Change in Carpal Height as Related to Outcomes of Total Wrist Arthroplasty

Abstract Total wrist arthroplasty (TWA) is a motion-preserving surgical procedure employed for the treatment of painful wrist arthritis. Although restoration of carpal height and alignment is assumed to influence postoperative function, the correlation between radiographic parameters and clinical outcomes remains limited by a lack of high-quality evidence consistently linking static radiographic measures to long-term functional success following TWA. A retrospective multicenter review of 49 TWA surgeries was performed. Pre- and postoperative radiographic measurements (carpal height, Youm and Nattrass ratios, carpal–ulnar distance) and motion-based metrics were compared to overall outcomes rated on a study-specific 5-point Likert-type scale. The cohort included 49 wrists (43% male, 57% female; mean age: 61 years) with a mean follow-up of 41.2 months (range: 6–103). No statistically significant association was observed between changes in radiographic parameters and overall clinical outcome. Despite variability in carpal height and alignment ratios, most patients achieved satisfactory or excellent outcomes. In the subset with available data, the mean flexion–extension arc improved from 52 degrees preoperatively to 69 degrees postoperatively. Radiographic measures alone do not predict patient-reported outcomes following TWA. These findings suggest that functional success is driven primarily by soft-tissue balance rather than static geometric restoration. Future research should therefore incorporate validated functional outcome measures and objective intraoperative assessments of soft-tissue tension. Level III retrospective cohort study.