The Difficult Total Wrist Arthroplasty

Introduction: Although the common historical complications of implant dislocation and implant loosening have dropped dramatically in frequency over the recent years, some patients present with more technical challenges in total wrist arthroplasty (TWA). A review of the special challenges of this cohort of “difficult” TWAs may provide some tips and technical options for treating surgeons.

Methods: Out of our cohort of 120 TWAs, we review cases of more challenging operations including those for osteoarthritis with or without distal radioulnar joint (DRUJ) arthritis (n = 16), catastrophic failure with implant pullout from trauma (n = 5), conversion of total wrist fusion to TWA (n = 4), and use of TWA in massive tumor cases (n = 1). The technical peculiarities of each clinical situation were assessed to form general principles of treatment. Pitfalls in assessing each clinical presentation were noted.

Results: Average follow-up examination was 4.5 years in all 26 cases (range 3–8 years). No further revisions of these cases have occurred to date. All cases were performed uncemented except for implant pullout and tumor procedures (n = 6). Technical tips on the use of any instrumentation, cement removal and placement, gap determination in fusion take-down procedures, shortening/onlay grafting/cerclage wiring in traumatic cases, and DRUJ treatment will be highlighted.

Conclusions: Successful treatment of difficult TWA procedures can be performed safely with reasonable expectations for mid- and long-term outcomes.

Bibliography

References

1 Weiss A-PC, Kamal RN, Shultz P. Total wrist arthroplasty. J Am Acad Orthop Surg 2013;21(3):140–148