This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Schindele, S.F Articles by Simmen, B.R. Search for Related Content PubMed Articles by Schindele, S.F Articles by Simmen, B.R.

S48 REVISION-WRIST-ARTHROPLASTY OF A SWANSON SILICON IMPLANT WITH ANOTHER SILICON IMPLANT IN 3 CASES OF RHEUMATOID AND PSORIATIC ARTHRITIS

Schulthess Clinic, Zürich

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.