title: Wrist Arthrodesis for Failed Total Wrist Arthroplasty.
abstract: OBJECTIVE
  Treatment options for failed total wrist arthroplasty include implant revision, resection arthroplasty, and arthrodesis. Variable results associated with different techniques have been reported for arthrodesis and the procedure has substantial technical challenges, including restoration of wrist height, obtaining stable fixation, and achieving bony fusion. This study evaluates the radiographic results of a surgical technique for conversion of a failed arthroplasty to an arthrodesis.
  
  
  METHODS
  A retrospective chart and radiograph review was performed in 20 wrists in 18 patients in whom conversion to an arthrodesis was performed using a contoured cancellous femoral head structural allograft and a wrist arthrodesis plate. Supplemental demineralized bone matrix combined with corticocancellous allograft chips was also used in 15 wrists. Median age at arthrodesis was 61 years (range, 45-78 years), and median follow-up was 34 months (range, 4-71 months).
  
  
  RESULTS
  Nineteen of 20 wrists fused following the index procedure at a median of 4 months (range, 3-7 months). Proximal plate loosening occurred in 1 wrist but the joint still fused at 6 months; a successful osteotomy and revision of screw fixation was done 2 years later to correct the deformity and hardware irritation in this case. Complications were otherwise limited to 1 superficial infection that resolved with intravenous antibiotics.
  
  
  CONCLUSIONS
  This technique for conversion of a failed total wrist arthroplasty to a wrist arthrodesis is safe, effective, and versatile. Wrist deformity is corrected, wrist height can be restored, stable fixation is obtained, and a high rate of fusion is achieved despite filling large defects using structural cancellous allograft.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX. Electronic address: bdm.adams@gmail.com.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Adams
authors.affiliation: Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA.
authors.forename: Ben P
authors.initials: BP
authors.lastname: Kleinhenz
authors.affiliation: Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA.
authors.forename: Justin J
authors.initials: JJ
authors.lastname: Guan
mesh_terms: D000328:Adult; D000368:Aged; D001174:Arthrodesis / Q000379:methods*; D019643:Arthroplasty, Replacement / Q000009:adverse effects* / Q000379:methods; D001860:Bone Plates; D001863:Bone Screws; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D011379:Prognosis; D011475:Prosthesis Failure; D016059:Range of Motion, Articular / Q000502:physiology*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*
keywords: Wrist arthrodesis; failed total wrist arthroplasty; failed wrist replacement; wrist fusion