Revision Surgery after Total Wrist Arthroplasty

Background: Third-generation implants for total wrist arthroplasty (TWA) have now been available for more than 17 years. Consequently, an increasing number need revision.

Purpose/Aim of Study: To report on our experience with revision surgery after failed TWA.

Materials and Methods: We prospectively and consecutively collected data on all TWAs that were revised in two clinics and made a general follow-up examination in May–June 2015.

Findings/Results: 19 wrists were revised in 19 patients (15 female, 4 male). Mean age at primary operation was 54 years (range: 28–78). The diagnosis was rheumatoid arthritis in eight cases, scapholunate advanced collapse (SLAC) wrist in four, idiopathic osteoarthritis in two, scaphoid nonunion advanced collapse (SNAC) wrist in one, syringomyelia in one, Kienböck disease in two, Preiser disease in one. The primary operation was performed in other clinics in seven cases. Indication for revision was loosening/subsidence in 11 cases, wrist ankylosis in flexion in two, malposition of implant components in three, severe periprosthetic osteolysis in one, dislocation and instability in one, and pain without loosening in one.

Nine implants were revised to a cemented Re-Motion (Small Bone Innovations, Inc., Morrisville, PA, USA) TWA, three to an uncemented Re-Motion TWA, one to an Amandys interpostion pyrocarbon prosthesis (Tornier, Montbonnot Saint Martin, France), and six were fused. Subsequent re-revision of three Re-Motions to fusion was done. One Re-Motion re-arthroplasty was reoperated with a new Re-Motion with bone graft due to massive osteolysis.

Mean follow-up time was 31 months (range, 3–102 months). The median QuickDASH (Disabilities of the Arm, Shoulder and Hand) score was 42 at follow-up (range 11–68). Median QuickDASH for patients with fused wrist was 52. Median QuickDASH for patients with an implant was 36. Scores improved in all except one (median improvement 25 points).

Median Visual Analog Scale (VAS) score for general pain level at follow-up was 2 on a scale from 0 to 100. Median VAS score for patients with a fused wrist was 8, and for patients with an implant, 1. Median VAS score improvement was 50.

QuickDASH and VAS scores did not differ statistically significantly between patients with a new implant and patients with a fused wrist.

At follow-up one implant was loose (tilted carpal plate, VAS 84, QuickDASH 68). This patient is scheduled for a re-revision. All fusions were consolidated. One of the patients with fusion complained of severe problems (VAS 80, QuickDASH 66), despite consolidated fusion .We attribute these complaints to a difficult psychological profile.

Conclusions and Clinical Implications: Both fusion and revision to a new TWA are feasible after a failed TWA. Revision to a new TWA may require supplementary major procedures.