# Total wrist arthroplasty revisited: survival, function, and patient-reported outcomes of BIAX and universal II prostheses over 15 years

## TL;DR

This study compares the long-term performance of two wrist prostheses, finding that the BIAX model outperforms the Universal II in terms of survival, pain reduction, and patient satisfaction over 15 years.

## Contribution

The study provides a 15-year follow-up comparison of BIAX and Universal II wrist prostheses using real-world clinical data from the TEP Register.

## Key findings

- The BIAX prosthesis had a 15-year survival rate of 60%, compared to 41% for the Universal II.
- BIAX showed lower complication rates and better patient-reported outcomes like pain and satisfaction.
- Long-term results indicate BIAX outperforms Universal II in clinical effectiveness and durability.

## Abstract

In the management of degenerative osteoarthritis and rheumatoid arthritis of the wrist, surgical intervention remains an important treatment option when conservative approaches such as medication, physiotherapy, and assistive devices prove insufficient. Despite decades of development, no single wrist prosthesis has yet emerged as the definitive standard in total wrist arthroplasty. To address this gap, the German Society for Hand Surgery established the Total Endoprosthesis (TEP) Register in 2004 to systematically collect and evaluate long-term clinical outcomes. The present prospective single-centre study analyses and presents the long-term results of patients enrolled in the TEP register, offering valuable insights into the performance and durability of wrist prostheses in a real-world clinical setting.

Between 2000 and 2011, a total of 29 total endoprostheses were implanted in 25 patients in a single centre study due to severe degenerative changes in the wrist. Of these, 22 had rheumatoid arthritis and 3 degenerative osteoarthritis. The prosthesis models BIAX (N = 13) and Universal II (N = 16) were implanted. The present study describes the mean outcome after a mean observation period of 13.8 (1.7–21.4) years for the BIAX prosthesis and 10.5 years (0.2–16.4) for the Universal II prosthesis.

The probability of survival after 15 years is 60% for the BIAX prosthesis and 41% for the Universal II prosthesis. After 21 years, results are only available for the BIAX prosthesis with a value of 60%. The BIAX prosthesis showed a lower complication rate. Subjectively, 15 years postoperatively, the BIAX prosthesis showed a lower mean value in the QuickDASH score (BIAX 33.8%, Universal II 50.3%), lower results in the visual analogue pain scale under stress (BIAX: 1 point; Universal II: 3 points) with higher patient satisfaction (BIAX: 86%; Universal II: 78%).

In conclusion, our observations show that the BIAX prosthesis is superior to the Universal II prosthesis 15 years after surgery in terms of survival probability, complication rate and better results in satisfaction, the visual analogue pain scale and the QuickDASH score.