Failure of silicone rubber wrist arthroplasty in rheumatoid arthritis

Of 71 silicone rubber wrist arthroplasties performed between 1976 and 1983, 20% were found to have fractured, and an additional 5% required revision for deformity and pain. In most cases, no specific cause for the failure could be identified. However, excessive wrist motion, overuse, and inadequate surgical technique appear to be contributory. Prosthetic fracture is associated with increasing wrist pain, instability, and deformity with decreasing strength and function. Twelve of 14 fractured prostheses required revision. Eleven of these were revised with another silicone rubber implant, and two of these have refractured. Based on this review, we have narrowed our indications for silicone rubber wrist arthroplasty and now give greater consideration to alternative methods of treatment.