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Boeckstyns MEH, Herzberg G. Complications after total wrist arthroplasty. J Hand Surg Eur Vol 2024; 49:177-187. [PMID: 38315136 DOI: 10.1177/17531934231203297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
We reviewed the incidence and management of complications after total wrist arthroplasty, as reported in the literature, with so-called fourth-generation implants and other recent designs. While early intraoperative and postoperative complications, including fractures, tendon lacerations, infection, nerve compression, tendonitis, stiffness and chronic regional pain syndrome, had an acceptable incidence, late complications, such as periprosthetic osteolysis and implant loosening, occurred more frequently. Implant survival at 10 years was in the range of 70%-80% in most publications. Several of the implants have been modified or withdrawn. Instability and dislocation were frequent after a pyrocarbon spacer. Failed arthroplasties can be salvaged by revision arthroplasty or total wrist arthrodesis. Revision arthroplasty has a lower survival rate than primary arthroplasty and does not clearly offer important significant advantages over total wrist arthrodesis in terms of patient-reported outcome measures. Further development of prosthetic design, new materials and more knowledge on patient-related risk factors are needed.
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2
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Brown M, Wharton R, Begum R, Trail I, Hayton M, Talwalkar S. Total wrist arthroplasty with the Freedom® prosthesis: a short-term follow-up. J Hand Surg Eur Vol 2024; 49:40-47. [PMID: 37694732 DOI: 10.1177/17531934231193119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
We retrospectively reviewed our series of primary total wrist arthroplasty with the Freedom® prosthesis. The primary outcome measure was revision, and secondary measures included radiographic loosening, pain, complications, movement range, grip strength and patient-reported measures. We reviewed 12 implants in 11 patients (mean age 59 years, range 45-80) with a mean radiological and clinical follow-up of 2.7 and 3 years, respectively. One radial component failed to integrate and was revised at Day 84. Four carpal components demonstrated areas of lucency. There was a statistically significant reduction in pain, and total flexion-extension increased. Despite high patient satisfaction on a ten-point visual analogue scale score (mean 8.7 out of 10), the mean patient-rated wrist evaluation, Quick Disabilities of the Arm, Shoulder and Hand and Patient Evaluation Measure scores were 52, 55 and 53, respectively. The Freedom® implant reduced pain and preserved wrist movement in our patients; however, annual surveillance is recommended due to the high incidence of early carpal component lucency.Level of evidence: IV.
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Affiliation(s)
- Matthew Brown
- Wrightington Hospital, Appley Bridge, Wigan, Lancashire, UK
| | - Rupert Wharton
- Wrightington Hospital, Appley Bridge, Wigan, Lancashire, UK
| | - Rumina Begum
- Wrightington Hospital, Appley Bridge, Wigan, Lancashire, UK
| | - Ian Trail
- Wrightington Hospital, Appley Bridge, Wigan, Lancashire, UK
| | - Mike Hayton
- Wrightington Hospital, Appley Bridge, Wigan, Lancashire, UK
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Chong HH, Zabaglo M, Asif A, Boksh K, Kulkarni K. A systematic review and network meta-analysis of outcomes after total wrist arthroplasty in inflammatory and non-inflammatory arthritis. J Hand Surg Eur Vol 2024; 49:17-24. [PMID: 37694836 DOI: 10.1177/17531934231199317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
This systematic review analysed the available evidence on the clinical outcomes of total wrist arthroplasty (TWA) in patients with inflammatory and non-inflammatory arthritis. After screening, 12 studies met the inclusion criteria. They involved 359 patients with 378 TWA implants. The results showed that TWA significantly improved Disabilities of the Arm, Shoulder and Hand (DASH)/Quick-DASH scores and pain visual analogue scale scores in both arthritis groups compared with preoperative values. However, there was no statistically significant difference in the outcome scores between the two groups. Three studies reported Patient-Rated Wrist Evaluation (PRWE) scores, and TWA significantly improved PRWE scores in non-inflammatory arthritis but not in inflammatory arthritis, with no significant difference in postoperative outcome scores between the two groups. Although the included studies have limitations, the review suggests that TWA may be a successful treatment for wrist pain in individuals with either inflammatory or non-inflammatory arthritis. However, further high-quality trials are needed to confirm these findings.
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Affiliation(s)
- Han Hong Chong
- Department of Trauma & Orthopaedic, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Mate Zabaglo
- Department of Trauma & Orthopaedic, Northampton General Hospital NHS Trust, Northampton, UK
| | - Aqua Asif
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Khalis Boksh
- Department of Trauma & Orthopaedic, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Kunal Kulkarni
- Department of Trauma & Orthopaedic, University Hospitals of Leicester NHS Trust, Leicester, UK
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Newton A, Kandemir G, Joyce T, Murali R, Hayton M, Talwalkar S, Trail I. Long-term outcomes of the Universal 2 total wrist replacement: revision and loosening at 10 years and beyond. J Hand Surg Eur Vol 2023:17531934231160380. [PMID: 36927271 DOI: 10.1177/17531934231160380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
The aim of this study was to ascertain the long-term revision rates of the Universal 2 wrist prosthesis in a previously published cohort of patients with rheumatoid arthritis. The time to, and reasons for revision were determined. Radiographs were analysed to determine whether loosening had occurred in the long-term according to the Wrightington zonal classification of loosening. Seventy-eight wrists from the original cohort of 85 wrists could be identified for analysis. The longest follow-up was 16 years and 29 wrists had follow-up beyond 10 years. Seventeen wrists had been revised or were on the waiting list for revision, an overall revision rate of 22%. The 10-year survivorship was 78%. Long-term revision was commonly for periprosthetic loosening with pain and component subsidence. In those with more than 10-year follow-up, significant lucency was seen in 16 carpal components and 15 radial components. Explant analysis showed significant polyethylene wear and we postulate this is the principal reason for component loosening.Level of evidence: IV.
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Affiliation(s)
| | | | | | - Raj Murali
- Wrightington, Wigan and Leigh NHS Trust, Wigan, UK
| | | | | | - Ian Trail
- Wrightington, Wigan and Leigh NHS Trust, Wigan, UK
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5
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Rodríguez-Nogué L, Martínez-Villén G. Total wrist fusion versus total wrist prosthesis: a comparative study. J Plast Surg Hand Surg 2023; 57:466-470. [PMID: 36538422 DOI: 10.1080/2000656x.2022.2153131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We present a comparative study of 41 total wrist fusions (TWFs) with contoured plate and 22 total wrist prostheses using the Universal 2™ model, with a mean follow-up of 6 years for the fusion and 6.5 years for the prosthesis. We evaluated grip strength, pain according to the visual analogue scale, functional results using the Quick Disabilities of the Arm, Shoulder and Hand and the Patient-Rated Wrist Evaluation, degree of satisfaction and complications, with no significant differences being observed in any of these variables. The results allow us to conclude that total wrist prosthesis implanted in patients with low or moderate functional demands offers medium-term functional results similar to TWF without increasing the number of complications.Level of evidence: III.
