Resumo

NEVES, João et al. Descolamento séptico de prótese total do punho: Sistematização de uma abordagem terapêutica. Rev. Port. Ortop. Traum. [online]. 2014, vol.22, n.4, pp.415-424. ISSN 1646-2122.

Introduction: The total wrist arthroplasty cannot mimic, in all its fullness, the complex mechanism of the wrist joint. Alternative therapies to the wrist osteoarthritis are numerous, and many more economic, unlike what happens with gonarthrosis and coxarthrosis treatment that offers an incomparably better cost benefit relation. Objective: The aim of this work is to present a clinical case of wrist arthroplasty failure due to chronic infection and try to discuss and draw a therapeutic approach (algorithm) for similar cases taking in consideration the degree of osteolysis, the presence of detachment and inherent instability and the condition of the soft tissues. The authors report a case of an individual, male, 58 years old, manual worker, that appears with pain and inflammatory signs on right wrist arthroplasty, with fistulous track. The revison procedure was performed in 2 stages: the first stage revision consisted on removal the implant, debridement and interposition of cement spacer with antibiotics and immobilization, the second stage revision a radio-metacarpal arthrodesis with plate precast and interposition of autologous graft harvested. Discussion and Results: The improvement of the implants in recent years have contributed to the increasing use of arthroplasty as a treatment option with good results. Although it presents itself with an attractive option in terms of future functional capabilities, arthroplasty remains with some risks and have a higher rate of complications in the medium and long term than fusion, so the selection of patients should be careful. The main problem of wrist arthroplasty revision is due to the loss of bone stock to promote fusion and the shortening after implant removal. Conclusions: The success of wrist arthroplasty depends on careful patient selection, careful preoperative planning, rigorous technique and an appropriate program of functional rehabilitation. The wrist arthrodesis can always be seen as an ultimate salvation procedure in the treatment of failure of wrist arthroplasty, either a mechanical or infectious failure.

Palavras-chave : Septic Failure; antibiotics; Spacer; radiocarpal arthrodesis.

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