Floor plan - 2013 Annual Meeting - American Association for Hand ...

Wrist Arthrodesis as a Salvage Operation for Failed Wrist Implant Arthroplasty
Institution where the work was prepared: Mayo Clinic, Rochester, MN, USA
Duncan B. Ackerman, MD; Marco Rizzo; Robert Rodrigues; Robert D. Beckenbaugh; Mayo Clinic
INTRODUCTION:
The purpose of this study was to evaluate the clinical utility of wrist arthrodesis as a salvage procedure for failed total wrist arthroplasty
(TWA). Arthrodesis can be a successful salvage procedure for failed wrist implant arthroplasty.
METHODS:
Between 1980 and 2006, twenty patients were identified as having undergone wrist arthrodesis for salvage of a failed TWA. Data collected
included: implant type, mode of implant failure, revisions prior to arthrodesis, method of fusion, the use of allograft or autograft
bone at the time of fusion, rate of union, clinical outcome, and patient satisfaction.
RESULTS:
Twenty wrists in twelve females (80%) and 4 males (20%) underwent TWA at an average age of 56 years (range, 40-78). The average time from
the index arthroplasty to wrist arthrodesis was 8.4 years (range, 7 months-20 years). The average follow-up was 4.1 years (range, 2 months-
21 years). The mode of failure in the majority of wrists were loosening, migration, or instability (n=12, 70%). Three patients (15%) underwent
removal of the components due to infection. Three wrists had undergone a total of 4 revisions prior to the index salvage procedure. The
method of fixation for arthrodesis included: Steinmann pins in 10 (50%) wrists, plates and screws in 6 (30%), staples in 2 (10%), external fixation
in one (5%), Steinmann pins and staples in one (5%). Allograft bone was utilized in 11 (55%) wrists and autogenous bone in 9 (45%).
Overall 10 (50%) wrists achieved radiographic union, 7 (35%) had a pseudarthrosis with minimal to no pain, and 3 (15%) had a nonunion.
DISCUSSION:
Bony union was achieved in only 50% of patients who underwent attempted arthrodesis as a salvage procedure for a failed wrist arthroplasty.
Despite a relatively low union rate, most patients had clinical improvement with little/no pain at last followup.
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