Capio Private Hospital, Hellerup, Denmark.
Clinique Parc & Val Ouest, Lyon, France.
J Hand Surg Eur Vol. 2024 Feb;49(2):177-187. doi: 10.1177/17531934231203297.
We reviewed the incidence and management of complications after total wrist arthroplasty, as reported in the literature, with so-called fourth-generation implants and other recent designs. While early intraoperative and postoperative complications, including fractures, tendon lacerations, infection, nerve compression, tendonitis, stiffness and chronic regional pain syndrome, had an acceptable incidence, late complications, such as periprosthetic osteolysis and implant loosening, occurred more frequently. Implant survival at 10 years was in the range of 70%-80% in most publications. Several of the implants have been modified or withdrawn. Instability and dislocation were frequent after a pyrocarbon spacer. Failed arthroplasties can be salvaged by revision arthroplasty or total wrist arthrodesis. Revision arthroplasty has a lower survival rate than primary arthroplasty and does not clearly offer important significant advantages over total wrist arthrodesis in terms of patient-reported outcome measures. Further development of prosthetic design, new materials and more knowledge on patient-related risk factors are needed.
我们回顾了文献中报道的全腕关节置换术后并发症的发生率和处理方法，包括所谓的第四代假体和其他最近的设计。虽然早期术中及术后并发症，包括骨折、肌腱撕裂、感染、神经压迫、腱鞘炎、僵硬和慢性区域性疼痛综合征，发生率可接受，但晚期并发症，如假体周围骨溶解和假体松动，更为常见。在大多数文献中，10 年的假体存活率在 70%-80%之间。一些假体已经进行了修改或撤市。在使用热解碳间隔物后，不稳定和脱位很常见。翻修关节成形术或全腕关节融合术可挽救失败的关节成形术。翻修关节成形术的存活率低于初次关节成形术，并且在患者报告的结果测量方面，并不明显优于全腕关节融合术。需要进一步开发假体设计、新材料和更多关于患者相关风险因素的知识。
