Survivorship of Revision Wrist Replacement

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 Several of the implants have been modified or withdrawn.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.

Reliability, Validity and Responsiveness of the Slovenian Version of the Patient Evaluation Measure (PEM-Slo) in Patients with Wrist and Hand Disorders

Introduction

The Patient Evaluation Measure (PEM) is a region-specific patient reported outcome measure (PROM) for hand and wrist disorders, first introduced in English for patients with hand surgery in 1995. The purpose of the study was to assess the psychometric properties of the translated and cross-culturally adapted Slovenian version of PEM (PEM-Slo).

Methods

The study was designed as a single-centre observational prospective study conducted from July 2020 to March 2021. The psychometric evaluation was performed on fifty-one patients with miscellaneous hand and wrist disorders. Reliability was tested for internal consistency and test-retest reliability. Convergent and divergent validity, responsiveness, floor and ceiling effect, and interpretability with the determination of minimal detectable change (MDC) and minimal clinically important difference (MCID) were assessed.

Results

The PEM-Slo has excellent internal consistency (Cronbach's α 0.932) and good to excellent test-retest reliability (intraclass correlation coefficient=0.874). Convergent validity was proved with high to moderate correlations of PEM-Slo with DASH, grip strength and self-care, usual activities, and pain EQ-5D-5L subscales, whereas no correlation of PEM-Slo with EQ-5D-5L mobility and anxiety/depression subscale confirmed divergent validity. The PEM-Slo responsiveness was high (standardised response mean=1.42, effect size=1.25). MDC was 18.01 and MCID was 17.31. No floor or ceiling effect was found.

Conclusion

The PEM-Slo is a reliable, valid and responsive PROM for Slovenian-speaking patients with hand and wrist disorders.

Technique for Failed Total Wrist Arthroplasty Conversion to a Total Wrist Arthrodesis with Allograft Interposition

The frequency of prosthetic total wrist arthroplasty continues to increase. With this increase comes the expected subsequent increase in need for revision or salvage procedures. The technique presented here involves the use of a cortical allograft interposition graft to restore bone stock and length for failed total wrist arthroplasty.

Salvage of the Failed Total Wrist Arthroplasty: A Systematic Review

Background  Although the performance of total wrist arthroplasty systems has improved, failure is encountered and is a major challenge to manage. Questions  Does physical function improve with surgical management of the failed wrist arthroplasty? Is there an improvement in secondary outcome measures including pain, grip strength, and range of motion? What are the reasons for failure in primary total wrist arthroplasty? What are the complications associated with revision of the failed total wrist arthroplasty? What are the survival profiles of the different revision strategies? Methods  A systematic review of available literature was performed. Studies were systematically assessed, and data extracted from suitable studies for review. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines were adhered to. The study protocol was modified from a previous protocol published on the PROSPERO database. Results  Fourteen studies were identified considering 218 patients/214 index operations with a follow-up duration following revision surgery of 2 months to 21 years (silicone wrist arthroplasty-42 cases; nonsilicone wrist arthroplasty-172 cases). The functional outcome of revision surgery was infrequently recorded and documented with only short-term assessments undertaken. Complications were seen in 1:2 revision procedures, with re-revision surgeries required in 21.6% of revised primary nonsilicone arthroplasties. Re-revision rate following a revision arthrodesis was 21.4% (15/70 cases) compared with revision arthroplasty of 34.8% (32/92 cases). Revision arthrodesis nonunion rate was 17.5% (22 cases). Conclusion  This review has confirmed the high level of surgical complexity and the likelihood of a complicated postoperative outcome when salvaging a failed wrist replacement. Level of Evidence  This is a Level 3, systematic review study.

Universal 2 total wrist arthroplasty for the salvage of failed Biaxial total wrist arthroplasty

Universal 2 implants may be an alternative to total wrist arthrodesis for the salvage of failed Biaxial total wrist prostheses. We assessed 40 Universal 2 revision implants retrospectively. Fourteen of these wrists were converted to total wrist arthrodeses, and two wrists received a third total wrist arthroplasty after a mean period of 5.5 years. Twenty-four of the Universal 2 implants that remained in situ after a mean follow-up of 9 years (range 4 to 13 years) were re-examined. Sixteen functioned satisfactorily. Patient-Rated Wrist and Hand Evaluation scores and Quick Disabilities of the Arm, Shoulder and Hand scores were 53 and 47, respectively. Twenty-nine patients would choose the Universal 2 again and would also recommend it to other patients. The survival of the revision implants was 60% at a mean follow-up of 9 years. Level of evidence: IV.