Future of wrist arthroplasty.

It is a great honor for me to be the Guest Editor for this special focus sectionon totalwrist arthroplasty (TWA) in thefirst issue of the Journal of Wrist Surgery. The development of TWA for advanced wrist destruction follows that of the other major joints. However, the pace is slow for two main reasons: (1) wrist fusion is a traditional and reliable method to treat wrist destruction irrespective of its etiology and (2) the first generationTWAsuffered fromanumber ofmediumand longterm problems. However, one fact was striking: despite all the complications of thefirst-generationTWA,many patients who underwent arthroplasty on one side and arthrodesis on the other still preferred wrist arthroplasty. Since 2000, new resurfacing TWA designs have been proposed with better early results that led to more indications in selected patients. In these last-generation implants, the amountof bone resection is minimal and the adjacent carpometacarpal and distal radioulnar joint may be kept intact. Should the implant fail, conversion to total wrist fusion may be much easier than with the first-generation TWA. With this in mind, it is interesting to note that the use of TWA progresses as the use of total ankle arthroplasty does. The rationale is similar: patients prefer motion irrespective of the joint destroyed. Given the better early results of the last-generation TWA, there are a number of new trends trying to go even further, to get a reliable prosthetic solution for patients with advanced wrist destruction. I wish to thank all authors of this special focus section which is intended to provide the reader with the latest information about the controversial topic of TWA. The very first article on the recent total distal radioulnar joint resurfacing implant is also included in this TWA special section.