Total Wrist Arthroplasty With Tantalum Coating: 20 Cases With a Mean Follow-Up of Six Years.

Abstract

Purpose: Despite improvements in total wrist arthroplasty (TWA) designs, periprosthetic osteolysis, and implant loosening are challenging issues. A new TWA implant design with a tantalum coating has been proposed to address these issues. This study reports the results of a pilot study of 20 cases operated on with the new TWA design.

Methods: Of the 20 cases, 14 were primary TWAs and 6 were revision TWAs. Patients were assessed using visual analog scale pain scores, wrist range of motion, hand grip strength, and patient-reported outcome measures (PROMs) before surgery and 1, 2, and no later than 8 years after surgery. Radiographic examination was performed to assess any loosening of the TWA.

Results: Of the 20 patients, 19, including 12 men and 7 women, came for postoperative follow-up at a mean of 6.5 years (5-8 years). Two reoperations were performed in two patients in the primary TWA group, compared with seven reoperations in six patients in the revision TWA group. Three of the reoperations were revision surgeries with conversion to radiocarpal arthrodesis, one in the primary TWA group and two in the revision TWA group. All three radiocarpal arthrodeses healed radiographically, but one of the patients underwent implant removal because of prominent hardware. Another patient in the revision TWA group had loosening of the articular head at the snap-fit mechanism and was offered revision surgery but declined further operative treatment. The radiographic examinations did not indicate implant loosening at the last follow-up. Range of motion, PROMs, and visual analog scale pain scores all improved at final follow-up.

Conclusions: The new TWA design gave improved PROMs, and the frequency of implant loosening was low. The number of revisions remains a concern, but most followed the revision TWA.

Type of study/level of evidence: Therapeutic IV.