Failed total wrist arthroplasty. Analysis of failures and results of operative management.

Overview

Nine metal on polyethylene total wrist arthroplasties were revised for failure, including eight trispherical devices and one Volz implant. Causes of failure include sepsis in one patient, progressive wrist flexion contracture in two patients, and mechanical failure in six patients. The most common mode of mechanical failure was metacarpal loosening with dorsal perforation of the stem. This was associated with an intact articulation between the third metacarpal and the capitate, with a proximal position of the metacarpal component in the shaft, and with poor cement fill of the metacarpal shaft. The one infected wrist was managed with resection arthroplasty. Five patients had conversion to a wrist arthrodesis and three patients underwent revision total wrist arthroplasty with custom trispherical components. Followup averaged 3.3 years. All patients undergoing arthrodesis attained a solid painless fusion after a single operation at an average of 4.8 months. The three patients treated with revision arthroplasty had wrists that were pain free, functional, and had no evidence of loosening at latest followup. Failed total wrist arthroplasties can be salvaged successfully to either a fusion or a revision arthroplasty in most patients.