1
|
Truss A, Morris G, Sawalha S, Waseem M. Intermediate and Long-Term Outcomes of the Universal 2 Total Wrist Replacement. J Wrist Surg 2024; 13:457-462. [PMID: 39296658 PMCID: PMC11407835 DOI: 10.1055/s-0043-1772714] [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: 03/23/2023] [Accepted: 07/25/2023] [Indexed: 09/21/2024]
Abstract
Introduction Arthritis of the wrist can lead to severe functionally debilitating pain which, after failed conservative measures, may require treatment with total wrist replacement (TWR). Various prosthetic designs, such as the Universal 2 implant, have been developed in attempts to combat the multitude of complications faced with replacing a complex and highly mobile joint. Having previously published short-term outcome results for the Universal 2 prosthesis, we now present the long-term survival data. Materials and Methods 19 patients underwent 21 TWR using the Universal 2 prosthesis between September 2004 and March 2008. Outcome data were collected in the form of Patient-Rated Wrist Evaluation (PRWE) and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires at short- (mean 4.8 years), intermediate- (mean 11.1 years), and long-term (mean 15.6 years) intervals. Nonparametric and Kaplan-Meier survival analysis was performed. Results At long-term follow-up, 7 out of the original 21 TWRs had required a revision or fusion procedure, or 7 out of 11 when excluding those lost to follow-up or who had died. At the intermediate follow-up, only one patient had required a revision procedure. Kaplan-Meier survival analysis demonstrated a median survival of 12.9 years and a 10-year survival probability of 68.1%. There was a statistically significant improvement from preoperative PRWE at short-term ( p = 0.001) and intermediate ( p = 0.01) follow-ups. This was not seen at the long-term follow-up ( p = 0.068). After an initial improvement in DASH score at short-term follow-up ( p = 0.003), the intermediate and long-term DASH scores were not significantly different from preoperative. Conclusion The Universal 2 poses a reasonable TWR implant choice for patients with debilitating arthritis. However, despite excellent short-term follow-up outcomes, longer term follow-up shows the design does continue to be plagued by implant failure and instability.
Collapse
Affiliation(s)
- Adam Truss
- Department of Trauma and Orthopaedics, East Cheshire NHS Trust, Macclesfield, United Kingdom
| | - Geraint Morris
- Department of Trauma and Orthopaedics, East Cheshire NHS Trust, Macclesfield, United Kingdom
| | - Seif Sawalha
- Department of Trauma and Orthopaedics, Countess of Chester Hospital NHS Foundation Trust, Chester, United Kingdom
| | - Mohammad Waseem
- Department of Trauma and Orthopaedics, East Cheshire NHS Trust, Macclesfield, United Kingdom
| |
Collapse
|
2
|
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.
Collapse
|
3
|
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: 3] [Impact Index Per Article: 3.0] [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.
Collapse
Affiliation(s)
| | | | | | - Raj Murali
- Wrightington, Wigan and Leigh NHS Trust, Wigan, UK
| | | | | | - Ian Trail
- Wrightington, Wigan and Leigh NHS Trust, Wigan, UK
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [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.
Collapse
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
| |
Collapse
|
6
|
Oestreich K, Lindau T. A "Congenitally Adapted" TFCC Tear in Radial Longitudinal Deficiency: Case Report and Review of Literature. J Wrist Surg 2022; 11:445-449. [PMID: 36339077 PMCID: PMC9633140 DOI: 10.1055/s-0041-1735303] [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: 04/14/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
We present a case of chronic wrist pain in a 14-year-old child with mild radial longitudinal deficiency and radiographic carpal collapse due to the absence of the scaphoid. Wrist arthroscopy demonstrated synovitis and a tear to the TFCC, which would be called "degenerative," according to the Palmer classification. This was debrided, and the patient is still asymptomatic at long-term follow-up. Review of the literature found one paper with a similar observation in a 17-year-old adolescent. We propose that paediatric "degenerative" tears ought to be called "congenitally adapted" tears.
