Twenty studies evaluated arthrodesis (n=860) and 18 studies evaluated arthroplasty (n=503). The number of wrists per study ranged from 12 to 140. Third-generation prostheses were inserted in 332 patients. Treatment groups were similar with respect to the percentage of women (79 per cent), mean age (56 and 57 years) and mean duration of follow-up (4.5 years). Studies did not consistently report disease severity or pre-operative measures of function.
Pain: Mild or no pain was reported by 90 per cent of patients undergoing arthroplasty, 98 per cent undergoing arthrodesis and 91 per cent who received a third-generation arthroplasty prosthesis.
Range of motion: Only three of the 14 studies that reported average flexion, extension and radial and ulnar deviation showed an average range of motion within the functional range for all values (5° flexion, 30° extension, 10° radial deviation and 14° ulnar deviation as described by Palmer).
Complications and revision: Total complication rates were 30 per cent for arthroplasty and 17 per cent for arthrodesis. Major complications were more common after arthroplasty (25 per cent) and third-generation prosthesis (21 per cent) than arthrodesis (13 per cent). Revision or re-operation rates were 15 per cent for arthrodesis, 21 per cent for arthroplasty (5.4 per cent requiring prosthesis removal and salvage arthrodesis) and 17 per cent for third-generation arthroplasty (six per cent requiring prosthesis removal or salvage arthrodesis).
Satisfaction: Percentages of patients reporting satisfaction were 91 per cent for arthroplasty and 93 per cent for arthrodesis.