High rate of complications and radiographic loosening of the biaxial total wrist arthroplasty in rheumatoid arthritis: 32 wrists followed for 6 (5–8) years

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.