Harvard Medical School, Boston, MA, USA.
Hand (N Y). 2022 Jan;17(1):114-118. doi: 10.1177/1558944719898817. Epub 2020 Feb 1.
Total wrist arthroplasty (TWA) is a treatment option for many debilitating wrist conditions. With recent improvements in implant design, indications for TWA have broadened. However, despite these improvements, there are still complications associated with TWA, such as unplanned reoperation and eventual implant removal. The goal of this study was to identify risk factors for an unplanned reoperation or implant revision after a TWA at 2 academic medical centers between 2002 and 2015. In this retrospective study, 24 consecutive TWAs were identified using CPT codes. Medical records were manually reviewed to identify demographic, patient- or disease-related, and surgery-related risk factors for reoperation and implant removal after a primary TWA. Forty-six percent of wrists (11 of 24 TWAs performed) had a reoperation after a median of 3.4 years, while 29% (7 of 24) underwent implant revision after a median of 5 years. Two patients had wrist surgery prior to their TWA, both eventually had their implant removed (08). There were no risk factors associated with reoperation or implant removal. Unplanned reoperation and implant removal after a primary TWA are common. Approximately 1 in 3 wrists are likely to undergo revision surgery. We found no factors associated with reoperation or implant removal; however, prior wrist surgery showed a trend toward risk of implant removal after TWA.
全腕关节置换术（TWA）是许多使人衰弱的腕部疾病的治疗选择。随着最近植入物设计的改进，TWA 的适应证已经扩大。然而，尽管有了这些改进，TWA 仍然存在并发症，如计划外再次手术和最终植入物取出。本研究的目的是确定在 2002 年至 2015 年间在 2 个学术医疗中心进行 TWA 后发生计划外再次手术或植入物修正的危险因素。在这项回顾性研究中，使用 CPT 代码确定了 24 例连续 TWA。通过手动审查病历，确定了初次 TWA 后再次手术和植入物取出的与人口统计学、患者或疾病相关以及手术相关的危险因素。46%的手腕（24 例 TWA 中有 11 例）在中位数为 3.4 年时进行了再次手术，而 29%（24 例中有 7 例）在中位数为 5 年后进行了植入物修正。两名患者在接受 TWA 之前进行了腕部手术，最终均将植入物取出（08）。没有与再次手术或植入物去除相关的危险因素。初次 TWA 后发生计划外再次手术和植入物去除很常见。大约有 1/3 的手腕可能需要进行修正手术。我们没有发现与再次手术或植入物去除相关的因素；然而，先前的腕部手术显示出 TWA 后植入物去除的风险趋势。