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Affiliation(s)
- Luis Rodríguez-Nogué
- Department of Orthopaedic and Traumatology (Hand and Reconstructive Surgery Unit), Miguel Servet Universitary Hospital, Zaragoza, Spain
| | - Gregorio Martínez-Villén
- Department of Orthopaedic and Traumatology (Hand and Reconstructive Surgery Unit), Miguel Servet Universitary Hospital, Zaragoza, Spain
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Reigstad O, Holm-Glad T, Korslund J, Grimsgaard C, Thorkildsen R, Røkkum M. 15-20 Year Follow-up After Wrist Arthroplasty Surgery - Revisiting the Development and Introduction of a New Prototype Concept for Total Wrist Arthroplasty. J Hand Surg Asian Pac Vol 2022; 27:945-951. [PMID: 36606350 DOI: 10.1142/s242483552250093x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: Wrist arthroplasties have not achieved clinical outcomes comparable to those of shoulders and knees, being offered low-demand patients due to a high failure rate. In the 90s, there were no wrist arthroplasties available for high-demand patients. An experimental setup for the development of a new wrist arthroplasty intended for all wrist patients were done. A long-term final follow-up to evaluate the performance of the experimental arthroplasty was performed. Methods: A novel uncemented modular wrist prosthesis with conical threaded fixation, metal-on-metal coupling and ball-and-socket articulation was developed. In an experimental study, eight patients (7 men, 53 years of age) were operated between 2001 and 2003, to treat non-inflammatory primary or secondary osteoarthritis. Published mid-term results (7-9 years) demonstrated satisfactory function, but two arthroplasties were converted to arthrodesis due to infection. Results: At final follow-up 15-20 years after primary surgery, the remaining six patients still had a wrist arthroplasty (in three the original) in situ. The clinical results were good. Low pain (median = 0), Quick Disability of Arm, Shoulder and Hand (QDASH median 11) and Patient Rated Wrist and Hand Evaluation (PRWHE median = 14) scores were reported. Wrist active range of motion (AROM) was 64% and grip strength 86% compared to the opposite side. None regretted choosing arthroplasty knowing the outcome. Conclusions: Despite technical errors and the implementation of an incomplete prototype, this new concept for arthroplasty has demonstrated promising long-term fixation, a stable articulation with good range of motion, satisfactory function and pain reduction in high-demand patients. Level of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- Ole Reigstad
- Orthopaedic Department, Martina Hansens Hospital, Baerum, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trygve Holm-Glad
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Johanne Korslund
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Christian Grimsgaard
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Rasmus Thorkildsen
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magne Røkkum
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Zijlker HJA, Ritt MJPF, Beumer A. Fourth-Generation Total Wrist Arthroplasty: A Systematic Review of Clinical Outcomes. J Wrist Surg 2022; 11:456-464. [PMID: 36339074 PMCID: PMC9633149 DOI: 10.1055/s-0041-1735840] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
Background The purpose of total wrist arthroplasty is to reduce pain and maintain mobility in a painful destructed wrist. First-, second-, and third-generation total wrist arthroplasties have shown unacceptable outcomes with high failure rates. In 2004, the fourth-generation total wrist implants were introduced to address the clinical problems encountered in the previous generations of total wrist implants. Methods Outcomes and complications of fourth-generation total wrist implants were systematically reviewed in the literature (2004-present), including the Universal 2, ReMotion, Freedom, Motec, and Maestro total wrist implants. Results The literature search yielded 114 papers, of which 18 (990 implants) were included in this systematic review. The quality of evidence was low. All implants effectively reduced pain and improved functionality of the wrist. The Motec wrist implant demonstrated the highest survival rate at 10 year follow-up (86%). Conclusion This systematic review suggests a substantial improvement of quality in fourth-generation total wrist arthroplasty.
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Affiliation(s)
- Hero Jan Aeilko Zijlker
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Annechien Beumer
- Department of Orthopaedic Surgery, Upper Limb Unit, Amphia Hospital, Breda, The Netherlands
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
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Martínez Villén G, Rodríguez Nogué L, García González E. Postoperative assessment and management of metallosis and periprosthetic osteolysis in patients treated with metal-on-polyethylene total wrist prostheses. J Hand Surg Eur Vol 2022; 47:952-958. [PMID: 35866419 DOI: 10.1177/17531934221113723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We analysed the relationship between serum metal ions, radiological periprosthetic osteolysis and the clinical features in a series of 25 patients treated with fourth-generation metal-on-polyethylene total wrist prostheses. The mean implant follow-up was 7 years. Our results show that titanium was the main elevated serum metal ion in patients with the prostheses that we used; elevated serum cobalt or chromium values were infrequent. The risk of loosening was higher in an implant older than 6 years, with more than five periprosthetic osteolysis points according to our radiograph zone system, and serum titanium values between 26 to 31 µg/L. The presence of metallosis pseudotumours does not guarantee but increases the risk of implant failure, which may be asymptomatic or associated with little pain.Level of evidence: IV.
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Affiliation(s)
- Gregorio Martínez Villén
- Department of Orthopaedic and Traumatology (Hand and Reconstructive Surgery Unit), Miguel Servet University Hospital, Zaragoza, Spain
| | - Luis Rodríguez Nogué
- Department of Orthopaedic and Traumatology (Hand and Reconstructive Surgery Unit), Miguel Servet University Hospital, Zaragoza, Spain
| | - Elena García González
- Department of Clinical Biochemistry, Miguel Servet University Hospital, Zaragoza, Spain
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Total Wrist Arthroplasty with Integra Freedom ® Implants: A Pilot Study with a New Evaluation System. Indian J Orthop 2022; 56:1040-1047. [PMID: 35669017 PMCID: PMC9123129 DOI: 10.1007/s43465-022-00618-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/27/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Recent innovations in wrist arthroplasty implants have led to remarkable improvements in terms of results with improved stability and preservation of bone stock. Despite the advances in such implants, poor outcomes and frequent complications still affect this procedure, not allowing a wider use of this treatment in wrist arthritis.The purpose of this study is to assess the preliminary mid-term results of a Wrist Arthroplasty System (Freedom®, Integra Lifesciences, Princeton, USA) in patients with rheumatoid arthritis or secondary osteoarthritis of the wrist and to propose a new classification system. MATERIALS AND METHODS We examined 12 patients (7 with rheumatoid arthritis and 5 with secondary osteoarthritis of the wrist) who underwent total wrist arthroplasties performed by a single surgeon using the fourth-generation prosthesis. Pre- and post-operative pain on a visual analogue score, functional parameters measured with Mayo Wrist score, patient-rated wrist evaluation score, range of motion, and radiographic analysis were collected. RESULTS At a mean follow-up of 48 (SD 16.9) months a significant improvement (p < 0.0001) of the mean visual analogue, Mayo and PRWE scores following total wrist arthroplasty was observed. Wrist movements improved significantly (p < 0.001). CONCLUSION We achieved significant improvements in pain relief, performance, and satisfaction both in rheumatic and non-rheumatic patients, confirmed by our scoring system. LEVEL OF EVIDENCE Level IV, case series.
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Eschweiler J, Li J, Quack V, Rath B, Baroncini A, Hildebrand F, Migliorini F. Total Wrist Arthroplasty—A Systematic Review of the Outcome, and an Introduction of FreeMove—An Approach to Improve TWA. Life (Basel) 2022; 12:life12030411. [PMID: 35330163 PMCID: PMC8951379 DOI: 10.3390/life12030411] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 01/11/2023] Open
Abstract
The Swanson silicone prosthesis was one of the first devices to realize total wrist arthroplasty (TWA). It has been used regularly since the early 1960s. This systematic review of the literature evaluated the status quos of TWA. The present study was conducted according to the PRISMA guidelines. A literature search was made in Medline, PubMed, Google Scholar, and the Cochrane Library databases. The focus of the present study was on implant survivorship and related functional outcomes. Data from 2286 TWA (53 studies) were collected. Fifteen studies were included for the analysis of implant survivorship. Fifteen studies were included for the analysis of pain. Twenty-eight studies were included for the analysis of the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Grip strength was tracked in 16 studies. The range of motion (RoM) was evaluated in 46 studies. For supination and pronation, 18 articles were available. Despite some methodological heterogeneities, TWA may be effective and safe in pain reduction and improving function and motion. There is still a range for a future improvement of the procedure.
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Affiliation(s)
- Jörg Eschweiler
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany; (J.L.); (V.Q.); (F.H.); (F.M.)
- Correspondence: ; Tel.: +49-(0)-241-8037368
| | - Jianzhang Li
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany; (J.L.); (V.Q.); (F.H.); (F.M.)
| | - Valentin Quack
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany; (J.L.); (V.Q.); (F.H.); (F.M.)
| | - Björn Rath
- Department of Orthopaedic Surgery, Klinikum Wels-Grieskirchen, 4710 Wels, Austria;
| | - Alice Baroncini
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152 Simmerath, Germany;
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany; (J.L.); (V.Q.); (F.H.); (F.M.)
| | - Filippo Migliorini
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany; (J.L.); (V.Q.); (F.H.); (F.M.)
