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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.
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: 2018-06-05Bibliographically approved

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Fischer, PerSagerfors, MarcusBrus, Ole

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