BIAXIAL LONG-STEMMED MULTIPRONGED DISTAL COMPONENTS FOR REVISION BONEDEFICIT TOTAL-WRIST ARTHROPLASTY

Revision total-wrist arthroplasty has a high incidence of complication s. Loosening is a signifi cant problem for the distal implant. Because of the high failure rate of single-pronged distal implants after revi sion total-wrist arthroplasty, a custom multipronged distal component (biaxial total-wrist implant) was designed for use in patients with de ficient bone stock who undergo revision operation. Ten cases of total- wrist arthroplasty with a custom long-stemmed multipronged distal comp onent are presented. The preoperative diagnosis was failed total-wrist arthroplasty in 9 cases. Mean time from previous total-wrist arthropl asty to revision procedure was 5.6 years. At fellow-up evaluation (mea n, 3.8 years; range, 3.0-4.8 years), 2 patients had undergone arthrode sis: 1 patient at an outside institution 1 year after surgery for peri prosthetic fracture of the radius, and 1 patient at our institution fo r distal implant loosening. The 8 other patients had functional total- wrist arthroplasties. At follow-up evaluation, all patients reported t hey were satisfied. Six patients reported no pain and 2 reported mild pain. Mean range of motion at follow-up evaluation was within the prev iously defined limits that allow patients to function in activities of daily living: 78 degrees for supination, 77 degrees for pronation, 39 degrees for extension, 17 degrees for flexion, 12 degrees for radial deviation, and 18 degrees for ulnar deviation. Revision total-wrist ar throplasty with custom long-stemmed, multipronged distal components of fers an alternative to those patients with deficient bone stock who re fuse arthrodesis. Early results demonstrate greater longevity compared with single-pronged components for revision total-wrist arthroplasty.