Abstract
Introduction: Silicon-implant-arthroplasty in cases of severe destruction of the radiocarpal joint was a routinely used procedure in rheumatoid arthritis to restore mobility and function. However in many cases an implant failure with a fracture rate of up to 50% with massive synovitis and a severe carpal collaps must be documented. Main problem is the extensive bone loss which makes further procedures difficult. Revision-wrist-arthrodesis with bone grafting (iliac bone, allograft or free fibula-graft) is the commonly used procedure. Therefore non-union in these cases is documented in up to 40%.
Material and Methods: Between 1999 and 2003 we performed in 2 cases of severe seropositive rheumatoid arthritis and in one case of psoriatic wrist joint destruction with extensive bone loss only a revision arthroplasty with debridement and insertion of a new Swanson silicon implant. At the time of revision mean age was 61 years and primary silicon arthroplasty was done 11 years ago. In one case a decompression of the median nerve in the carpal canal was necessary. In one case a transposition of the ECU to ECRB was performed to neutralize the ulnar drift of the remaining carpus.
Results: In all patients a good mobility in the wrist with pain free function could be achieved. All patients were satisfied with this procedure. Clinical, subjective and radiological results are presented.
Conclusion: Revision after silicon-wrist arthroplasty with severe bone loss without or only minimal carpal bone stock and a thin trumpet-like distal radius is difficult. Revision arthrodesis often ends in a non-union despite substantial bone-grafts. Debridement and revision with a new silicon implant is easy to perform and respectable function and a pain free situation might be achieved.
Correspondence should be addressed to ERASS Office, Schulthess Klinik, Lengghalde 2, CH-8008 ZURICH, Switzerland.
