Total wrist arthroplasty in patients with rheumatoid arthritis.
OBJECTIVE
After very good midterm results with an uncemented total wrist arthroplasty we evaluated the long-term outcome in a retrospective study.


METHODS
Forty uncemented anatomic physiologic (APH, Implant-Service Vertreibs-GmbH, Hamburg, Germany) wrist prosthesis implantations performed in 40 patients were reviewed. The mean follow-up period was 52 months (range, 24-73 mo) and the following parameters were examined: radiographs, grip strength, range of motion, and patient's satisfaction.


RESULTS
After a good short-term outcome the results deteriorated with time. The following complications occurred: 2 infections, 3 implant failures, 2 prosthesis migrations, and 33 loosenings/dislocations. All patients (39 of 40) underwent revision surgery, and severe titanium wear in the soft tissues was found intraoperatively in all cases. It became clear that even in a non-weight-bearing joint such as the wrist, titanium alloy may wear and result in tissue metallosis when used as a bearing surface of the implant. As a salvage procedure the prosthesis was removed and an arthrodesis was performed in all patients.


CONCLUSIONS
Because of the deterioration of the results including an unacceptable revision rate we currently do not consider the anatomic physiologic wrist prosthesis to be a suitable implant in patients with rheumatoid arthritis.
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000601:surgery*; D001174:Arthrodesis; D019643:Arthroplasty, Replacement; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies; D014955:Wrist Joint / Q000503:physiopathology / Q000601:surgery*