Conversion of Total Wrist Arthrodesis to a Total Wrist Arthroplasty: Twelve Patients Followed for 7 (2-16) Years.

Purpose: Total wrist arthroplasty has become a viable alternative to arthrodesis. Wrist arthrodesis is not necessarily the final surgery for many of the patients because some patients never accept the residual pain and reduced function that accompanies a stiff wrist. The purpose of this study was to evaluate the clinical performance (pain, function, and satisfaction) of rearticulation, as well as the complications and reoperations of the procedure in a prospective unselected case series of patients.

Methods: Twelve (7 men) patients with a mean age of 53 (42-67) years were converted to a total wrist arthroplasty at a mean of 8 (3-17) years after wrist arthrodesis. The patients had undergone 53 wrist surgeries prior to rearticulation.

Results: One wrist with a periprosthetic fracture of the ulna and a loose distal radioulnar joint arthroplasty that had been removed during the conversion was finally fused a second time. At follow-up 7 (2-16) years after conversion, increased wrist active range of motion (0°-98°), supination (75°-85°), reduced Patient-Rated Wrist Evaluation score (56-30), and reduced visual analog scale pain scores were found. All arthroplasties were radiologically stable, well-fixed and osseointegrated. None regretted the surgery knowing the outcome.

Conclusions: Conversion from total wrist arthrodesis to a modern wrist arthroplasty is feasible, yielding good functional results, significant pain relief, and stable implants.

Type of study/level of evidence: Therapeutic IV.