Revision Arthroplasty of the Wrist

Abstract

Purpose: Management of failed total wrist arthroplasty (TWA) can be challenging, and treatment options include salvage arthrodesis or revision arthroplasty. To our knowledge, there are no previously published series on this subject. The aim of the study was to report outcome after revision arthroplasty of the wrist operated at a Swedish referral center. Methods: A cohort of 18 consecutive revision TWAs was evaluated preoperatively, 1 and 5 years postoperatively. Indication for revision arthroplasty was failed TWA. The operations were performed between 2003 and 2015. The primary endpoint was implant survivorship. Secondary outcome measures included visual analogue scale (VAS) pain scores, range of motion, hand grip strength, and functional scoring with Canadian Occupational Performance Measure (COPM). Results: Of the 18 revision cases, 4 were revised after a mean of 4.5 years (range, 3-5 years). Mean follow-up was 6.1 years (range, 1-12 years). Synthetic bone graft was used in 9 cases, allogenous corticocancellous bone graft in 1 case, and cement in 6 cases. Of the revised cases, 1 TWA was removed because of infection and 3 cases underwent total wrist arthrodesis. Range of motion and grip strength was preserved compared with preoperative results. VAS pain score at rest and in activity decreased considerably 1 year (0 at rest; 2.4 in activity) and 5 years postoperative (0.1 at rest; 1.1 in activity) compared with preoperative results (1.5 at rest; 3.8 in activity). COPM performance and satisfaction were improved considerably 1 year (5.9 performance; 6.6 satisfaction) and 5 years postoperative (4.1 performance; 4.3 satisfaction) compared with preoperative results (3.5 performance; 3.1 satisfaction). Conclusion: Revision arthroplasty of the wrist is a motion preserving option to wrist arthrodesis in the management of failed TWA. Good functional outcome can be achieved in selected cases.