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152 Simmerath, Germany;
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Pong TM, van Leeuwen WF, Oflazoglu K, Blazar PE, Chen N. Unplanned Reoperation and Implant Revision After Total Wrist Arthroplasty. Hand (N Y) 2022; 17:114-118. [PMID: 32009458 PMCID: PMC8721795 DOI: 10.1177/1558944719898817] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Total wrist arthroplasty (TWA) is a treatment option for many debilitating wrist conditions. With recent improvements in implant design, indications for TWA have broadened. However, despite these improvements, there are still complications associated with TWA, such as unplanned reoperation and eventual implant removal. The goal of this study was to identify risk factors for an unplanned reoperation or implant revision after a TWA at 2 academic medical centers between 2002 and 2015. Methods: In this retrospective study, 24 consecutive TWAs were identified using CPT codes. Medical records were manually reviewed to identify demographic, patient- or disease-related, and surgery-related risk factors for reoperation and implant removal after a primary TWA. Results: Forty-six percent of wrists (11 of 24 TWAs performed) had a reoperation after a median of 3.4 years, while 29% (7 of 24) underwent implant revision after a median of 5 years. Two patients had wrist surgery prior to their TWA, both eventually had their implant removed (P = .08). There were no risk factors associated with reoperation or implant removal. Conclusion: Unplanned reoperation and implant removal after a primary TWA are common. Approximately 1 in 3 wrists are likely to undergo revision surgery. We found no factors associated with reoperation or implant removal; however, prior wrist surgery showed a trend toward risk of implant removal after TWA.
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Affiliation(s)
| | | | | | | | - Neal Chen
- Harvard Medical School, Boston, MA, USA
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12
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Akhbari B, Shah KN, Morton AM, Molino J, Moore DC, Wolfe SW, Weiss APC, Crisco JJ. Total Wrist Arthroplasty Alignment and Its Potential Association with Clinical Outcomes. J Wrist Surg 2021; 10:308-315. [PMID: 34381634 PMCID: PMC8328540 DOI: 10.1055/s-0041-1725172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/21/2021] [Indexed: 10/21/2022]
Abstract
Purpose There is a lack of quantitative research that describes the alignment and, more importantly, the effects of malalignment on total wrist arthroplasty (TWA). The main goal of this pilot study was to assess the alignment of TWA components in radiographic images and compare them with measures computed by three-dimensional analysis. Using these measures, we then determined if malalignment is associated with range of motion (ROM) or clinical outcomes (PRWHE, PROMIS, QuickDash, and grip strength). Methods Six osteoarthritic patients with a single type of TWA were recruited. Radiographic images, computed tomography images, and clinical outcomes of the wrists were recorded. Using posteroanterior and lateral radiographs, alignment measurements were defined for the radial and carpal components. Radiographic measurements were validated with models reconstructed from computed tomography images using Bland-Altman analysis. Biplanar videoradiography (<1mm and <1 degree accuracy) was used to capture and compute ROM of the TWA components. Linear regression assessed the associations between alignment and outcomes. Results Radiographic measures had a 95% limit-of-agreement (mean difference ± 1.96 × SD) of 3 degrees and 3mm with three-dimensional values, except for the measures of the carpal component in the lateral view. In our small cohort, wrist flexion-extension and radial-ulnar deviation were correlated with volar-dorsal tilt and volar-dorsal offset of the radial component and demonstrated a ROM increase of 3.7 and 1.6 degrees per degree increase in volar tilt, and 10.8 and 4.2 degrees per every millimeter increase in volar offset. The carpal component's higher volar tilt was also associated with improvements in patient-reported pain. Conclusions We determined metrics describing the alignment of TWA, and found the volar tilt and volar offset of the radial component could potentially influence the replaced wrist's ROM. Clinical Relevance TWA component alignment can be measured reliably in radiographs, and may be associated with clinical outcomes. Future studies must evaluate its role in a larger cohort.
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Affiliation(s)
- Bardiya Akhbari
- Department of Biomedical Engineering, Brown University, Providence, Rhode Island
| | - Kalpit N. Shah
- Department of Orthopedics, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island
| | - Amy M. Morton
- Department of Orthopedics, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island
| | - Janine Molino
- Department of Orthopedics, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island
| | - Douglas C. Moore
- Department of Orthopedics, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island
| | - Scott W. Wolfe
- Hand and Upper Extremity Center, Hospital for Special Surgery, New York, New York
- Weill Medical College of Cornell University, New York, New York
| | - Arnold-Peter C. Weiss
- Department of Orthopedics, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island
- Division of Hand, Upper Extremity & Microvascular Surgery, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island
| | - Joseph J. Crisco
- Department of Biomedical Engineering, Brown University, Providence, Rhode Island
- Department of Orthopedics, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island
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13
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Lestienne V, Chaves C, Tanwin Y, Loubersac T, Gaisne E, Kerjean Y, Bellemère P. Results of interposition arthroplasty with the Amandys® pyrocarbon implant in rheumatoid wrist at a mean 5 years' follow-up. HAND SURGERY & REHABILITATION 2021; 40:579-587. [PMID: 34033930 DOI: 10.1016/j.hansur.2021.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/27/2021] [Accepted: 05/15/2021] [Indexed: 12/21/2022]
Abstract
Management of severe joint involvement in rheumatoid wrist is controversial. The gold-standard is total wrist fusion, but total wrist replacement offers a motion-conserving alternative. The purpose of this study was to present the results of interposition arthroplasty with the Amandys® pyrocarbon implant in rheumatoid wrist. We performed a retrospective review of 28 arthroplasties for rheumatoid wrist arthritis. Eighteen females and 5 males were included, with a mean age of 55.7 years. Mean follow-up was 64 months. We measured range of motion, grip strength, and pain (on VAS). Function was evaluated preoperatively and at last follow-up with the DASH and PRWE scores. Mean range of motion in flexion-extension was maintained while mean inclination and rotational range of motion showed significant improvement. Mean grip strength increased from 10 kg to 17 kg. Mean pain score decreased from 6/10 to 2/10. Mean PRWE and QuickDASH scores decreased from 62/100 to 25/100 and from 62/100 to 36/100, respectively. Three patients underwent early reoperation to reposition a dislocated implant. No implants had to be removed. Amandys® pyrocarbon arthroplasty is a reliable alternative to total fusion or total replacement in rheumatoid wrist. Indications must be limited to well-aligned wrists with competent capsule-ligament structures.
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Affiliation(s)
- V Lestienne
- Institut de la Main Nantes-Atlantique, Santé Atlantique, Avenue Claude Bernard, 44800 Saint Herblain, France
| | - C Chaves
- Institut de la Main Nantes-Atlantique, Santé Atlantique, Avenue Claude Bernard, 44800 Saint Herblain, France
| | - Y Tanwin
- Service de chirurgie orthopédique et traumatologique, CHU d'Amiens, 1 rue du Professeur Christian Cabrol, 80054 Amiens, France
| | - T Loubersac
- Institut de la Main Nantes-Atlantique, Santé Atlantique, Avenue Claude Bernard, 44800 Saint Herblain, France
| | - E Gaisne
- Institut de la Main Nantes-Atlantique, Santé Atlantique, Avenue Claude Bernard, 44800 Saint Herblain, France
| | - Y Kerjean
- Institut de la Main Nantes-Atlantique, Santé Atlantique, Avenue Claude Bernard, 44800 Saint Herblain, France
| | - P Bellemère
- Institut de la Main Nantes-Atlantique, Santé Atlantique, Avenue Claude Bernard, 44800 Saint Herblain, France.
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14
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Akhbari B, Morton AM, Shah KN, Molino J, Moore DC, Weiss APC, Wolfe SW, Crisco JJ. In vivo articular contact pattern of a total wrist arthroplasty design. J Biomech 2021; 121:110420. [PMID: 33895657 PMCID: PMC8130596 DOI: 10.1016/j.jbiomech.2021.110420] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/26/2021] [Accepted: 03/25/2021] [Indexed: 11/20/2022]
Abstract
Total wrist arthroplasty (TWA) designs suffer from relatively high complication rates when compared to other arthroplasties. Understanding the contact pattern of hip and knee replacement has improved their design and function; however, the in vivo contact pattern of TWA has not yet been examined and is thus the aim of this study. We hypothesized that the center of contact (CoC) is located at the geometric centers of the carpal component and radial component in the neutral posture and that the CoC moves along the principal arcs of curvature throughout primary anatomical motions. Wrist motion and implant kinematics of six patients with the Freedom® total wrist implant were studied during various tasks using biplanar videoradiography. The location of the CoC of the components was investigated by calculating distance fields between the articular surfaces. We found the CoC at the neutral posture was not at the geometric centers but was located 3.5 mm radially on the carpal component and 1.2 mm ulnarly on the radial component. From extension to flexion, the CoC moved 10.8 mm from dorsal to volar side on the carpal component (p < 0.0001) and 7.2 mm from volar to dorsal on the radial component (p = 0.0009). From radial to ulnar deviation, the CoC moved 12.4 mm from radial to ulnar on the carpal component (p < 0.0001), and 5.6 mm from ulnar to radial on the radial component (p = 0.009). The findings of this study may eventually improve TWA success by advancing future designs through a more accurate understating of their kinematic performance in vivo.
