Survivorship of Revision Wrist Replacement

Abstract

This study aims to report the 5-year survivorship of revision wrist arthroplasties and to report midterm clinical and radiological results. 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. 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. 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. It is reasonable to offer revision wrist arthroplasty in selective cases, but regular clinical and radiological follow-up is recommended.

Universal 2 total wrist arthroplasty for the salvage of failed Biaxial total wrist arthroplasty

“…The absence of preoperative PROMs makes it impossible to demonstrate improvement of wrist function, which is another limitation of our study. The PRWHE scores found in our patients (53/100) are slightly better than in the revision TWAs described by Pinder et al. (2018) (61/100), but worse than the PRWHE scores found in our patients with primary Universal 2 implants (24/100 and 42/100) (Ferreres et al., 2011; Pfanner et al., 2017).…”

“…To prevent these limitations, failed implants can possibly be salvaged by a revision implant. Pinder et al. (2018) evaluated BIAX and Universal 2 implants that were used to salvage failed BIAX, Swanson and Universal 2 implants.…”

“…Only a few studies reviewed the revision of a failed TWA by replacing the implant with a different type (Cobb and Beckbaugh, 1996; Fatti et al., 1991; Khan et al., 2014; Lorei et al., 1997; Pinder et al., 2018; Rettig and Beckenbaugh, 1993). These studies concerned small and/or heterogeneous case series or case reports and described short-term, sometimes mid-term, outcomes.…”

Complications after total wrist arthroplasty

“…Only few articles report PROMs after revision arthroplasty. Pinder et al (2018) had PROM data on six of the 18 patients with inflammatory disease in their series. The median Quick DASH score was 57 (range 9-89) and median Patient-Rated Wrist Evaluation (PRWE) score was 35 (range 13-90).…”

“…The cumulative implant survival was 74%, and the median DASH and PRWE scores at 5 years were 60 and 37, respectively. In another series of 19 cases, the cumulative 5-year implant revision survival was 83% (Pinder et al, 2018). published a series of 40 wrists in 37 patients with a failed biaxial prosthesis that were converted to a Universal 2 total wrist arthroplasty.…”