Outcomes of Revision Total Wrist Arthroplasty

Wagner, Eric R.; Srnec, Jason J.; Fort, Michael W.; Barras, Laurel A.; Rizzo, Marco

doi:10.5435/jaaosglobal-d-21-00035

Cited by 6 publications

(5 citation statements)

References 19 publications

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“…None of the re-revisions required further surgery during this short follow-up period. Complications after revision arthroplasty were frequent in a series of 69 patients who underwent 76 revision procedures of various implants, mostly older generation implants from 1974 to 2013 (Wagner et al., 2021). They included distal loosening ( n = 15), proximal loosening ( n = 3), dislocation ( n = 7), intraoperative fracture ( n = 7), postoperative fracture ( n = 2) and component fracture ( n = 3).…”

Section: Specific Complications and Their Managementmentioning

confidence: 99%

Complications after total wrist arthroplasty

Boeckstyns,

Herzberg

2024

J Hand Surg Eur Vol

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We reviewed the incidence and management of complications after total wrist arthroplasty, as reported in the literature, with so-called fourth-generation implants and other recent designs. While early intraoperative and postoperative complications, including fractures, tendon lacerations, infection, nerve compression, tendonitis, stiffness and chronic regional pain syndrome, had an acceptable incidence, late complications, such as periprosthetic osteolysis and implant loosening, occurred more frequently. Implant survival at 10 years was in the range of 70%–80% in most publications. Several of the implants have been modified or withdrawn. Instability and dislocation were frequent after a pyrocarbon spacer. Failed arthroplasties can be salvaged by revision arthroplasty or total wrist arthrodesis. Revision arthroplasty has a lower survival rate than primary arthroplasty and does not clearly offer important significant advantages over total wrist arthrodesis in terms of patient-reported outcome measures. Further development of prosthetic design, new materials and more knowledge on patient-related risk factors are needed.

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Section: Specific Complications and Their Managementmentioning

confidence: 99%

Complications after total wrist arthroplasty

Boeckstyns,

Herzberg

2024

J Hand Surg Eur Vol

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“…В случае эндопротезирования установка в организм человека инородного тела планируется на продолжительный период времени. Рисками эндопротезирования сустава могут служить вывихи, нагноение, сохранение боли и ограничения функции, расшатывание компонентов эндопротеза [22][23][24][25][26][27][28][29][30][31][32]. Эти проявления могут отмечаться в разное время и по разным причинам.…”

Section: оригинальные статьиunclassified

Survival of unconstrained ceramic wrist joint implants

Aleksandrov,

Simonova,

Lukinov

2023

jour

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Introduction Survival of implants is an important indicator of improvement in the patient's quality of life. In foreign literature, the issue of implant survival finds special attention.The aim of the work was to evaluate the efficacy and survival of an unconstrained ceramic wrist joint endoprosthesis.Materials and methods We analysed 83 cases of total wrist arthroplasty with an unconstrained ceramic implant at long-term follow-up. At the Novosibirsk RSITO, total wrist arthroplasty was performed in 81 patients with severe changes in the wrist joint from 2011 to 2021. Two patients underwent arthroplasty on two joints. A retrospective uncontrolled cohort study was conducted which divided the hospitalized patients into three groups according to the etiological cause of the disease. Radiological methods were used to control the state of the implant (radiography in two projections and CT-scans of the wrist joint). For binary indicators, the number, rates and 95 % confidence interval of frequencies were calculated according to the Wilson formula in the groups. Comparison was carried out by Fisher's exact two-sided test. The p-error was corrected using the Benjamini – Hochberg method. Kaplan – Meier curves were constructed for survival analysis. The groups were compared using a generalized chi-square test.Results Each case of repeated surgical intervention was evaluated from the standpoint of selected groups. Depending on the time elapsed from surgery to revision, we calculated the time frame for overall and group survival of the components of the wrist joint endoprosthesis. The causes and scope of surgical revision are presented.Discussion There are no data on the survival of unconstrained ceramic wrist joint implants in the foreign literature. Graphic images according to a proposal for the division of the orthopaedic postoperative period are presented. Conclusions 1. Intermediate conclusions in regard to total arthroplasty with an unconstrained ceramic endoprosthesis of the wrist joint inspire optimism in obtaining a stable positive effect of motion range lost due to the degenerative process in the wrist joint. 2. An 11-year follow-up period demonstrates that the survival rate of an unconstrained ceramic wrist endoprosthesis is 88 %.

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“…In summary, revision TWR or conversion to TWA should be born in mind only if PPO become clinically symptomatic and/ or presented with safe radiographic signs of loosening such subsidence and/or progressive angulation in the sagittal or coronal plane of the carpal component ( 9A-C) [43,84,96,97]. For this circumstance, patients need to be educated that the results after revision TWR are significantly worse compared to firstline TWR, the cumulative 5-year survival rate is reported to be 83% only, and in 25 -37% of cases repeat revision surgery is required within 6.6 -10.3 years (mean) [98][99][100]. In contrast, recent evidence suggests that conversion of a failed TWR to second-line TWA (Figure 9) will produce comparable outcomes in PROMs and pain relief with those after first-line TWA, and the complication rates are also comparably high and differs not significantly with 47% for second-line TWA respectively 41% for first-line TWA [101,102].…”

Section: Figure 9 [14]: (Same Patient As In Figure 2 Now the 8-year F...mentioning

confidence: 99%

Total Wrist Replacement: State of the Art, Challenges and Pitfalls: A Comparative Review

Schmidt¹

2022

Arch Clin Trials

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Background Total wrist replacement (TWR) as motion-preserving procedure continues to be critically discussed in the literature, although the complication rates have been significantly reduced with the current 3rd generation designs compared with older types. Possible reasons for this are often also a lack of knowledge about the currently available evidence, the complication management, and the lack of practical experience by the surgeons. Methods Based on an extended review of literature and own experience, the aim of this article is to give practicable insights for the clinician on: (1) biomechanical fundamentals, (2) differences in design, survivorship and functional outcome between the recent types, (3) possible pitfalls, and (4) failures and salvage options. Results The goal of TWR is that the overall wrist motion is maintained respectively improved despite it works with a locked midcarpal joint. Regarding survivorship and functional outcome the Maestro is (was) being superior over all other types that is (was) based on features in design. There is no scientific evidence as to why the Maestro was withdrawn from the marketplace by the company. For assessment of instability and/or impingement the use of dynamic radiographs is recommended. The problem of TWR is unchanged failure of the carpal components primarily based on mechanical dysbalance, and secondarily followed by metal and/or polyethylene wear, but surgical revision of asyptomatic periprosthetic osteolysis without safe radiagraphic signs of loosening is only required in not more than 20% of cases. For a failed TWR, revision TWR or conversion to total wrist arthrodesis are viable salvage options. Conclusions The knowledge about recent evidence and features in design of the available types, exact assessment of radiographic findings, presence of technical skills by the surgeons, and observance of the patient's expectations are the basic requirements for a successful TWR.

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Outcomes of Revision Total Wrist Arthroplasty

Cited by 6 publications

References 19 publications

Complications after total wrist arthroplasty

Complications after total wrist arthroplasty

Survival of unconstrained ceramic wrist joint implants

Total Wrist Replacement: State of the Art, Challenges and Pitfalls: A Comparative Review

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