Implants et prothèses du poignet et du carpe

Abstract

Total or partial replacement of the wrist is not yet a current surgery. Total wrist arthroplasty has less satisfactory clinical outcomes compared to hip and knee arthroplasty. With the silicone spacers developed by Swanson, the revision rate is important because of implant fracture, carpal collapse and synovitis but preservation of wrist function through the years seems enhanced by titanium grommet. Some authors continue selective use of the Swanson wrist implant. For total wrist arthroplasty, the changes in design from the first to the third generation, with closer approximation to the wrist joint's center of rotation, have led to encouraging results. Total implant seems to be a good solution to restore functional range of motion after posttraumatic wrist arthritis when arthrodesis is required by non manual laborers older than 50 years of age. Nevertheless long term loosening of total wrist arthroplasty is a significant problem. The use of a ulnar head prosthesis seems could be a solution to restore stability and relieve secondary symptoms that may be associated with partial or total excision of the ulnar head. Total or partial carpal bone replacements with silicone implant are abandoned. The series of Titanium bone replacement are very rare. The problem of this type of replacement is that the carpal instability is not treated.