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Revision Arthroplasty of the Wrist in Patients With Rheumatoid Arthritis, Mean Follow-Up 6.6 Years
Örebro University, School of Medical Sciences. Department of Hand Surgery.
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Hand Surgery.ORCID iD: 0000-0002-5083-3591
Örebro University, School of Medical Sciences. (Clinical Epidemiology and Biostatistics)
Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
2018 (English)In: Journal of Hand Surgery-American Volume, ISSN 0363-5023, E-ISSN 1531-6564, Vol. 43, no 5, p. 489.e1-489.e7Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Management of failed total wrist arthroplasty (TWA) can be challenging; surgical treatment options include salvage arthrodesis, revision arthroplasty, and resection arthroplasty. There are few studies regarding salvage arthrodesis, and revision arthroplasty has been infrequently investigated. The aim of the study was to report the outcome after revision arthroplasty of the wrist.

METHODS: A retrospective cohort of 16 revision TWAs was evaluated between 2003 and 2016. Data were collected before surgery and 1 and 5 years after surgery. The indication for revision arthroplasty was failed TWA. The primary end point was implant survival. Secondary outcome measures included visual analog scale (VAS) pain scores, range of motion, handgrip strength, and functional scoring with the Canadian Occupational Performance Measure (COPM), Patient-Rated Wrist Evaluation (PRWE), and Disabilities of the Arm, Shoulder, and Hand (DASH).

RESULTS: Mean follow-up was 6.6 years. Synthetic bone graft was used in 9 cases, allograft corticocancellous bone graft in 1 case, and cement in 6 cases. Of the 16 revision TWAs, 4 were re-revised, 1 because of infection, and 3 cases underwent total wrist arthrodesis. In the non-re-revised cases, range of motion and grip strength was preserved compared with preoperative results. The VAS pain score in activity improved, but not significantly, at 1 (median, 1; range, 0-4.5) and 5 years after surgery (median, 0) compared with before surgery (median, 5). The COPM performance and satisfaction as well as PRWE scores improved significantly at 1 year (median COPM performance, 4.8; COPM satisfaction, 5.6; and PRWE, 24) and improved, but not significantly, at the 5-year follow (median COPM performance, 4.8; COPM satisfaction, 5.0; and PRWE, 37) in the non-re-revised cases.

CONCLUSIONS: Revision arthroplasty of the wrist is a valid motion-preserving option to wrist arthrodesis in the management of failed TWA. However, the outcome is uncertain and as many as 25% require additional surgery.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Place, publisher, year, edition, pages
Elsevier, 2018. Vol. 43, no 5, p. 489.e1-489.e7
Keywords [en]
Total wrist arthroplasty, osteoarthritis, rheumatoid arthritis
National Category
Orthopaedics Surgery
Identifiers
URN: urn:nbn:se:oru:diva-67046DOI: 10.1016/j.jhsa.2017.10.038ISI: 000432437100018PubMedID: 29224946Scopus ID: 2-s2.0-85044505797OAI: oai:DiVA.org:oru-67046DiVA, id: diva2:1207010
Note

Funding Agency:

Örebro County Council Research Committee

Available from: 2018-05-18 Created: 2018-05-18 Last updated: 2019-10-18Bibliographically approved
In thesis
1. Hemi and total wrist arthroplasty
Open this publication in new window or tab >>Hemi and total wrist arthroplasty
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: To study implant survival and implant loosening following primary total wrist arthroplasty (TWA) using four different implants. To report outcome following wrist revision arthroplasty. To evaluate a new radial wrist hemi arthroplasty (RWHA) design clinically and biomechanically.

Method: The studies included 136 primary TWAs and 16 revision TWAs, both studies with prospectively collected data. Six fresh frozen cadaveric wrist specimen were used for biomechanical analysis. The RHWA was evaluated clinically in a pilot series of 20 cases.

Results: Total implant survival was 92% but with high frequency of implant loosening of surviving Re-Motion implants. None of the surviving Maestro implants were considered radiographically loose. Implant survival following revision arthroplasty was 75%, considerably lower than following primary TWAs. However, none of the patients with surviving revision implants had pain at rest and little or no pain in activity. The surgical procedure and placement of the RHWA was feasible. Overall, the kinematic and functional changes appeared acceptable compared to the native wrist. None of the patients underwent revision following RHWA but reoperation was performed in 7 patients on the indication of persistent pain. However, patients reported relief of pain and improvement of patient-reported outcome measures.

Conclusion: High long-term implant survival and no signs of radiographic loosening was found for the Maestro implant. However, the Maestro implant is no longer available on the market and we believe there is a need for new TWA designs. Revision arthroplasty is a valid option in the management of failed TWA. However, implant survival is lower than for primary TWAs and as many as 25% require additional surgery. Promising results were found using the new RHWA design but the implant needs modification before further testing.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2019. p. 83
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 198
Keywords
Rheumatoid arthritis, Wrist, Arthroplasty, Implant survival, Biomechanics
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-76146 (URN)978-91-7529-298-4 (ISBN)
Public defence
2019-11-22, Örebro universitet, Campus USÖ, hörsal C3, Södra Grev Rosengatan 32, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2019-09-06 Created: 2019-09-06 Last updated: 2019-10-25Bibliographically approved

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Fischer, PerSagerfors, MarcusBrus, Ole

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