Biaxial total-wrist arthroplasty

Sixty-four consecutive biaxial total wrist arthroplasties performed in 52 patients between March 1983 and June 1988 were reviewed. Fifty-seven cases involving 45 patients were followed for a minimum of 5 years or until failure. Of the remaining 7 patients, 6 had died and 1 was lost to follow-up study. For the 46 intact implants in living patients, the mean follow-up period was 6.5 years (range, 5-9.9 years). The mean patient age at operation was 58 years. The underlying diagnosis was rheumatoid arthritis in 63 cases and juvenile rheumatoid arthritis in 1 case. At follow-up evaluation, pain was reported as none in 75%, mild in 19%, moderate in 3%, and severe in 3%. Patients rated their improvement as much better in 62%, better in 30%, some improvement in 4%, and worse in 4%. Range of motion at last follow-up averaged 36 degrees extension, 29 degrees flexion, 10 degrees radial deviation, and 20 degrees ulnar deviation. Grip strength improved from 4.1 kg preoperatively to 5.9 kg at last follow-up evaluation. Pain was likewise significantly improved at 1 year and 5 years. Failures occurred in 11 cases. The causes of failure were loosening of the distal implant in 8 cases and infection, dislocation, and progressive soft tissue imbalance in 1 case each. An abnormal resting stance and distal implant subsidence (greater than or equal to 3 mm) at 1 year were associated with implant failure at final follow-up evaluation. The Kaplan-Meier probability of survival free of revision was 83% at last follow-up evaluation.