Treatment of severe radiocarpal arthritis remains controversial. Since 1992, the newly designed universal total wrist arthroplasty has been used as an alternative to radiocarpal fusion.

A total of 49 patients underwent total wrist arthroplasty between 1992 and 1998. A total of 43 patients with 47 wrists were available for follow-up. Thirty-two patients had rheumatoid arthritis, nine patients had osteoarthritis and two patients had Kienboch’s disease. The average age of the patient was 55 years and the average length of follow-up was 42 months.

Results at follow-up showed 89% of the wrist were without pain. Neutral alignment was present in 96% of the wrists. A functional arc of motion was present in 87% of the wrists. Ninety-four percent of the patients were satisfied. Radiographs showed excellent alignment of the implant, without evidence of distal migration of the carpal component. Complications occurrred in 12 of 47 wrists (25.5%). Six of the wrists had a dislocation. Three wrists developed metallosis, requiring revision of the prosthesis. One patient required removal of the prosthesis and wrist fusion. The revision rate in this series was 11%. The fusion rate was 2%. Eleven of 12 patients had resolution of their complication with appropriate intervention, and did not require a salvage procedure.

This study revealed that total wrist arthroplasty can result in a painless and functional wrist in the majority of patients. We feel that total wrist arthroplasty remains a viable alternative in patients with severe radiocarpal arthritis.

We investigated 14 patients with pyogenic flexor tenosynovitis for increased tissue pressures in involved digits. All showed raised pressures, in eight to 30 mmHg or more. These levels are consistent with a compartment syndrome.

We describe the results of a modified operative technique which includes irrigation of the sheath and the leaving open of a lateral incision. This also allows early active mobilisation of the finger and has given satisfactory early results.