arthritis and Arthroplasty: The Hand, Wrist and Elbow. 1st ed. Philadelphia, PA: Saunders; 2009: 90-105
- 4 Nydick JA, Watt JF, Garcia MJ, Williams BD, Hess AV. Clinical outcomes of arthrodesis and arthroplasty for the treatment of posttraumatic wrist arthritis. J Hand Surg Am 2013; 38 (5) 899-903
- 5 Cavaliere CM, Chung KC. A systematic review of total wrist arthroplasty compared with total wrist arthrodesis for rheumatoid arthritis. Plast Reconstr Surg 2008; 122 (3) 813-825
- 6 Murphy DM, Khoury JG, Imbriglia JE, Adams BD. Comparison of arthroplasty and arthrodesis for the rheumatoid wrist. J Hand Surg Am 2003; 28 (4) 570-576
- 7 Anderson MC, Adams BD. Total wrist arthroplasty. Hand Clin 2005; 21 (4) 621-630
- 8 Graham TJ, Harman TW, Higgins JP , et al. Rheumatoid wrist arthrodesis using plate fixation. Atlas Hand Clin 2005; 10: 289-305
- 9 Franko OI, Zurakowski D, Day CS. Functional disability of the wrist: direct correlation with decreased wrist motion. J Hand Surg Am 2008; 33 (4) 485-492
- 10 Agency for Healthcare Research and Quality. HCUP NIS database documentation. Avalable at: http://www.hcup-us.ahrq.gov/db/nation/nis/nisdbdocumentation.jsp . Accessed July 18, 2014
- 11 Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project (HCUP). HCUP comorbidity software. Available at: http://www.hcup-us.ahrq.gov/toolssoftware/comorbidity/ . Accessed July 18, 2014
- 12 Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40 (5) 373-383
- 13 US Census Bureau. 2010 census. Available at: http://www.census.gov/population/race/data/cen2010.html . Accessed July 24, 2014
- 14 Morapudi SP, Marlow WJ, Withers D, Ralte P, Gabr A, Waseem M. Total wrist arthroplasty using the Universal 2 prosthesis. J Orthop Surg (Hong Kong) 2012; 20 (3) 365-368
- 15 Herzberg G. Prospective study of a new total wrist arthroplasty: short term results. Chir Main 2011; 30 (1) 20-25
- 16 Herzberg G, Boeckstyns M, Sorensen AI , et al. “Remotion” total wrist arthroplasty: preliminary results of a prospective international multicenter study of 215 cases. J Wrist Surg 2012; 1 (1) 17-22
- 17 Ferreres A, Lluch A, Del Valle M. Universal total wrist arthroplasty: midterm follow-up study. J Hand Surg Am 2011; 36 (6) 967-973
- 18 Boeckstyns ME, Herzberg G, Merser S. Favorable results after total wrist arthroplasty: 65 wrists in 60 patients followed for 5–9 years. Acta Orthop 2013; 84 (4) 415-419
- 19 Harlingen Dv, Heesterbeek PJ , J de Vos M, High rate of complications and radiographic loosening of the biaxial total wrist arthroplasty in rheumatoid arthritis: 32 wrists followed for 6 (5–8) years. Acta Orthop 2011; 82 (6) 721-726
- 20 Ward CM, Kuhl T, Adams BD. Five to ten-year outcomes of the Universal total wrist arthroplasty in patients with rheumatoid arthritis. J Bone Joint Surg Am 2011; 93 (10) 914-919
- 21 Kretschmer F, Fansa H. BIAX total wrist arthroplasty: management and results after 42 patients [in German]. Handchir Mikrochir Plast Chir 2007; 39 (4) 238-248
- 22 Nikiphorou E, Carpenter L, Morris S , et al. Hand and foot surgery rates in rheumatoid arthritis have declined from 1986 to 2011, but large-joint replacement rates remain unchanged: results from two UK inception cohorts. Arthritis Rheumatol 2014; 66 (5) 1081-1089
- 23 Feldon P, Terrono AL, Nalebuff EA, Millender LH. Rheumatoid arthritis and other connective tissue diseases. In: Wolfe SW, Pederson WC, Hotchkiss RN, Kozin SH, eds. Green's Operative Hand Surgery. Philadelphia, PA: Churchill Livingstone; 2011: 1993-2065
- 24 Yeoh D, Tourret L. Total wrist arthroplasty: a systematic review of the evidence from the last 5 years. J Hand Surg Eur Vol 2015; 40 (5) 458-468
- 25 Krukhaug Y, Lie SA, Havelin LI, Furnes O, Hove LM. Results of 189 wrist replacements. A report from the Norwegian Arthroplasty Register. Acta Orthop 2011; 82 (4) 405-409
- 26 Weiss AP, Kamal RN, Shultz P. Total wrist arthroplasty. J Am Acad Orthop Surg 2013; 21 (3) 140-148