gms | German Medical Science

Objectives/Interrogation: For decades design and development of TWA has been accompanied by quite a few failures, so that it has been denied by most surgeons until today. The difficult and complex anatomy of the wrist caused different ways of development and often led into an impasse. Compared to knee and hip arthroplasties which could be conceived and developed further a consistent method could not be applied. But in the last years some new concepts established themselves, so that TWA is not only applied in individual cases. The indications could be expanded and standardized. Of course complications do occur as they also do in the other joints.

Methods: The presentation refers to more than 600 TWA's which have been performed since 2005. 44% suffered from Rheumatoid Arthritis, the remaining diseases consisted of osteoarthritis, posttraumatic arthritis and osteoarthritis, SLAC-wrist, SNAC-wrist, Kienböck's disease. Complications occurred in 4.3% of all cases. Other methods of complications management are available base on the type of TWA retrospectively. The purpose of this presentation is to demonstrate the varieties of those methods in typical cases of complications.

Results and Conclusions: The application of five different types of endoprotheses for TWA yielded an outcome of individual benefits and disadvantages.

For instance BIAX(DePuy) was soon abandoned due to insufficient fixation and subsequent loosening in the carpus. Generally good results were achieved with Universal II(KMI) with the advantage of screw fixation in the carpus. However this gain was annulled with requirement of the ulnar head resection.

With ReMotion(SBI/Stryker) ulnar head resection could be avoided. Complications occurred in the form of cystoid alteration of the metaphysic spongious bone of the radius and radial impingement. Maestro(Biomet) has the advantage of having a modular system with scaphoid augmentation. The superiority of Freedom (Integra), the follow-on generation of iUniversal II is demonstrated with its protection of the DRUJ. Thus complications management depends on the different types of endoprotheses. This presentation will discuss revision surgery, with and without TWA change, with view to management in infective situations. Since 2013 there have been 14 patients with TWA complications, with only one case requiring a wrist arthrodesis.

In our experience, it has showed that complications in TWA are controllable, and that TWA changes are feasible without the consequence of total wrist arthrodesis.