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Affiliation(s)
- Bardiya Akhbari
- Center for Biomedical Engineering and School of Engineering, Brown University, Providence, RI 02912, United States.
| | - Amy M Morton
- Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903, United States.
| | - Kalpit N Shah
- Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903, United States.
| | - Janine Molino
- Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903, United States.
| | - Douglas C Moore
- Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903, United States.
| | - Arnold-Peter C Weiss
- Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903, United States; Division of Hand, Upper Extremity & Microvascular Surgery, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02912, United States.
| | - Scott W Wolfe
- Hand and Upper Extremity Center, Hospital for Special Surgery, New York, NY 10021, United States; Weill Medical College of Cornell University, New York, NY 10021, United States.
| | - Joseph J Crisco
- Center for Biomedical Engineering and School of Engineering, Brown University, Providence, RI 02912, United States; Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903, United States.
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15
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Long-Term Results of the Modular Physiological Wrist Prosthesis (MPW ®) in Patients with Inflammatory Diseases. Life (Basel) 2021; 11:life11040355. [PMID: 33919621 PMCID: PMC8074085 DOI: 10.3390/life11040355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022] Open
Abstract
The wrist is among the predilection sites of over 90% of cases of rheumatoid arthritis (RA). In advanced cases, total wrist arthroplasty (TWA) is an alternative to arthrodesis. The aim of this study is to present the long-term results of the modular physiological wrist prosthesis (MPW®) and to match them in context with the results of a standard population survey. In a retrospective study with follow-up, patients with an MPW® endoprosthesis were evaluated concerning the clinical and radiological outcome, complications were reviewed (incidence and type), and conversion to wrist fusion was assessed. Patient function measurements included the Mayo wrist score, the patient-specific wrist test, and therefore the DASH score (arm, shoulder, and hand). Thirty-four MPW® wrist prostheses were implanted in 32 patients, including thirty primary implantations and four changes of the type of the endoprosthesis. Sixteen patients (18 prostheses) underwent clinical and radiological follow-up. The average follow-up time was 8.5 years (1 to 16). Poor results of the MPW prosthesis are caused by the issues of balancing with luxation and increased PE wear. Salvage procedures included revision of the TWA or fusion. In successful cases, the flexion and extension movement averaged 40 degrees. The grip force was around 2.5 kg. The common DASH score was 79 points, with limited and problematic joints of the upper extremity. The MPW wrist prosthesis offered good pain relief and functional movement in over 80% of cases. The issues of dislocation and increased PE wear prevent better long-term results, as do the joints affected. A follow-up study with fittings under a contemporary anti-rheumatic therapy with biologicals suggests increasing score results. Type of study/level of evidence: Case series, IV.
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16
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Martínez Villén G, Rodríguez Nogué L. Universal 2™ total wrist arthroplasty: A single-surgeon 6.5-year follow-up study of 22 prostheses. HAND SURGERY & REHABILITATION 2021; 40:413-419. [PMID: 33813044 DOI: 10.1016/j.hansur.2021.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 11/18/2022]
Abstract
Total wrist arthroplasty remains controversial, with the few studies undertaken being heterogeneous and having low patient numbers. This prospective study involved 22 Universal 2™ total wrist prostheses implanted by the same surgeon between 2003 and 2017. There were 13 women and nine men with an average age of 56 (42-69.5) years. Indications for total wrist arthroplasty were post-traumatic arthritis, rheumatoid arthritis and Kienböck's disease. The mean follow-up was 6.5 (3-17) years. Two failed implants required total wrist fusion. Postoperative pain, grip strength, QuickDASH, patient-rated wrist evaluation, and Mayo wrist scores improved significantly compared with preoperative scores. The prosthesis preserved equal or slightly greater range of motion than the preoperative range of motion, sufficient to undertake activities of daily living and improve quality of life. Postoperative radiographs 1 month after the surgery and then annually showed signs of bone deterioration in 64% of implants, most osteolysis without loosening, compatible with asymptomatic function. Although a high number of radiographic signs of implant changes were apparent in the midterm, 91% of prostheses are still in place. The long-term survival of this implant is uncertain. LEVEL OF EVIDENCE: Therapeutic IV.
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Affiliation(s)
- G Martínez Villén
- Department of Orthopaedic and Traumatology, Miguel Servet University Hospital, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain; Hand and Reconstructive Surgery Unit, Miguel Servet University Hospital, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain.
| | - L Rodríguez Nogué
- Department of Orthopaedic and Traumatology, Miguel Servet University Hospital, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain
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17
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Outcomes of Revision Total Wrist Arthroplasty. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202103000-00008. [PMID: 33730000 PMCID: PMC7969306 DOI: 10.5435/jaaosglobal-d-21-00035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/13/2021] [Indexed: 11/22/2022]
Abstract
In this study, we analyzed the outcomes of revision total wrist arthroplasty done over a 40-year period. During this period, 76 consecutive revision total wrist arthroplasties were done in 69 patients with a mean age of 56 and a follow-up of 10.3 years. Patients commonly experienced pain relief, with 58 (91%) experiencing no or mild pain postoperatively. There was no statistically significant change in flexion or extension, but a statistically significant decrease in ulnar deviation and a corresponding increase in radial deviation. However, a high rate of complications and repeat revision surgery were observed. The primary indications for a repeat revision surgery were distal loosening (n = 11), proximal loosening (n = 1), deformity and pain (n = 8), periprosthetic infection (n = 3), dislocation (n = 2), subluxation (n = 1), intraoperative fracture (n = 1), and suspected metal allergy (n = 1). Complications were distal loosening (n = 15), proximal loosening (n = 3), dislocation (n = 7), intraoperative fracture (n = 7), postoperative fracture (n = 2), and component fracture (n = 3). When advising the patient, clear information must be given about the high rate of complications connected with revision arthroplasty and the risk of further revision, eventually leading to total wrist fusion.
