Biaxial long-stemmed multipronged distal components for revision/bone deficit total-wrist arthroplasty

Revision total-wrist arthroplasty has a high incidence of complications. Loosening is a significant problem for the distal implant. Because of the high failure rate of single-pronged distal implants after revision total-wrist arthroplasty, a custom multipronged distal component (biaxial total-wrist implant) was designed for use in patients with deficient bone stock who undergo revision operation. Ten cases of total-wrist arthroplasty with a custom long-stemmed multipronged distal component are presented. The preoperative diagnosis was failed total-wrist arthroplasty in 9 cases. Mean time from previous total-wrist arthroplasty to revision procedure was 5.6 years. At follow-up evaluation (mean, 3.8 years; range, 3.0-4.8 years), 2 patients had undergone arthrodesis: 1 patient at an outside institution 1 year after surgery for periprosthetic fracture of the radius, and 1 patient at our institution for distal implant loosening. The 8 other patients had functional total-wrist arthroplasties. At follow-up evaluation, all patients reported they were satisfied. Six patients reported no pain and 2 reported mild pain. Mean range of motion at follow-up evaluation was within the previously defined limits that allow patients to function in activities of daily living: 78 degrees for supination, 77 degrees for pronation, 39 degrees for extension, 17 degrees for flexion, 12 degrees for radial deviation, and 18 degrees for ulnar deviation. Revision total-wrist arthroplasty with custom long-stemmed, multipronged distal components offers an alternative to those patients with deficient bone stock who refuse arthrodesis. Early results demonstrate greater longevity compared with single-pronged components for revision total-wrist arthroplasty.