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Total Wrist Arthroplasty in Patients Younger than 60 Years of Age; an analysis of 261 consecutive primary arthroplasties
Eric R. Wagner, MD; Jason Srnec, BS; Casey M. DeDeugd, MD; Marco Rizzo, MD
Mayo Clinic, Rochester, MN

Purpose: The outcomes of upper extremity small joint arthroplasty in young patients has yet to be examined. The purpose of this investigation was to define the association between a young age and outcomes after TWA.

Methods: Using our institution's total joint registry, 445 consecutive primary TWA arthroplasties were performed at our institution from 1974 to 2013. The average age was 57 years (16-83). There were 261 arthroplasties performed in patients <60 years of age. In these younger patients, the surgical diagnoses included osteoarthritis (3%), inflammatory arthritis (91%), and post-traumatic arthritis (PTA, 7%). The implants in this study included Remotions (n=19), Biax (n=99), Volz (n=10), Meuli (n=91), Universal (n=4), and Swanson (n=38). Cement was used in 215 (82%), while 27 (10%) required augmentation with bone graft.

Results: Overall, there were 110 (25%) TWA arthroplasties that required revision surgery at a mean of 5.4 years postoperatively. In the young patients (<60 years), 81 (31%) required revision surgery at a mean 5.6 years postoperatively for loosening (n=36), component fracture (n=6), infection (n=7), wrist instability (n=20), and other (n=12). Risk of revision surgery was not associated with age taken as a continuous variable (p=0.44), but there was an increased risk of revision surgery when comparing those younger than 60 to those older than 60 years (HR 1.61, p=0.02). The 5, 10, and 20-year implant survival rates for the patients <60 years were 80%, 70%, and 60%, respectively, which was significantly lower the older patients (Figure 1). Amongst the these younger patients, the risk for revision surgery was increased in osteoarthritis, but this was not significant (Figure 1). Swanson implants had improved implant survival (Table 1). In the younger patients, there were 4 intraoperative complications involving fracture in the younger patients. Postoperative complications in the younger patients included dislocation (n=24), infection (n=13), postoperative fractures (n=11), implant loosening (n=41), recurrent subluxation (n=17) heterotopic ossification (n=5), tendon/ligament injury (n=12), and wear (n=6). The risk of carpal component loosening was increased in patients younger than 60 years, while dislocation and fractures were not.

Conclusions: Younger age lead to slightly higher rate of revision surgery and complications, particularly implant loosening after total wrist arthroplasty. Swanson implants performed better in this younger population. These findings help when counseling patients, estimating risk, and potentially evaluating risk in health policy.

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