Seventy-five patients with Steinbrocker stage III et IV rheumatoid wrists underwent arthroplasty with Swanson implant. Sixty-two implants were reviewed at 5 years postoperatively. Functional criteria, namely pain, mobility and grip proved satisfactory in 66% of cases. Radiological examination revealed 23% radial implant fractures, 50% dislocated or fractured ulnar implants and 29% foreign body synovitis. This high rate of complication is disappointing given the encouraging initial results, and leads us to reconsider the appropriateness of such surgery in severe cases of rheumatoid wrist.