Comparative outcomes of total wrist arthrodesis for salvage of failed total wrist arthroplasty and primary wrist arthrodesis

Abstract

A retrospective study compared outcomes of total wrist arthrodesis as a salvage for total wrist arthroplasty versus primary total wrist arthrodesis. Seventy-one wrists were reviewed after a minimum follow-up of 12 months. Thirty-two wrists with failed total wrist arthroplasty were converted to a wrist arthrodesis and 39 wrists received a primary wrist arthrodesis. Seven converted wrist arthrodeses and five primary arthrodeses failed to fuse. Mean patient-rated wrist and hand evaluation scores and work-related questionnaire for upper extremity disorders scores were 43 and 39 for converted total wrist arthrodesis and 38 and 33 for the primary total wrist arthrodesis. Overall, there were 25 complications in 15 patients in the converted wrist arthrodesis group and 21 complications in 16 patients after a primary wrist arthrodesis. The results between the two groups were slightly in favour of patients with a primary wrist arthrodesis. Therefore, we conclude that the timing, primary or conversion, of total wrist arthrodesis could influence patient outcomes. Level of evidence: III

Wrist & Hand

“…Therefore, it is useful to see the work of a team from Amsterdam (The Netherlands), who performed a retrospective review of their series of patients undergoing either primary wrist arthrodesis or salvage wrist arthrodesis following failed arthroplasty. 4 Interestingly, this paper shows a relatively high complication rate in the primary arthrodesis group, as well as those patients undergoing conversion of a failed wrist arthroplasty to arthrodesis. However, the successful fusion rate in the converted group is higher in this paper than in the literature.…”

“…Therefore, it is useful to see the work of a team from Amsterdam (The Netherlands) , who performed a retrospective review of their series of patients undergoing either primary wrist arthrodesis or salvage wrist arthrodesis following failed arthroplasty. 4 They reviewed 11 years’ worth of records extracting indication, patient demographics, perioperative findings, radiographic findings, complications, and reoperations. Patients with incomplete radiographs, less than 12 months follow-up, or lost to follow-up were excluded.…”

Massive Osteolysis and Pseudotumor Formation following Maestro Total Wrist Arthroplasty

“…Metallosis pseudotumors increase the risk of implant failure, which in some cases can be asymptomatic or associated with little pain [ 3 ]. Revision to arthrodesis after failed TWA is possible, but severe bone loss may be an issue [ 8 ]. A previous study of failed TWA in rheumatoid patients using tricortical iliac crest bone graft and Steinmann pins found that conversion to an arthrodesis is possible, but complication rates are high [ 9 ].…”