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18
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Fischer P, Sagerfors M, Jakobsson H, Pettersson K. Total Wrist Arthroplasty: A 10-Year Follow-Up. J Hand Surg Am 2020; 45:780.e1-780.e10. [PMID: 32247543 DOI: 10.1016/j.jhsa.2020.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 12/20/2019] [Accepted: 02/03/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess long-term implant survival in total wrist arthroplasty (TWA), comparing 4 different implants. METHODS In a prospective cohort of 124 patients, 136 TWAs were evaluated 5 years and 10 years after surgery. The TWAs were implanted between 2005 and 2009. The primary outcome was implant survival. Survival analysis was performed with revision and radiographic loosening as the final end point. Revision was defined as exchange of whole or parts of the prosthesis. Implant loosening was assessed using radiographic examination at the 5-year and 10-year follow-up. Secondary outcome measures included wrist range of motion, hand grip strength, visual analog scale (VAS) pain scores, and patient-related outcome measures, including Disabilities of the Arm, Shoulder, and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE), and Canadian Occupational Performance Measure (COPM). RESULTS Total cumulative implant survival was 92% with revision as the primary end point. When including a nonrevised radiographic loose implant as a failure, total implant survival was 75%. Radiographic loosening differed significantly between the implants with a range in frequency from 0% to 37.5%. At the 10-year follow-up, assessing the nonrevised TWAs, range of motion was preserved compared with preoperative values. Significant improvement was recorded for hand grip strength, VAS pain scores, and patient-related outcome measures at the 10-year follow-up compared with preovperative values. CONCLUSIONS High 10-year implant survival was found when defining the primary end point as revision of any cause. When including radiographic loosening of the implant in the survival analysis, implant survival was considerably lower. However, radiographic loosening does not seem to correlate with changes in secondary outcome measures, questioning the need for revision surgery in these cases. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Per Fischer
- Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Marcus Sagerfors
- Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Hugo Jakobsson
- Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Kurt Pettersson
- Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Akhbari B, Morton AM, Shah KN, Molino J, Moore DC, Weiss APC, Wolfe SW, Crisco JJ. Proximal-distal shift of the center of rotation in a total wrist arthroplasty is more than twice of the healthy wrist. J Orthop Res 2020; 38:1575-1586. [PMID: 32401391 PMCID: PMC7336861 DOI: 10.1002/jor.24717] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/02/2020] [Accepted: 05/08/2020] [Indexed: 02/04/2023]
Abstract
Reproduction of healthy wrist biomechanics should minimize the abnormal joint forces that could potentially result in the failure of a total wrist arthroplasty (TWA). To date, the in vivo kinematics of TWA have not been measured and it is unknown if TWA preserves healthy wrist kinematics. Therefore, the purpose of this in vivo study was to determine the center of rotation (COR) for a current TWA design and to compare its location to the healthy wrist. The wrist COR for six patients with TWA and 10 healthy subjects were calculated using biplane videoradiography as the subjects performed various range-of-motion and functional tasks that included coupled wrist motions. An open-source registration software, Autoscoper, was used for model-based tracking and kinematics analysis. It was demonstrated that the COR was located near the centers of curvatures of the carpal component for the anatomical motions of flexion-extension and radial-ulnar deviation. When compared to healthy wrists, the COR of TWAs was located more distal in both pure radial deviation (P < .0001) and pure ulnar deviation (P = .07), while there was no difference in its location in pure flexion or extension (P = .99). Across all coupled motions, the TWA's COR shifted more than two times that of the healthy wrists in the proximal-distal direction (17.1 vs 7.2 mm). We postulate that the mismatch in the COR location and behavior may be associated with increased loading of the TWA components, leading to an increase in the risk of component and/or interface failure.
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Affiliation(s)
- Bardiya Akhbari
- Center for Biomedical Engineering and School of Engineering, Brown University, Providence, RI 02912
| | - Amy M. Morton
- Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903
| | - Kalpit N. Shah
- Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903
| | - Janine Molino
- Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903
| | - Douglas C. Moore
- Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903
| | - Arnold-Peter C. Weiss
- Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903
| | - Scott W. Wolfe
- Hand and Upper Extremity Center, Hospital for Special Surgery, New York, NY 10021,Weill Medical College of Cornell University, New York, NY 10021
| | - Joseph J. Crisco
- Center for Biomedical Engineering and School of Engineering, Brown University, Providence, RI 02912,Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903
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20
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A Minimum 5-Year Longitudinal Study of a New Total Wrist Arthroplasty in Patients With Rheumatoid Arthritis. J Hand Surg Am 2020; 45:255.e1-255.e7. [PMID: 31421936 DOI: 10.1016/j.jhsa.2019.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 03/22/2019] [Accepted: 06/26/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the longitudinal clinical outcomes using a new semiconstrained wrist prosthesis for the treatment of severe rheumatoid arthritis of the wrist. METHODS Twenty patients with rheumatoid arthritis (20 wrists) underwent total wrist arthroplasty with the prosthesis in a clinical trial. The preoperative Larsen classification was grade IV in 16 wrists and grade V in 4 wrists. Assessments were performed before surgery, 1.5 years after surgery, and at final follow-up (≥ 5 years after surgery) using the visual analog scale for pain, Figgie wrist score, Japanese version of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and plain radiographs. RESULTS At final follow-up, no patient had wrist pain. The preoperative flexion-extension arc at final follow-up was similar to the preoperative range. The mean 1.5-year postoperative Figgie score was significantly improved and was unchanged at final follow-up. The DASH score significantly improved from before surgery to 1.5 years after surgery; the DASH score was improved further at final follow-up, but not significantly. Five of the 19 wrists evaluated had radiographic findings indicating carpal component loosening at final follow-up; however, all patients with the loosening were asymptomatic and had not undergone revision surgery. CONCLUSIONS Total wrist arthroplasty using this wrist prosthesis leads to favorable clinical outcomes regarding pain relief and retained range of wrist motion. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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21
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Abstract
The most widely used procedures for salvaging a destroyed wrist are four-corner arthrodesis, radiocarpal arthrodesis, proximal row carpectomy, total wrist arthrodesis, and total wrist replacement or resurfacing. The purpose of this article is to give an overview of the functional results obtained with the various salvage procedures and of the common methods for assessing the surgical outcomes. The outcomes are assessed by clinical measurements and scoring methods, but the actual functional status and well-being of the patients should be presented together with patient-reported outcomes. No salvage procedure can restore entirely full wrist function. Understanding indications, risks, and the outcomes of these procedures would favour a better decision for surgery and help choose the proper treatment from among the surgical options discussed with patients.
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22
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Schmidt I. Functional Outcomes After Salvage Procedures for Wrist Trauma and Arthritis (Four-Corner Fusion, Proximal Row Carpectomy, Total Wrist Arthroplasty, Total Wrist Fusion, Wrist Denervation): A Review of Literature. Open Orthop J 2019. [DOI: 10.2174/1874325001913010217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Background:
Several salvage procedures for the arthritically destroyed wrist exist. Each of these has advantages as well as disadvantages.
Aims:
The aim of this article is to give practical insights for the clinician on: (1) biomechanical and clinical fundamentals of normal and impaired wrist motion; (2) difficulties in assessment of postoperative outcome between measured motion by the surgeon and self-reported outcome by the patient; (3) indications for each procedure; and (4) differences in functional outcome between partial and complete motion-preserving as well as complete motion-restricting salvage procedures.
Methods:
In trend, Proximal Row Carpectomy (PRC) is slightly superior over four-corner fusion (4CF) in terms of functional outcome, but the methodology-related postoperative motion is decreased for both procedures. Furthermore, PRC is easier to perform, needs lower costs, and has fewer complications than 4CF. Total Wrist Arthroplasty (TWA) has the advantage compared to PRC and 4CF that the preoperative motion values are preserved, but it is limited by decreased load-bearing capacity for the wrist. Total Wrist Fusion (TWF) is associated with a higher load-bearing capacity for the wrist than TWA, but it is limited for carrying out essential activities of daily living. Both PRC and 4CF can be combined primarily by wrist denervation. Wrist denervation alone does not impair the movement of the wrist.
Results and Conclusion:
Salvage procedures for the arthritically destroyed wrist should be detected regarding patients age- and gender-related claims in work and leisure. Not all of them can be successfully re-employed in their original occupations associated with high load-bearing conditions.
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Abstract
BACKGROUND Total wrist arthroplasty is still a rare procedure. This issue is being discussed controversially, particular in German-speaking countries. Lately, its acceptance has risen, especially as an alternative to wrist fusion regarding treatment of panarthritis or similar pathologies. Previous arthroplasty designs had short survival spans and devastating complications. THE CURRENT SITUATION Currently, these problems have been reduced by the development of fourth generation arthroplasty systems. Nowadays, survival spans of 10 years and more can be seen on a regular basis. The development of hemi-arthroplasty may be of interest, especially for traumatic destruction of the distal radius. This review outlines the current state of wrist arthroplasty and is based on the author's 15 years of experience.
