Artikel
Revision-Arthrodesis after Failed Total Wrist Arthroplasty
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Veröffentlicht: | 6. Februar 2020 |
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Objectives/Interrogation: Traumatic arthrosis, osteo arthrosis, rheumatoid arthritis and other lesions at the region of the wrist may lead to severe pain, malposition, instability and malfunction of the wrist joint. Resections of parts of the destroyed joint, partial fusions and the wrist arthrodesis are today the standard methods to treat these complaints. Different types of total wrist arthroplasties were developed to preserve painfree motion. But there is a high incidence of failures of total wrist arthroplasties. We review our experiences in revising total wrist implant arthroplasties to arthrodeses. The most common mode of failure of the arthroplasties in our series was metacarpal loosening with dorsal perforation of the stem. Loosening of the proximal stem, progressive malposition of the wrist and other causes appeared.
We used for the revision arthrodesis in all our cases tricortical iliac crest bone grafts and additional spongiosa transplants from this donor site region. In one case we used a vascularized iliac crest bone graft to bridge the bone defect because of a bad host quality of the recipient area. Fixation was achieved with plates and screws.
Methods: Our average follow-up period was 60 month. 81 patients with failed wrist implants (7 different types) were treated with this technique. 80 wrist's undergoing arthrodesis achieved a solid painless fusion after a single operation. In one case a non-union with a loosening of the screws due to using a non-rigid plate was seen. In this case a revision was necessary to achieve a bone healing. In defined time spans all patients received examinations of range of movement of the finger joints and the force of the hands. Clinical and radiological control was carried out in comparison of both hands. The assessment of the result after healing according to the DASH-score (Disability of Arm/Shoulder /Hand) was done.
Results and Conclusions: All patients were satisfied, pain free and achieved an increased pinch and grip strength after bony fusion (measured with Yamar-Vigorimeter). A persisting loss of carpal height was seen in all cases. Arthrodesis after failed total wrist arthroplasty is a satisfactory salvage procedure even in cases with a bad quality of the recipient area. We recommend a rigid fixation technique to prevent non-unions.