What Are the Risk Factors and Complications Associated With Intraoperative and Postoperative Fractures in Total Wrist Arthroplasty?

Periprosthetic radius fracture after total wrist arthroplasty: A case report

Total wrist arthroplasty (TWA) is indicated in select low demand patients with pan-carpal arthritis to decrease pain and preserve motion. Complications of TWA are well described including aseptic loosening, superficial and deep infection, wound issues, component dislocation, stiffness, and both intraoperative and post-operative fracture. With 4th generation implant designs, the incidence of many of these complications have decreased, but these complications remain challenging to address. In particular, sparse literature is available for the treatment of periprosthetic radius fractures after TWA. This report describes the management of an open, periprosthetic distal third radius fracture 18 months after index TWA in a medically complex 53-year-old female with lag screw fixation and a dorsal wrist spanning plate (DSP).

Global mapping of institutional and hospital-based (Level II-IV) arthroplasty registries: a scoping review

PURPOSE

Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II-IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II-IV JARs must be created to effectively assess and categorize these data.

METHODS

Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II-IV JARs worldwide. The secondary aim was to record their lifetime, publications' number and frequency and recognise differences with national JARs.

RESULTS

One hundred five Level II-IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case-control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies.

CONCLUSIONS

This is the first study mapping all Level II-IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.

Complications after total wrist arthroplasty

We reviewed the incidence and management of complications after total wrist arthroplasty, as reported in the literature, with so-called fourth-generation implants and other recent designs. While early intraoperative and postoperative complications, including fractures, tendon lacerations, infection, nerve compression, tendonitis, stiffness and chronic regional pain syndrome, had an acceptable incidence, late complications, such as periprosthetic osteolysis and implant loosening, occurred more frequently. Implant survival at 10 years was in the range of 70%-80% in most publications. Several of the implants have been modified or withdrawn. Instability and dislocation were frequent after a pyrocarbon spacer. Failed arthroplasties can be salvaged by revision arthroplasty or total wrist arthrodesis. Revision arthroplasty has a lower survival rate than primary arthroplasty and does not clearly offer important significant advantages over total wrist arthrodesis in terms of patient-reported outcome measures. Further development of prosthetic design, new materials and more knowledge on patient-related risk factors are needed.

Total Wrist Arthroplasty as a Motion-Sparing Option for Distal Radius Malunion in a Patient of Advanced Age: A Case Report

CASE

A 62-year-old woman presented with wrist pain secondary to a distal radius fracture malunion 4 months after a fall onto an outstretched hand. She was not an ideal candidate for osteotomy and bone graft because of the degree of displacement and osteoporosis, so after nonoperative treatment was unsuccessful, she was offered total wrist arthroplasty (TWA) or arthrodesis and opted for TWA.

CONCLUSION

At 14-month follow-up, the patient reported significant improvement in her pain and function. The current generation of TWA implants may allow use in the management of symptomatic distal radius malunions in older, low-demand patients.

Management of Proximal Pole Scaphoid Nonunions: A Critical Analysis Review

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Optimal management of nonunions of the proximal pole of the scaphoid is controversial and dependent on many patient and pathophysiologic considerations.

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If the proximal pole subchondral bone support is sufficient, options include open reduction and internal fixation, either alone or in combination with autologous nonvascularized or vascularized bone graft.

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If the proximal pole is not salvageable, replacement with osteochondral autografts or osteochondral flaps is the only option for reconstruction of the native anatomy.

Surgical Treatment of Wrist Arthritis in Young Patients

Surgical treatment of wrist arthritis in the younger patient population remains a challenging issue, and various surgical options need to be carefully considered for each patient. Proximal row carpectomy and 4-corner arthrodesis have proven to be reliable options for reducing pain and restoring adequate function in most young high-demand patients if the lunate facet is spared. Selective neurectomy has proven to be a promising stand-alone or complementary procedure for the treatment of pain that is associated with wrist arthritis in patients of all ages, with spared motion and the opportunity to perform additional procedures if pain continues. Alternative procedures, including capitolunate arthrodesis, total wrist arthrodesis, radial styloidectomy, total wrist arthroplasty, and wrist hemiarthroplasty, have considerable strengths and weaknesses and need to be studied further in younger patients.

Computed tomography-based three-dimensional preoperative planning for total wrist arthroplasty

Total wrist arthroplasty is indicated for severely damaged joints; however, it is sometimes difficult to place the implant in the proper position. We report a case of total wrist arthroplasty using computed tomography (CT)-based 3D planning. After a 3D digital model of the wrist was reconstructed using preoperative planning software, the computer-aided design models of the implant were superimposed on the wrist and the appropriate size and position of the implant were determined. During surgery, the planned parameters were measured using a slide gauge to reproduce the planned position of the implant. The size of the implant used at surgery was the same as in 3D planning. Comparing the CT before and after surgery, the position of the implant was almost the same as in 3D planning on the radial side, but the carpal side was placed 7 mm proximal to the position in preoperative planning. Two years after surgery, the patient had no complications and radiography showed no obvious signs of aseptic loosening. Our method may contribute to a reduced incidence of complications, such as intraoperative fracture and postoperative dislocation, leading to improve long-term outcomes of total wrist arthroplasty.