Total wrist arthroplasty. Problems with implant failures.

Prosthetic replacement of the wrist requires careful consideration of anatomic and mechanical factors, appreciation of the techniques of implant fixation, and recognition of soft tissue imbalance across the wrist. Cemented wrist implants have an unacceptably high rate of failure (15%-30%) with a five-year progressively decreasing prosthesis "survival rate." Three different implant designs have been studied and analyzed with respect to long-term success. In the revision of failed wrist implants, the surgeon must evaluate requirements for a stable wrist and appropriately reconsider resection, a more stable total joint arthroplasty, and wrist arthrodesis.