FAILED TOTAL WRIST ARTHROPLASTY - ANALYSIS OF FAILURES AND RESULTS OFOPERATIVE MANAGEMENT

Nine metal on polyethylene total wrist arthroplasties were revised for failure, including eight trispherical devices and one Volt implant, C auses of failure include sepsis in one patient, progressive wrist flex ion contracture in two patients, and mechanical failure in six patient s, The most common mode of mechanical failure was metacarpal loosening with dorsal perforation of the stem. This was associated with an inta ct articulation between the third metacarpal and the capitate, with a proximal position of the metacarpal component in the shaft, and with p oor cement fill of the metacarpal shaft, The one infected wrist was ma naged with resection arthroplasty, Five patients had conversion to a w rist arthrodesis and three patients underwent revision total wrist art hroplasty with custom trispherical components, Followup averaged 3.3 y ears, All patients undergoing arthrodesis attained a solid painless fu sion after a single operation at an average of 4.8 months, The three p atients treated with revision arthroplasty had wrists that were pain f ree, functional, and had no evidence of loosening at latest followup. Failed total wrist arthroplasties can be salvaged successfully to eith er a fusion or a revision arthroplasty in most patients.