Subscribe to RSS
DOI: 10.1055/s-0037-1603320
Survivorship of Revision Wrist Replacement
Publication History
26 October 2016
17 April 2017
Publication Date:
15 May 2017 (online)
![](https://www.thieme-connect.de/media/jws/201801/lookinside/thumbnails/10-1055-s-0037-1603320_1600102-1.jpg)
Abstract
Purpose This study aims to report the 5-year survivorship of revision wrist arthroplasties and to report midterm clinical and radiological results.
Materials and Methods All patients receiving a revision wrist arthroplasty in our unit between January 1, 1997 and October 31, 2010 were identified, and clinical notes retrospectively analyzed for Quick Disabilities of the Arm, Shoulder and Hand (quickDASH), Patient Evaluation Method (PEM), Patient-Rated Wrist Evaluation (PRWE), the range of movement, and visual analog score (VAS). In cases where patient review had not occurred within the past year, they were invited for assessment, and this data was included in the analysis. Plain radiographs were analyzed for loosening of each component. The 5-year survival was plotted using Kaplan–Meier analysis.
Results Of the 19 patients identified, 1 was lost to follow-up and therefore excluded from all analyses. Mean age at revision wrist arthroplasty was 55.8 years and the mean time from primary to revision wrist arthroplasty was 6.7 years. At revision arthroplasty, 7 patients received the Biaxial implant (DePuy, Inc., Warsaw, IN) and 11 received the Universal II implant (Integra, Inc., Plainsboro, NJ). The 5-year implant revision survivorship was 83%. Depending on the variable of interest, clinical data were available for either three, four or five patients. At final follow-up (mean: 10.4 years), mean visual analog score was 2.9, mean quickDASH 57, mean PEM 49, mean PRWE 61, and mean arc of flexion/extension was 26 degrees. Radiological data were available for 12 patients, with evidence of gross loosening present in around 60% of the carpal components and 50% of the radial components at mean 6.7 years.
Conclusion Revision wrist replacement implant survival is acceptable, but the majority of the surviving implants are radiologically loose. It is not clear at this time whether they are better or worse than a fusion after a failed primary wrist arthroplasty.
Clinical Relevance It is reasonable to offer revision wrist arthroplasty in selective cases, but regular clinical and radiological follow-up is recommended.
-
References
- 1 Palmer AK, Werner FW, Murphy D, Glisson R. Functional wrist motion: a biomechanical study. J Hand Surg Am 1985; 10 (01) 39-46
- 2 Yeoh D, Tourret L. Total wrist arthroplasty: a systematic review of the evidence from the last 5 years. J Hand Surg Eur Vol 2015; 40 (05) 458-468
- 3 Ryu JY, Cooney III WP, Askew LJ, An KN, Chao EY. Functional ranges of motion of the wrist joint. J Hand Surg Am 1991; 16 (03) 409-419
- 4 Nydick JA, Greenberg SM, Stone JD, Williams B, Polikandriotis JA, Hess AV. Clinical outcomes of total wrist arthroplasty. J Hand Surg Am 2012; 37 (08) 1580-1584
- 5 Nydick JA, Watt JF, Garcia MJ, Williams BD, Hess AV. Clinical outcomes of arthrodesis and arthroplasty for the treatment of posttraumatic wrist arthritis. J Hand Surg Am 2013; 38 (05) 899-903
- 6 Ferreres A, Lluch A, Del Valle M. Universal total wrist arthroplasty: midterm follow-up study. J Hand Surg Am 2011; 36 (06) 967-973
- 7 Badge R, Kailash K, Dickson DR. , et al. Medium-term outcomes of the Universal-2 total wrist arthroplasty in patients with rheumatoid arthritis. Bone Joint J 2016; 98-B (12) 1642-1647
- 8 Takwale VJ, Nuttall D, Trail IA, Stanley JK. Biaxial total wrist replacement in patients with rheumatoid arthritis. Clinical review, survivorship and radiological analysis. J Bone Joint Surg Br 2002; 84 (05) 692-699
- 9 Cobb TK, Beckenbaugh RD. Biaxial long-stemmed multipronged distal components for revision/bone deficit total-wrist arthroplasty. J Hand Surg Am 1996; 21 (05) 764-770
- 10 Rettig ME, Beckenbaugh RD. Revision total wrist arthroplasty. J Hand Surg Am 1993; 18 (05) 798-804
- 11 Talwalkar SC, Hayton MJ, Trail IA, Stanley JK. Management of the failed biaxial wrist replacement. J Hand Surg [Br] 2005; 30 (03) 248-251
- 12 Vogelin E, Nagy L. Fate of failed Meuli total wrist arthroplasty. J Hand Surg [Br] 2003; 28 (01) 61-68
- 13 Beaton DE, Wright JG, Katz JN. ; Upper Extremity Collaborative Group. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am 2005; 87 (05) 1038-1046
- 14 Dias JJ, Bhowal B, Wildin CJ, Thompson JR. Assessing the outcome of disorders of the hand. Is the patient evaluation measure reliable, valid, responsive and without bias?. J Bone Joint Surg Br 2001; 83 (02) 235-240
- 15 MacDermid JC, Turgeon T, Richards RS, Beadle M, Roth JH. Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma 1998; 12 (08) 577-586
- 16 Bellemère P, Maes-Clavier C, Loubersac T, Gaisne E, Kerjean Y, Collon S. Pyrocarbon interposition wrist arthroplasty in the treatment of failed wrist procedures. J Wrist Surg 2012; 1 (01) 31-38
- 17 Lorei MP, Figgie MP, Ranawat CS, Inglis AE. Failed total wrist arthroplasty. Analysis of failures and results of operative management. Clin Orthop Relat Res 1997; (342) 84-93
- 18 Khan Y, Konan S, Sorene E. Revision of a failed Swanson arthroplasty to a total wrist replacement restores wrist function and movements. J Plast Surg Hand Surg 2014; 48 (02) 136-138
- 19 Khan Y, Sorene E. Salvage Universal 2 total wrist replacement for a failed Swanson prosthesis. Inj Extra 2010; 41: 74-75
- 20 Beer TA, Turner RH. Wrist arthrodesis for failed wrist implant arthroplasty. J Hand Surg Am 1997; 22 (04) 685-693
- 21 Ferlic DC, Jolly SN, Clayton ML. Salvage for failed implant arthroplasty of the wrist. J Hand Surg Am 1992; 17 (05) 917-923
- 22 Carlson JR, Simmons BP. Wrist arthrodesis after failed wrist implant arthroplasty. J Hand Surg Am 1998; 23 (05) 893-898