Reoperative Surgery in Failed Wrist Arthroplasty

Abstract

Despite wrist arthritis and other degenerative conditions of the wrist being quite common, total wrist arthroplasty is a relatively uncommon procedure, especially when compared to arthroplasty about the hip, knee, and shoulder. Newer implants require minimal bone resection; however, not only are there still numerous older implants still in patients, but these newer implants can still have complications. Revising a wrist arthroplasty to another implant is believed to have a rather high complication and failure rate, although no large studies are available. In most cases of wrist arthroplasty revision, wrist arthrodesis will be considered the procedure of choice. Given bone loss, there is usually the need for a significant amount of structural bone grafting that can either be in the form of autograft or allograft. Plate fusion is most commonly utilized, but newer intramedullary fusion implants do offer some unique possibilities. In some circumstances, the wrist may be fused as a temporary measure to establish more bone stock, and then the wrist fusion taken down and a new arthroplasty implant placed. The patients suffering with these conditions frequently may have loss in finger range of motion secondary to scarring of the extensor and flexor tendons. The challenges of implant revisions should be thoroughly reviewed with the patient as there is the possibility of significant complications