Fischer Per, Sagerfors Marcus, Brus Ole, Pettersson Kurt
Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
J Hand Surg Am. 2018 May;43(5):489.e1-489.e7. doi: 10.1016/j.jhsa.2017.10.038. Epub 2017 Dec 8.
Management of failed total wrist arthroplasty (TWA) can be challenging; surgical treatment options include salvage arthrodesis, revision arthroplasty, and resection arthroplasty. There are few studies regarding salvage arthrodesis, and revision arthroplasty has been infrequently investigated. The aim of the study was to report the outcome after revision arthroplasty of the wrist.
A retrospective cohort of 16 revision TWAs was evaluated between 2003 and 2016. Data were collected before surgery and 1 and 5 years after surgery. The indication for revision arthroplasty was failed TWA. The primary end point was implant survival. Secondary outcome measures included visual analog scale (VAS) pain scores, range of motion, handgrip strength, and functional scoring with the Canadian Occupational Performance Measure (COPM), Patient-Rated Wrist Evaluation (PRWE), and Disabilities of the Arm, Shoulder, and Hand (DASH).
Mean follow-up was 6.6 years. Synthetic bone graft was used in 9 cases, allograft corticocancellous bone graft in 1 case, and cement in 6 cases. Of the 16 revision TWAs, 4 were re-revised, 1 because of infection, and 3 cases underwent total wrist arthrodesis. In the non-re-revised cases, range of motion and grip strength was preserved compared with preoperative results. The VAS pain score in activity improved, but not significantly, at 1 (median, 1; range, 0-4.5) and 5 years after surgery (median, 0) compared with before surgery (median, 5). The COPM performance and satisfaction as well as PRWE scores improved significantly at 1 year (median COPM performance, 4.8; COPM satisfaction, 5.6; and PRWE, 24) and improved, but not significantly, at the 5-year follow (median COPM performance, 4.8; COPM satisfaction, 5.0; and PRWE, 37) in the non-re-revised cases.
Revision arthroplasty of the wrist is a valid motion-preserving option to wrist arthrodesis in the management of failed TWA. However, the outcome is uncertain and as many as 25% require additional surgery.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
全腕关节置换术（TWA）失败后的处理具有挑战性；手术治疗选择包括挽救性关节融合术、翻修关节成形术和切除关节成形术。关于挽救性关节融合术的研究较少，翻修关节成形术也很少被研究。本研究的目的是报告腕关节翻修关节成形术后的结果。
对2003年至2016年间16例腕关节翻修TWA患者进行回顾性队列研究。在手术前以及手术后1年和5年收集数据。翻修关节成形术的指征是TWA失败。主要终点是植入物存活率。次要结局指标包括视觉模拟量表（VAS）疼痛评分、活动范围、握力，以及使用加拿大职业表现测量法（COPM）、患者自评腕关节评估（PRWE）和上肢、肩部和手部功能障碍（DASH）进行功能评分。
平均随访6.6年。9例使用合成骨移植，1例使用同种异体皮质松质骨移植，6例使用骨水泥。16例腕关节翻修TWA中，4例再次翻修，1例因感染，3例行全腕关节融合术。在未再次翻修的病例中，与术前结果相比，活动范围和握力得以保留。与术前（中位数为5）相比，术后1年（中位数为1；范围为0 - 4.5）和5年（中位数为0）时活动时的VAS疼痛评分有所改善，但改善不显著。在未再次翻修的病例中，COPM表现和满意度以及PRWE评分在术后1年显著改善（COPM表现中位数为4.8；COPM满意度为5.6；PRWE为24），在5年随访时有所改善，但改善不显著（COPM表现中位数为4.8；COPM满意度为5.0；PRWE为37）。
在处理失败的TWA时，腕关节翻修关节成形术是一种有效的保留活动功能的替代腕关节融合术的选择。然而，结果不确定，多达25%的患者需要再次手术。
研究类型/证据水平：治疗性IV级。
