Volz total wrist arthroplasty in rheumatoid arthritis: a long-term review

The results of 30 Volz total wrist arthroplasties in 23 patients with stage III or stage IV rheumatoid arthritis were reviewed 36 to 106 months after the operation (average 69 months). Sixty percent were rated good or excellent, 27% were rated fair, and 13% were rated poor. Good or excellent results were achieved in 77% with single-prong metacarpal components, but in only 47% of the double-prong group. Wrist imbalance was the primary cause of poorer results with the double-prong metacarpal component. Pain relief and patient satisfaction were achieved in 86% of the cases. Typical radiologic patterns of deterioration were resorption of bone under the collar of the radial component (79%, average 3.7 mm) and metacarpal component loosening (24%). Most patients with component loosening had little or no discomfort. Complications occurred in 12 cases but affected the final outcome in only three patients.