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Zijlker HJA, Ritt MJPF, IJsselstein CB. Long-Term Results of Universal 2 Total Wrist Arthroplasty. J Wrist Surg 2019; 8:317-320. [PMID: 31404363 PMCID: PMC6685816 DOI: 10.1055/s-0039-1685469] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 03/03/2019] [Indexed: 10/27/2022]
Abstract
Background The Universal 2 is a widely used total wrist implant that aims to maintain function of the wrist. Purpose Promising mid-term results of the Universal 2 total wrist implant are described in the literature. This study evaluates the long-term results in terms of implant survival and patient satisfaction. Patients and Methods Patients who received a Universal 2 implant between 2004 and 2009 were retrospectively identified through a database search. Clinical outcome and complications of the implant were assessed by examination of the patient's medical records, X-rays, and a questionnaire, consisting of the Patient-Rated Wrist and Hand Evaluation questionnaire (PRWHE) and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaires and additional questions. Results Twenty-five patients (26 wrists) were included in this study. Twenty-one (81%) Universal 2 implants remained in situ after a mean follow-up of 11 years. Moderate PRWHE (44) and QuickDASH (41) scores were found in these cases. Five Universal 2 implants failed and were converted to a total wrist arthrodesis after a mean period of 9.2 years due to distal component loosening ( n = 3), recurrent luxation ( n = 1), or recurrent synovitis ( n = 1). Twenty-three (92%) patients were (very) satisfied with the Universal 2 implant. Conclusion The Universal 2 demonstrates a high (81%) implant survival with a high patient satisfaction after a mean follow-up of 11 years. Prospective studies of the Universal 2 implant are necessary to objectify improvement in wrist function and to provide a better comparison to other fourth generation wrist implants.
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Affiliation(s)
- H. J. A. Zijlker
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - M. J. P. F. Ritt
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - C. B. IJsselstein
- Department of Plastic, Reconstructive and Hand Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands
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25
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Reigstad O, Holm-Glad T, Korslund J, Grimsgaard C, Thorkildsen R, Røkkum M. High re-operation and complication rates 11 years after arthrodesis of the wrist for non-inflammatory arthritis. Bone Joint J 2019; 101-B:852-859. [PMID: 31256671 DOI: 10.1302/0301-620x.101b7.bjj-2018-0943.r4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Plate and screw fixation has been the standard treatment for painful conditions of the wrist in non-rheumatoid patients in recent decades. We investigated the complications, re-operations, and final outcome in a consecutive series of patients who underwent wrist arthrodesis for non-inflammatory arthritis. PATIENTS AND METHODS A total of 76 patients, including 53 men and 23 women, with a mean age of 50 years (21 to 79) underwent wrist arthrodesis. Complications and re-operations were recorded. At a mean follow-up of 11 years (2 to 18), 63 patients completed questionnaires, and 57 attended for clinical and radiological assessment. RESULTS Of the 76 patients, 46 (60.5%) had complications, resulting in 65 re-operations, mainly related to the plate and screws. In the 63 patients who completed the questionnaires, the mean Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) score was 36 (0 to 91), the mean Patient-Rated Wrist and Hand Evaluation (PRWHE) score was 40 (0 to 96), and 14 patients (22%) reported no wrist pain. Grip strength, pinch strength, and pronation and supination were significantly reduced compared with the contralateral forearm. The outcome was worse in patients who had previously undergone surgery to the wrist, and those with complications. A total of 13 are awaiting further re-operations, giving a total re-operation rate of 63% (40/63). CONCLUSION We observed complications and re-operations throughout the follow-up period and therefore consider wrist arthrodesis to be more complicated than previously assumed. Many of the patients never got used to or accepted their stiff wrists and reported a substantial reduction in function and residual pain. Motion-sparing surgery should be offered prior to wrist arthrodesis. Cite this article: Bone Joint J 2019;101-B:852-859.
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Affiliation(s)
- O Reigstad
- Hand and Microsurgery Department, Division of Orthopaedic Surgery, Oslo University Hospital, OUS-Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - T Holm-Glad
- Hand and Microsurgery Department, Division of Orthopaedic Surgery, Oslo University Hospital, OUS-Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - J Korslund
- Hand and Microsurgery Department, Division of Orthopaedic Surgery, Oslo University Hospital, OUS-Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - C Grimsgaard
- Hand and Microsurgery Department, Division of Orthopaedic Surgery, Oslo University Hospital, OUS-Rikshospitalet, Oslo, Norway
| | - R Thorkildsen
- Hand and Microsurgery Department, Division of Orthopaedic Surgery, Oslo University Hospital, OUS-Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - M Røkkum
- Hand and Microsurgery Department, Division of Orthopaedic Surgery, Oslo University Hospital, OUS-Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Kakar S, Haddad FS. Wrist fusions and other key issues in upper limb-related surgery. Bone Joint J 2019; 101-B:755-756. [PMID: 31256669 DOI: 10.1302/0301-620x.101b7.bjj-2019-0629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- S Kakar
- Mayo Clinic, Rochester, Minnesota, USA
| | - Fares S Haddad
- The Bone & Joint Journal, Professor of Orthopaedic Surgery, University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
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27
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Zijlker HJA, Berkhout MJ, Ritt MJPF, van Leeuwen N, IJsselstein CB. Universal 2 total wrist arthroplasty for the salvage of failed Biaxial total wrist arthroplasty. J Hand Surg Eur Vol 2019; 44:614-619. [PMID: 30651022 PMCID: PMC6585160 DOI: 10.1177/1753193418822425] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Universal 2 implants may be an alternative to total wrist arthrodesis for the salvage of failed Biaxial total wrist prostheses. We assessed 40 Universal 2 revision implants retrospectively. Fourteen of these wrists were converted to total wrist arthrodeses, and two wrists received a third total wrist arthroplasty after a mean period of 5.5 years. Twenty-four of the Universal 2 implants that remained in situ after a mean follow-up of 9 years (range 4 to 13 years) were re-examined. Sixteen functioned satisfactorily. Patient-Rated Wrist and Hand Evaluation scores and Quick Disabilities of the Arm, Shoulder and Hand scores were 53 and 47, respectively. Twenty-nine patients would choose the Universal 2 again and would also recommend it to other patients. The survival of the revision implants was 60% at a mean follow-up of 9 years. Level of evidence: IV.
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Affiliation(s)
- Hero J. A. Zijlker
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands,Hero J. A. Zijlker, Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Van Ostadestraat 278-3, 1073TW, Amsterdam, The Netherlands.
| | - Merel J. Berkhout
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Marco J. P. F. Ritt
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Niels van Leeuwen
- Department of Plastic, Reconstructive and Hand Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Cees B. IJsselstein
- Department of Plastic, Reconstructive and Hand Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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28
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Berber O, Garagnani L, Gidwani S. Systematic Review of Total Wrist Arthroplasty and Arthrodesis in Wrist Arthritis. J Wrist Surg 2018; 7:424-440. [PMID: 30349758 PMCID: PMC6196084 DOI: 10.1055/s-0038-1646956] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 03/20/2018] [Indexed: 12/19/2022]
Abstract
Background End-stage wrist arthritis has traditionally been treated with a total wrist fusion. There is a recent trend toward motion preserving surgery in the form of total wrist replacement. Questions Is there a functional benefit to performing a total wrist replacement instead of a total wrist fusion in patients with end-stage wrist arthritis? Is there any difference in secondary outcome measures including pain, grip strength, and range of motion? Does the risk of adverse events and treatment failure differ between the two techniques? Methods A systematic literature search was performed to identify studies reporting either total wrist arthrodesis or arthroplasty for end-stage wrist arthritis. Studies were systematically screened and assessed for risk of bias and quality. Data were extracted and reviewed. Results A total of 43 studies were included in the review: 17 on arthrodesis, 24 on arthroplasty, and 2 matched cohort studies. This represented 669 index arthrodesis operations in 603 patients, and 1,371 index arthroplasty operations in 1,295 patients. A significant improvement in functional outcome was seen with both interventions. Similar improvements were seen in pain scores, and modest improvements were seen in grip strength. Range of motion following arthroplasty improved to a functional level in two studies. Complication rates were higher after arthroplasty (range: 0.2-9.5%) than those after arthrodesis (range: 0.1-6.1%; p = 0.06). Fourth-generation implants (range 0.1-2.9%) performed better than earlier designs (range: 0.2-8.1%; p = 0.002). Implant revision rates ranged from 3.5 to 52.6%. Fourth-generation prostheses survival rates were 78% at 15 years (Universal 2), 86% at 10 years (Motec), 90% at 9 years (Re-Motion), and 95% at 8 years (Maestro). Conclusion The newer fourth-generation wrist implants appear to be performing better than earlier designs. Both wrist arthrodesis and wrist arthroplasty improve function, pain, and grip strength. The risk of complication following wrist replacements is higher than that after total wrist arthrodesis.
