High rate of complications and radiographic loosening of the biaxial total wrist arthroplasty in rheumatoid arthritis

Background and purpose The third generation of total wrist arthroplasty (TWA) was designed to solve the early loosening problem, but there have been few long-term follow-ups. We present the outcome of the biaxial total wrist prosthesis (no longer available) after 5–8 years of follow-up.

Patients and methods 40 biaxial wrist prostheses were implanted uncemented in 36 patients with rheumatoid arthritis. 32 wrists were followed clinically and radiographically. 7 prostheses had been revised at median 21 (8–71) months; 1 patient died from an unrelated cause. Mean follow-up of the remaining 32 wrists was 6 (5–8) years. Kaplan-Meier survival analysis was performed with revision defined as failure.

Results Survival after 7 years was 81% (95% CI: 64–91). There were 31 complications. 22 wrists showed radiographic loosening. Range of motion improved, except for pronation. The mean DASH score improved and the median postoperative pain score (from 0 to 10) was 0 (0–6) at rest and 0 (0–7) during activity.

Interpretation One quarter of the prostheses had been revised and radiographic loosening had occurred in two thirds of the cases. Radiographic and clinical follow-up is therefore necessary for patients with this implant.