gms | German Medical Science

Objectives/Interrogation: The aim of this work is to present a clinical case of a chronic periprosthetic infection after total wrist arthroplasty (TWA) and to discuss and draw a possible therapeutic approach for similar cases.

Methods: The authors report a case of an individual, male, 58 years old, manual worker, that appears with pain and inflammatory signs with a sinus tract on the right wrist, that had undergone TWA 8 years before. The authors started with an empirical antibiotherapy and then they decided to do a revision procedure in 2 stages: the first one consisted on the removal of the implant, debridement and interposition of cement spacer with antibiotics and immobilization; the second one consisted on a radio-metacarpal arthrodesis with precast plate and interposition of autologous graft harvested on iliac crest. The time of follow-up was 5 years.

Results and Conclusions: After a successful first stage revision, the second one was performed and after 2 years of follow-up, the patient satisfaction had improved, he had no pain, the fusion was radiologic evident and the DASH score was 28. After 5 years of follow-up the DASH score had improved to 22. The algorithm that we propose is based on patient risk factors, blood tests, imaging exams and harvested material for microbiology and antibiogram. The treatment options mentioned are antibiotherapy (empirical and directed) and surgical treatment (two stages revision).

The improvement of the implants in recent years have contributed to the increasing use of arthroplasty as a treatment option. Although it presents itself with an attractive option in terms of future functional capabilities, arthroplasty remains with some risks and has a higher rate of complications in the medium and long term than fusion, so the selection of patients should be careful. The wrist arthrodesis can always be seen as an ultimate salvation procedure in the treatment of failure of wrist arthroplasty, either a mechanical or infectious failure.