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Affiliation(s)
- Onur Berber
- Hand and Wrist Unit, Department of Orthopaedics, Guy's and St Thomas' Hospitals, London, United Kingdom
- University of Brighton, Brighton, United Kingdom
| | - Lorenzo Garagnani
- Hand and Wrist Unit, Department of Orthopaedics, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Sam Gidwani
- Hand and Wrist Unit, Department of Orthopaedics, Guy's and St Thomas' Hospitals, London, United Kingdom
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Reigstad O, Røkkum M. Wrist arthroplasty using prosthesis as an alternative to arthrodesis: design, outcomes and future. J Hand Surg Eur Vol 2018; 43:689-699. [PMID: 29985078 DOI: 10.1177/1753193418784707] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We developed an uncemented screw-shaped ball-and-socket wrist prosthesis and modified it during a decade of trails from 1996 to 2005. The final Motec® wrist prosthesis was launched in 2006. Since then we have used this prosthesis in 110 wrists (110 patients) from 2006 to 2018. This article reviews the design, functional outcomes, complications, clinical usefulness and possible future modifications of the Motec® wrist prosthesis.
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Affiliation(s)
- Ole Reigstad
- 1 Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Magne Røkkum
- 1 Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,2 Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Kennedy JW, Ross A, Wright J, Martin DJ, Bransby-Zachary M, MacDonald DJ. Universal 2 total wrist arthroplasty: high satisfaction but high complication rates. J Hand Surg Eur Vol 2018. [PMID: 29519175 DOI: 10.1177/1753193418761513] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED The Universal 2 total wrist arthroplasty is intended to alleviate wrist pain and restore function. There is limited evidence regarding its success and safety. We report outcomes in 48 wrists of 46 patients with Universal 2 arthroplasty between 2006 and 2014. We recorded range of motion of the operated wrist, patient satisfaction, complication and revision rates, and radiological appearances of the wrists with mean follow-up of 7 years (3.5 to 11 years). We found a significant improvement in DASH scores after surgery, with active range of wrist motion being 33° flexion and 24° extension. Thirty-nine patients would undergo the procedure again if he had similar wrist problems. Twenty-three patients had loosening of at least one component of the implant. Complications were found in 13 wrists; seven underwent revision. We conclude that the Universal 2 arthroplasty produces significant improvements in DASH scores and high levels of satisfaction of the patients. However, the surgery has a high complication rate. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- John W Kennedy
- Department of Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | - Andrew Ross
- Department of Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | - Jonathan Wright
- Department of Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | - David J Martin
- Department of Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | | | - Duncan J MacDonald
- Department of Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
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Cai X, Ding J, Xu Y. [Research progress of artificial wrist joint prosthesis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:501-504. [PMID: 29806311 DOI: 10.7507/1002-1892.201712031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the research progress of the artificial wrist joint prosthesis. Methods Domestic and abroad literature concerning artificial wrist joint prosthesis was reviewed and analyzed thoroughly. Results Artificial wrist joint prosthesis has been developed to the 4th generation. The artificial wrist joint arthroplasty has advantages of pain relief and functional improvement and can achieve ideal short-term effectiveness. But there are some problems, such as loosening, subsidence, fracture, and dislocation of prosthesis. The long-term effectiveness of the 3rd and 4th generation prosthesis still need to be followed up. Conclusion The biomechanics of wrist joint is extremely complicated, which results in less application and slow development of artificial wrist joint prosthesis. Early-term effectiveness of artificial wrist joint arthroplasty is basically satisfactory, but there are still some long-term complications. So the artificial wrist joint prosthesis remains to be developed.
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Affiliation(s)
- Xingbo Cai
- Department of Orthopedics, Kunming General Hospital of Chengdu Military Command, Kunming Yunnan, 650032, P.R.China
| | - Jing Ding
- Department of Orthopedics, Kunming General Hospital of Chengdu Military Command, Kunming Yunnan, 650032,
| | - Yongqing Xu
- Department of Orthopedics, Kunming General Hospital of Chengdu Military Command, Kunming Yunnan, 650032, P.R.China
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Gaspar MP, Pham PP, Pankiw CD, Jacoby SM, Shin EK, Osterman AL, Kane PM. Mid-term outcomes of routine proximal row carpectomy compared with proximal row carpectomy with dorsal capsular interposition arthroplasty for the treatment of late-stage arthropathy of the wrist. Bone Joint J 2018; 100-B:197-204. [PMID: 29437062 DOI: 10.1302/0301-620x.100b2.bjj-2017-0816.r2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIMS The aims of this study were to compare the mid-term outcomes of patients with late-stage arthritis of the wrist treated with proximal row carpectomy (PRC) and dorsal capsular interposition (DCI) arthroplasty with a matched cohort treated with routine PRC alone. PATIENTS AND METHODS A total of 25 arthritic wrists (24 patients) with pre-existing degenerative changes of the proximal capitate and/or the lunate fossa of the radius were treated with PRC + DCI over a ten-year period. This group of patients were matched 1:2 with a group of 50 wrists (48 patients) without degenerative changes in the capitate or lunate fossa that were treated with a routine PRC alone during the same period. The mean age of the patients at the time of surgery was 56.8 years (25 to 81), and the demographics and baseline range of movement of the wrist, grip strength, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, and Patient-Rated Wrist Evaluation (PRWE) score were similar in both groups. RESULTS At a mean follow-up of 5.9 years (1.8 to 11.8), significant improvements in mean grip strength, the flexion-extension arc of movement of the wrist, QuickDASH, and PRWE scores were seen in both groups. There was no diifference between the groups for any of the outcomes. One patient in the PRC + DCI group required additional surgery for a deep infection, while two in the PRC group had complications (one wound dehiscence requiring revision closure, one transient radial sensory neuritis). One patient in each group required total arthrodesis of the wrist for progressive degenerative radiocarpal changes. A total of 70 patients (93%) were satisfied with the outcomes. CONCLUSION PRC with DCI is an effective form of treatment for late-stage arthritis of the wrist involving the capitolunate joint, with mid-term outcomes that are similar to those in patients without degenerative changes affecting the capitate or lunate fossa who are treated with a routine PRC alone. Cite this article: Bone Joint J 2018;100-B:197-204.
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Affiliation(s)
- M P Gaspar
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University, 834 Chestnut Street, The Franklin Building, Suite G114, Philadelphia, PA 19107, USA and Darden School of Business, University of Virginia, 100 Darden Boulevard, Charlottesville, Virginia 22903, USA
| | - P P Pham
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University, 834 Chestnut Street, The Franklin Building, Suite G114, Philadelphia, PA 19107, USA
| | - C D Pankiw
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University, 834 Chestnut Street, The Franklin Building, Suite G114, Philadelphia, PA 19107, USA
| | - S M Jacoby
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University, 834 Chestnut Street, The Franklin Building, Suite G114, Philadelphia, PA 19107, USA
| | - E K Shin
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University, 834 Chestnut Street, The Franklin Building, Suite G114, Philadelphia, PA 19107, USA
| | - A L Osterman
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University, 834 Chestnut Street, The Franklin Building, Suite G114, Philadelphia, PA 19107, USA
| | - P M Kane
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University, 834 Chestnut Street, The Franklin Building, Suite G114, Philadelphia, PA 19107, USA
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Pinder EM, Chee KG, Hayton M, Murali SR, Talwalkar SC, Trail IA. Survivorship of Revision Wrist Replacement. J Wrist Surg 2018; 7:18-23. [PMID: 29383271 PMCID: PMC5788755 DOI: 10.1055/s-0037-1603320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
Abstract
Purpose This study aims to report the 5-year survivorship of revision wrist arthroplasties and to report midterm clinical and radiological results. Materials and Methods All patients receiving a revision wrist arthroplasty in our unit between January 1, 1997 and October 31, 2010 were identified, and clinical notes retrospectively analyzed for Quick Disabilities of the Arm, Shoulder and Hand (quickDASH), Patient Evaluation Method (PEM), Patient-Rated Wrist Evaluation (PRWE), the range of movement, and visual analog score (VAS). In cases where patient review had not occurred within the past year, they were invited for assessment, and this data was included in the analysis. Plain radiographs were analyzed for loosening of each component. The 5-year survival was plotted using Kaplan-Meier analysis. Results Of the 19 patients identified, 1 was lost to follow-up and therefore excluded from all analyses. Mean age at revision wrist arthroplasty was 55.8 years and the mean time from primary to revision wrist arthroplasty was 6.7 years. At revision arthroplasty, 7 patients received the Biaxial implant (DePuy, Inc., Warsaw, IN) and 11 received the Universal II implant (Integra, Inc., Plainsboro, NJ). The 5-year implant revision survivorship was 83%. Depending on the variable of interest, clinical data were available for either three, four or five patients. At final follow-up (mean: 10.4 years), mean visual analog score was 2.9, mean quickDASH 57, mean PEM 49, mean PRWE 61, and mean arc of flexion/extension was 26 degrees. Radiological data were available for 12 patients, with evidence of gross loosening present in around 60% of the carpal components and 50% of the radial components at mean 6.7 years. Conclusion Revision wrist replacement implant survival is acceptable, but the majority of the surviving implants are radiologically loose. It is not clear at this time whether they are better or worse than a fusion after a failed primary wrist arthroplasty. Clinical Relevance It is reasonable to offer revision wrist arthroplasty in selective cases, but regular clinical and radiological follow-up is recommended.