Collapse
Affiliation(s)
- Kerstin Oestreich
- Department of Plastic Surgery, Hand & Upper Limb Service, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - T.R. Lindau
- Pulvertaft Hand Center, Royal Derby Hospital, Derby, United Kingdom
| |
Collapse
|
7
|
Ghijsen SC, Nap FJ, Schuurman AH. Pseudotumor after Total Wrist Arthroplasty Mimicking a Neoplasm. J Wrist Surg 2022; 11:441-444. [PMID: 36339072 PMCID: PMC9633145 DOI: 10.1055/s-0041-1742282] [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: 04/02/2021] [Accepted: 07/27/2021] [Indexed: 12/26/2022]
Abstract
Background Total wrist arthroplasty can lead to a variation of complications. One of these is the formation of a pseudotumor. Although this complication is well known after total hip arthroplasty, it is rare in patients with wrist implants. Case Description A 55-year-old man with a Universal 2 (Integra, Plainsboro, NJ) wrist prosthesis was seen with a progressive mass on the radial side of his wrist since 1 year, initially suspicious for a neoplasm. However, after exploration, histopathology confirmed a particle-induced foreign body reaction. Literature Review There is little literature on pseudotumor formation after total wrist arthroplasty. Currently, there is no clear consensus about the etiology of pseudotumors but possible causes may include foreign body reaction, hypersensitivity, and wear debris. Clinical Relevance This case report shows that particle debris-induced pseudotumors should be considered when a patient with a wrist prosthesis presents with a mass suspicious for a neoplasm. In addition, treatment options of pseudotumors after wrist arthroplasty in literature is discussed.
Collapse
Affiliation(s)
- Sophie C. Ghijsen
- Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank J. Nap
- Department of Radiology, Central Military Hospital (CMH) Utrecht and University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arnold H. Schuurman
- Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
8
|
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; 12:411. [PMID: 35330163 PMCID: PMC8951379 DOI: 10.3390/life12030411] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [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.
Collapse
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.)
| | - 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;
| |
Collapse
|
9
|
Tanwin Y, Maes-Clavier C, Lestienne V, Gaisne E, Loubersac T, Kerjean Y, Bellemère P. Medium-Term Outcomes for Amandys Implant: A 5-Year Minimum Follow-Up of 63 Cases. J Wrist Surg 2022; 11:6-15. [PMID: 35127258 PMCID: PMC8807105 DOI: 10.1055/s-0041-1726406] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/09/2021] [Indexed: 10/21/2022]
Abstract
Background Amandys is a pyrocarbon interposition implant used as a therapeutic alternative to total wrist fusion (TWF) or total wrist arthroplasty (TWA) in painful and disabling extensive destruction of the wrist. Objective To review mid-term outcomes in a continuous prospective series of patients who underwent wrist arthroplasty Amandys with a minimum follow-up of 5 years. Methods Clinical evaluation included a satisfaction survey, pain, two functional scores, the short version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and the Patient-Rated Wrist Evaluation (PRWE), active wrist mobility, and grip strength compared with the contralateral side. Radiological evaluation was used to detect implant subsidence, carpal migration, bone lysis, or implant malposition. All per- and postoperative complications were collected. Results Fifty-nine patients (63 procedures) were evaluated with a mean follow-up of 7 years; 57% of the patients were males, and the mean age was 58 years. Among the patients, 90% were satisfied or very satisfied. Pain was significantly improved, with a gain of 4/10 ( p < 0.001). Functional outcomes also improved between the second and fifth year of follow-up. Active mobility was preserved and grip strength was significantly improved by 7 kg ( p < 0.001). No implant subsidence or carpal migration was observed. Ten patients (11.9%) underwent revision surgery for conflict (1%), rotation (6%), or implant dislocation (5%). All complications and revisions occurred early with no new events after 1 year of follow-up. Discussion Mid-term clinical and radiological outcomes were stable with improvement of functional scores. The survival rate was comparable to that reported for TWF with conserved mobility. We report fewer complications compared with those reported for TWA or TWF. Early instability of the implant was the main etiology of the revisions. Repositioning of the implant was successful. No conversion to TWA or TWF was necessary. Conclusions Mid-term outcomes of the Amandys implants were encouraging. Patients conserved good wrist motion with improved strength and functional scores. The implant was well tolerated. Functional outcomes continue to improve with the follow-up. The survival rate remains stable after 2 years. The level of evidence of this study is IV (therapeutic case series).
Collapse
Affiliation(s)
- Youssouf Tanwin
- Service de Chirurgie Orthopédique et Traumatologique, CHU d'Amiens, Amiens, France
| | | | - Victor Lestienne
- Service de Chirurgie de la Main, Institut de la Main Nantes-Atlantique, Santé Atlantique Saint-Herblain, France
| | - Etienne Gaisne
- Service de Chirurgie de la Main, Institut de la Main Nantes-Atlantique, Santé Atlantique Saint-Herblain, France
| | - Thierry Loubersac
- Service de Chirurgie de la Main, Institut de la Main Nantes-Atlantique, Santé Atlantique Saint-Herblain, France
| | - Yves Kerjean
- Service de Chirurgie de la Main, Institut de la Main Nantes-Atlantique, Santé Atlantique Saint-Herblain, France
| | - Philippe Bellemère
- Service de Chirurgie de la Main, Institut de la Main Nantes-Atlantique, Santé Atlantique Saint-Herblain, France
| |
Collapse
|
10
|
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: 4] [Impact Index Per Article: 1.3] [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.
Collapse
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
| |
Collapse
|