There is an high incidence of failures of total wrist arthroplasties. We review our experiences in revising total wrist implant arthroplasties to arthrodeses. The most common mode of failure of the arthroplasties in our series was metacarpal loosening with dorsal perforation of the stem. Loosening of the proximal stem, progressive mal-position of the wrist and other causes appeared.

We used for the revision arthrodesis in all our cases tricortical iliac crest bone grafts and additional spongiosa transplants from this donor site region. In one case we used a vascularized iliac crest bone graft to bridge the bone defect because of a bad host quality of the recipient area. Fixation was achieved with plates and screws.

Our average follow-up period was 32 month. 40 patients with 41 failed wrist implants (3 different types) were treated with this technique. 40 wrist undergoing arthrodesis attained a solid painless fusion after a single operation. In one case a non-union with a loosening of the screws due to using a non-rigid plate was seen. In this case a revision was necessary to achieve a bone healing. All patients were satisfied, pain free and achieved an increased pinch and grip strength after bony fusion (measured with Yamar-Vigorimeter). A persisting loss of carpal height was seen in all cases.

Arthrodesis after failed total wrist arthroplasty is a satisfactory salvage procedure even in cases with a bad quality of the recipient area. We recommend a rigid fixation technique to prevent non-unions.

From January 2000 to March 2004 16 thumbs after total avulsion-amputation were replanted in our hospitals. In 15 cases this was successful. In one case the thumb was lost 28 hours after replantation. Mostly the amputation was in the region of the first phalanx or the IP-joint of the thumb.

In all cases our operative procedure for this form of amputation was the reconstruction of the vessels with vein grafts after the osteosynthesis and the reconstruction of the tendons. The donorsite region for the grafts was in 12 cases the dorsal forefoot and in 4 cases the distal forearm. In none of these cases there was the possibility of reconstructing both arteries. Mostly only an anastomosis for one artery and one vein could be done. For none of these patients it was possible to reconstruct the nerves primarily. Until now transphers of neurovascular skinislands of longfingers, free nerve transplantations with coaptations to the proximal stump of the injured nerve, free nerve transplantations with coaptations to the trunk of the median nerve or in one case an end-to-side coaptation have been performed to achieve a resensibility of the thumbs. In one case a patient rejected an operative nervereconstruction, because a sprouting of the proximal stump of the injured nerve lead to a (reduced) sensibility of the thumb. In 4 cases a therapy to achieve a resensibility has so far not been carried out.

After replantations of injured thumbs necroses of the skin in different kinds were noticed. In 4 cases secondary skinreconstructions were necessary. All 15 successful replanted thumbs achieved very good results concerning function, strength and patient’s satisfaction.

Our results don’t agree with the mostly bad results after total avulsionamputations mentioned in literature. We think that the replantation after total avulsionamputation of the thumb has a high chance of being successful and can achieve very good longtime results.

Aims: The purpose of this study was to find out if navigation devices can improve the alignement of knee arthroplasties even in experience surgeons. Methods: An external group of investigators – members of the Department of Epidemiology of the German Research Institute of Rheumatology – designed a prospective randomized study for the anlayzes of the alignement of knee implants with and without the support of a navigation device. Long standing X-rays before and after surgery were performed. The analyzes of X-rays was done in an external department of radiology. The analyzing radiologers didn’t know to which group the X-rays belonged. In total 120 patients with and 120 patients without the use of the Stryker navigation device were analyzed. The results were compared with the Qui square test. Results: There was a significant difference between the group of non navigated and navigated total knee arthroplasties. In the group without navigation system between 3 and 6% of the implants were positioned in mal-alignement of more than 3°. In the navigated group there was no case which differed to far from the ideal mechanical line. Conclusions: Even in the hands of very experienced surgeons the use of a navigation device can improve the alignment of implants. This study could prove it in concern of varus/valgus-position of the femoral and tibial component but also in the flexion/extension-position of the femoral component and the slope of the tibia component. The positioning was much more accurate in the navigated group. There was no case in the navigated group with wrong alignement.

Aims: The purpose of this study was to þnd out if an open navigation system is useful in early revision cases of TKA. We used an open navigation device which was developed in our hospital. The question was to þnd out if the mal positioning of the implants can be analyzed by the navigation device. Methods: 41 early revision cases were performed with the support of our navigation device. All these cases came to the hospital because of pain or swelling, there was now infection and now loosening in this group. We analyzed the positioning of the implant by cinematic navigation that means pre-operative CT and other preparations were not necessary. We measured the position of the implants and compared it to the ideal position which was calculated by the navigation device. Results: The need of early revision in total knee arthroplasty is caused by mal-positioning of the implants. The mal-positioning leads to a mal alignment and to a soft tissue imbalance. The most common failure in Germany is a wrong internal rotation of the femur component. This is causing overload of the medium side of the polyethylene and an instability of the lateral side. Often mal tracking of the patella is caused by mal rotation of the femur component. In all these cases the navigation device could lead the surgeon to the right position of the implant in revision surgery. Conclusions: A development of open navigation systems is necessary for the use of these systems in revision surgery. Revision surgery needs from time to time the intraoperative calculation of the positioning because early revisions are always caused by mal alignments. Therefore the use of a navigation device can improve the knowledge of the surgeon and help to perform the revision surgery in an excellent way.

There is an incidence of failures of total wrist arthroplasties. We review our experiences in revising total wrist implant arthroplasties to arthrodeses. The most common mode of failure of the arthroplasties in our series was metacarpal loosening with dorsal perforation of the stem.

We used for the revision arthrodesis in all our cases tricortical iliac crest bone grafts and additional spongiosa transplants from this donor site region. In one case we used a vascularized iliac crest bone graft to bridge the bone defect because of a bad host quality of the recipient area. Fixation was achieved with plates and screws.

Our average follow-up period was 28 month. 14 patients with 15 failed wrist implants were treated with this technique. 14 patients undergoing arthrodesis attained a solid painless fusion after a single operation. In one case a non-union with a loosening of the screws due to using a non-rigid plate was seen. In this case a revision was necessary to achieve a bone healing. All patients were pain free and achieved an increased grip strength after bony fusion.

Arthrodesis after failed total wrist arthroplasty is a satisfactory salvage procedure even in cases with a bad quality of the recipient area. We recommend a rigid fixation technique to prevent non-unions.