BIAX total wrist arthroplasty: Management and results after 42 patients

The BIAX total wrist arthroplasty was introduced in 1983 by Cooney, Beckenbaugh and Linscheid in the USA. However the production of this prosthesis was discontinued in 2004 without having developed a follow-up model. Between 2001 and 2003 we have implanted the BIAX prosthesis in 42 cases. In contrast to other studies, our patients had more post-traumatic (n = 19) and degenerative athroses (n = 20), only 3 patients had rheumatoid arthritis of the wrist. Follow-up time was 2.6 (+/- 0.8) years. The patients were 53 (+/- 11) years old. Indication for total wrist arthroplasty was comparable to that for arthrodesis. However, as pain reduction is lower in heavy workers these patients were excluded from arthroplasty implantation. Range of movement was preserved by total arthroplasty or slightly improved. Pain was reduced by 4.5 (+/- 2.3) points from 7.6 (+/- 1.0) to 3.0 (+/- 2.1) using a visual analogue scale with 0 points for no pain and 10 points for severe pain. Patient satisfaction with the operation was 7.7 (+/- 2.2, 1 bad, 10 excellent). 4 patients had a postoperative dislocation. After reposition the joints were permanently stable. In one case a flexion contracture of unknown origin was treated by tendon transfer. In 11 patients the prosthesis had to be removed after 2 (+/- 0.9) years. Four of these patients received an arthrodesis, 7 had a change to the Universal2 prosthesis. The reason for explantation was mainly abrasion of the dorsal polyethylene edge of the proximal socket, resulting in foreign body reaction, synovialitis and loosening of the prostheses in 7 patients and permanent dislocation in 2 patients due to the then flattened socket. These complications led us to abandon the implantation of the BIAX prostheses.