Wrist Arthroplasty: A Complicated Matter: Level 4 Evidence

Abstract

Despite continued advances in implant design for partial and total wrist arthroplasty, these surgeries present a high incidence of complications, many of which require revision surgery with the potential of a complicated post-operative course. We hypothesize that the incidence of complication is higher then the current reported literature. Follow up duration averaged 2.6 years with longest being 12.4 years. A retrospective review of 105 wrist surgeries in 100 patients who underwent surgery with prosthetic replacement of the distal radius, the proximal carpus or both at a single institution (2005-2014) was performed. Patient factors including age, sex, BMI, handedness, underlying disease and previous injury were recorded. Outcomes were focused particularly on post-operative complications and need for revision surgery. Fourty-seven total wrist arthroplasties (TWA), 52 distal radius hemi-arthroplasties (DRH), and 6 proximal carpal hemiarthroplasties (CH) were performed. Majority (61.7%) of TWA were performed for Rheumatoid Arthritis (RA) or other inflammatory arthropathies, whereas degenerative or post-traumatic arthritis represented the underlying condition for majority of both the DRH (76.9%), and CH (66.7%) groups. Overall complication rate was 50.1% (53/105). Post-operative contracture accounted for the largest number of complications needing additional surgery (20%) though the incidence was much higher in DRH than in TWA (42.3 vs. 16.7%). Component failure composed 15% of all complications, with TWA having the highest incidence across the groups with 24%. Superficial infections occurred at 7.1 and 7.6% in TWA and DRH, respectively. One superficial infection resulted in wound dehiscence that was operatively debrided and closed. All other superficial infections resolved with a short course of oral antibiotics. Deep infections occurred in 4.7 and 3.8% of TWA and DRH, respectively. They were associated with a high number of medical co-morbidities and multiple prior surgeries. All deep infections required removal of hardware, antibiotic spacer placement, and a prolonged course of IV antibiotics prior to a definitive operation. •Though total and partial wrist arthroplasty can provide significant pain relief for the arthritic wrist, there remains a significant potential for complications and need for further surgery.•Patients should be counseled on the potential risks and post-operative course.•It should be noted that the likelihood of failure of wrist arthroplasty tends to increase as time from surgery increases.•Certain patients should be screened with great caution, particularly those with multiple medical co-morbidities, and those pre-disposed to wound issues such as those with low BMI, or poor skin quality.