gms | German Medical Science

Objectives/Interrogation: Wrist arthroplasty surgery is increasingly performed e as an alternative to wrist arthrodesis. In our institution all patients with destroyed radiocarpal joints are offered wrist arthroplasty. The patients are included in a prospective follow-up study. The results in non-inflammatory wrist patients are presented.

Methods: 13 (8 women, 9 dominant wrists) patients 68 (44-85) years of age with destroyed radiocarpal joints due to SLAC (8), SNAC (3) and lunate malaci (2) had a ReMotion (Stryker, Michigan, USA) wrist arthroplasty implanted. 5 patients had 6 prior wrist surgeries. 7/8 SLAC wrists had bilateral wrist degeneration. Radiographs were taken and active range of motion, grip- and key pinch strength was measured. The patients completed QDASH, PRWHE and VAS pain score preoperatively and at yearly follow-ups.

Results: During the follow-up period 3 arthroplasties were revised to a new arthroplasty due to distal loosening and ostelysis (2) or massive osteolysis (1). Additional bone removal on the radial side were done in one patient due to impingement. Removal of the two distal screws due to pain in the cmc joints were done in another. Arthrolysis, removal of ectopic bone in the joint, and a Darrachs procedure were done in one patient, and finally one had a CRPS resolving after 2 years. At final follow-up 4 (2-6) years after surgery the clinical results were satisfactory in the non-revised patients, demonstrating significant reduced PRWHE (63 to 31)and VAS pain at activity (69 to 39). QDASH was reduced (49 to 34) and grip strength increased (11 to 15 kgs) but the two latter did not reach statistical significance. The radiographic analysis demonstrated loosening in 2/10 arthroplasties (not revised) and major osteolysis in 2/10. None of the patients regretted choosing arthroplasty as compared to arthrodesis.

Conclusion: Published results on the Remotion wrist arthroplasty has mainly been in inflammatory wrist patients rendering satisfactory results. In our series of non-inflammatory patients we found satisfactory clinical results but a relatively high complication and revision rate after 4 years. Patients prefer arthroplasty to arthrodesis, but they must expect complications, and should be informed about the expected outcomes including additional surgeries, osteolysis and fixation problems.