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Affiliation(s)
- E. M. Pinder
- Upper Limb Unit, Wrightington Hospital, Wigan, United Kingdom
| | - K. G. Chee
- Upper Limb Unit, Wrightington Hospital, Wigan, United Kingdom
| | - M. Hayton
- Upper Limb Unit, Wrightington Hospital, Wigan, United Kingdom
| | - S. R. Murali
- Upper Limb Unit, Wrightington Hospital, Wigan, United Kingdom
| | - S. C. Talwalkar
- Upper Limb Unit, Wrightington Hospital, Wigan, United Kingdom
| | - I. A. Trail
- Upper Limb Unit, Wrightington Hospital, Wigan, United Kingdom
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Gil JA, Kamal RN, Cone E, Weiss APC. High Survivorship and Few Complications With Cementless Total Wrist Arthroplasty at a Mean Followup of 9 Years. Clin Orthop Relat Res 2017; 475:3082-3087. [PMID: 28721601 PMCID: PMC5670059 DOI: 10.1007/s11999-017-5445-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/07/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Total wrist arthroplasty (TWA) has been described as traditionally being performed with fixation in the radius and carpus with cement. The TWA implant used in our series has been associated with promising results in studies with up to 6 years followup; however, studies evaluating survivorship, pain, and function with this implant are limited. QUESTION/PURPOSE: (1) To report ROM and pain scores after wrist reconstruction with cementless fourth-generation TWA at a mean followup of 9 years (range, 4.8-14.7 years). (2) To report complications of a cementless fourth-generation TWA and the cumulative probability of not undergoing a revision at a mean followup of 9 years. METHODS This is a retrospective case series of 69 patients who were treated for pancarpal wrist arthritis between 2002 and 2014. Of those, 31 had inflammatory arthritis (rheumatoid arthritis [n = 29], juvenile rheumatoid arthritis [n = 1], and psoriatic arthritis [n = 1]); all of these patients received TWA with the cementless implant studied in this investigation. Another 38 patients had osteoarthritis or posttraumatic arthritis; in this subgroup, 28 patients were 65 years or younger, and all underwent wrist fusion (none were offered TWA). Ten patients with osteoarthritis were older than 65 years and all were offered TWA; of those, eight underwent TWA, and two declined the procedure and instead preferred and underwent total wrist arthrodesis. The mean age of the 39 patients who had TWA was 56 ± 8.9 years (range, 31-78 years) at the time of surgery; 36 were women and three were men. The patients who underwent TWA were seen at a minimum of 4 years (mean, 9 years; range, 4-15 years), and all had been examined in 2016 as part of this study except for one patient who died 9 years after surgery. The dominant wrist was involved in 60% (25) of the patients. All patients were immobilized for 4 weeks postoperatively and then underwent hand therapy for 4 to 6 weeks. Pain and ROM were gathered before surgery as part of clinical care, and were measured again at latest followup; at latest followup, radiographs were analyzed (by the senior author) for evidence of loosening, defined as any implant migration compared with any previous radiograph with evidence of periimplant osteolysis and bone resorption. Subjective pain score was assessed by a verbal pain scale (0-10) and ROM was measured with a goniometer. Complications were determined by chart review and final examination. Kaplan Meier survival analysis was performed to estimate the cumulative probability of not undergoing a revision. RESULTS The mean preoperative active ROM was 34o ± 18° flexion and 36° ± 18° extension. Postoperatively, the mean active ROM was 37° ± 14° flexion and 29° ± 13° extension. The mean difference between the preoperative pain score (8.6 ± 1.2) and postoperative pain score (0.4 ± 0.8) was 8.1 ± 1.9 (p < 0.001). Implant loosening occurred in three (7.7%) patients. No other complications occurred in this series. Kaplan-Meier survivorship analysis estimated the cumulative probability of remaining free from revision as 78% (95% CI, 62%-91%) at 15 years. CONCLUSION Cementless fourth-generation TWA improves pain while generally preserving the preoperative arc of motion. The cumulative probability of remaining free from revision at 14.7 years after the index procedure is 77.7% (95% CI, 62.0%-91.4%). Future studies should compare alternative approaches for patients with endstage wrist arthritis; such evaluations-which might compare TWA implants, or TWAs with arthrodesis-will almost certainly need to be multicenter, as the problem is relatively uncommon. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Joseph A. Gil
- 0000 0001 0557 9478grid.240588.3Department of Orthopaedics, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI USA
| | - Robin N. Kamal
- Department of Orthopaedic Surgery, Stanford University Medical Center, Hand and Upper Extremity Clinic, Redwood City, CA USA
| | - Eugene Cone
- 0000 0004 1936 7961grid.26009.3dDivision of Urology, Department of Surgery, Duke University School of Medicine, Durham, NC USA
| | - Arnold-Peter C. Weiss
- 0000 0001 0557 9478grid.240588.3Department of Orthopaedics, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI USA ,University Orthopedics, Inc, 2 Dudley Street, Suite 200, Providence, RI 02905 USA
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CORR Insights ®: High Survivorship and Few Complications With Cementless Total Wrist Arthroplasty at a Mean Followup of 9 Years. Clin Orthop Relat Res 2017; 475:3088-3089. [PMID: 28971355 PMCID: PMC5670073 DOI: 10.1007/s11999-017-5502-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 09/11/2017] [Indexed: 01/31/2023]
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Sargazi N, Philpott M, Malik A, Waseem M. Ulna Autograft for Wrist Arthrodesis: A Novel Approach in Failed Wrist Arthoplasty. Open Orthop J 2017; 11:768-776. [PMID: 28979589 PMCID: PMC5620406 DOI: 10.2174/1874325001711010768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 06/09/2017] [Accepted: 07/18/2017] [Indexed: 12/29/2022] Open
Abstract
Rheumatoid arthritis is a polyarthropathy affecting approximately 1% of the population worldwide. Wrist involvement is observed around 75% of patients, resulting in substantial disability and morbidity. A multidisciplinary approach to management of such patients is undertaken to prevent disease progression, many go on to develop debilitating disease requiring surgical intervention. Total wrist arthroplasty and arthrodesis are the main options available for those with end-stage disease, with arthroplasty preferred due to its ability to preserve a good degree of wrist function. Where complications occur with total wrist arthroplasty, salvage surgery with arthrodesis can be considered, however this requires satisfactory bone stock to enable stable fusion of the joint following arthroplasty. We report our experience of Ulna strut allografts in wrist arthrodesis in the management of failed total wrist arthroplasty.
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Affiliation(s)
- Nastaran Sargazi
- Department of Trauma and Orthopaedics, Macclesfield District General Hospital, Macclesfield, UK
| | - M Philpott
- Department of Trauma and Orthopaedics, Macclesfield District General Hospital, Macclesfield, UK
| | - A Malik
- Department of Trauma and Orthopaedics, Macclesfield District General Hospital, Macclesfield, UK
| | - M Waseem
- Department of Trauma and Orthopaedics, Macclesfield District General Hospital, Macclesfield, UK
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