Risk factors for reoperation after total wrist arthroplasty
Pong, Taylor Marie
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BACKGROUND: Total wrist arthroplasty (TWA) is a surgical option for treatment of end-stage wrist arthritis and other debilitating wrist conditions. Despite improvements in the TWA implant and procedure, there are still many complications after an initial TWA. The most common complications include infection, hardware loosening, and tendon rupture. These complications are indications for an unplanned reoperation after an initial TWA. OBJECTIVE: The purpose of this retrospective study was to determine the rate of reoperation and implant removal after TWA. We tested the null hypotheses that there are no demographic or surgery-related factors associated with an unplanned reoperation or implant revision after a TWA. We also studied the secondary question whether there were radiographic features that predicted reoperation or implant revision after a TWA. METHODS: We used Current Procedural Terminology (CPT) codes to identify all 29 consecutive TWAs performed at two academic medical centers between 2002 and 2015. We manually reviewed medical records to collect demographic (age, sex), patient- or disease-related (tobacco use, indication of rheumatoid arthritis, prior wrist surgery) and surgery-related (implant type) factors. Reoperation was defined as any unplanned wrist surgery related to the TWA. We used a Fisher’s exact test to compare the proportions of categorical variables and a Mann-Whitney-U test to compare the average age among wrists that did and did not undergo reoperation and implant removal, and calculated P-values. RESULTS: The rate of reoperation was 48% (14 of 29 TWAs performed); of which 34% (10 of 29) underwent implant removal. The most common indication for reoperation was component loosening, which occurred in 5 wrists. Five patients had wrist surgery prior to their TWA, of whom 4 eventually had their implant removed (p = 0.036). No other factors were associated with reoperation or implant removal. CONCLUSIONS: We found that reoperation and implant removal after TWA are common. Despite improvements, approximately 1 in 3 wrists are likely to undergo revision surgery. Prior wrist surgery was the only risk factor statistically associated with implant removal after TWA. Patients should be counseled of the high rate of reoperation and implant removal before electing to undergo TWA when considering all treatment options for end-stage wrist arthritis.