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Severe Foreign Body Reaction in Wrist Arthroplasty Using a Carbon Reinforced Poly-Ether-EtherKetone Articulation - A Secondary Analysis of 11 Cases
Daniel Reiser, MD, PhD
1; Marcus Sagerfors, MD, PhD
2(1)Örebro University Hospital, Örebro, Sweden, (2)Orebro university, Faculty of Medicine and Health, Orebro, Sweden
Purpose:Wrist arthroplasty using carbon fiber reinforced poly-ether-ether-ketone (CFR-PEEK) components has been proposed to reduce implant wear. However, emerging reports suggest complications may occur. This study aimed to assess implant failure, synovitis, and histopathological findings in patients receiving total or hemi wrist arthroplasty with CFR-PEEK articulations.
Methods:A secondary analysis of two pilot series (n=40) was conducted, involving 20 patients treated with total wrist arthroplasty (TWA) and 20 with radial hemi wrist arthroplasty (RHWA). Eleven patients developed synovitis, of whom 8 required reoperation and 3 are awaiting revision. Histological analyses of biopsied tissue during revision surgeries were performed.
Results:In the RHWA group, 6 patients were reoperated a total of 15 times; 5 were eventually converted to radiocarpal arthrodesis (RCA). In the TWA group, 5 patients underwent 13 reoperations; 4 had component revisions or conversions to other implants. Histopathology showed macrophage-mediated incorporation of CFR-PEEK wear particles without giant-cell reactions. Clinical follow-up revealed persistent pain on activity, swelling, and limited wrist motion. Figures 2-4 illustrate implant design and revision findings.
Conclusions:A high rate of complications related to CFR-PEEK articulations in the wrist was observed, including severe synovitis and repeated reoperations. Histopathology revealed a foreign body response characterized by macrophage activity. These findings underscore the need for caution and vigilant follow-up when using CFR-PEEK in wrist implants.
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