1
|
Reigstad O, Holm-Glad T, Korslund J, Myhre C, Thorkildsen R, Røkkum M. Long-Term Outcomes of Wrist Arthroplasty Using the ReMotion™ Implant in Non-inflammatory Wrist Pathology. J Hand Surg Asian Pac Vol 2024; 29:200-210. [PMID: 38726500 DOI: 10.1142/s2424835524500218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Background: Wrist arthroplasty is increasingly offered to patients with symptomatic wrist arthritis as an alternative to wrist arthrodesis. The purpose of this study was to present our outcomes with the ReMotion™ wrist arthroplasty in a consecutive series of patients with wrist arthritis from non-inflammatory conditions. Methods: Thirteen (eight women, nine dominant wrists) patients, 68 (44-85) years of age with advanced radiocarpal arthritis due to SLAC/SNAC (11) and Kienbock disease (2) had a ReMotion™ (Stryker, Michigan, USA) wrist arthroplasty implanted, and were prospectively followed for 7 (4-9) years. The outcome measures included patient-rated wrist and hand evaluation (PRWHE) score, disabilities of the arm, shoulder and hand questionnaire (QuickDASH) score, visual analogue pain score (0-10) on the radial and ulnar aspect of the wrist at rest (VASrR/VASuR) and activity (VASrA/VASuA), active wrist range of motion (AROM) including flexion, extension, ulnar and radial deviation, pronation and supination and grip and key-pinch strength measured preoperatively and at yearly follow-ups by independent hand therapists. Results: Six patients had ten re-operations during the follow-up including four revisions to a new arthroplasty. Four were considered loose at follow-up. A significant reduction in PRWHE (63 to 12), radial pain at activity (6 to 1) and increased pronation (85° v 90°) was observed. Conclusions: We found a high complication and reoperation rate, two out of 13 had no complications or reoperations. The ReMotion™ arthroplasty should be used with caution in non-inflammatory wrist patients and the patients followed closely. A high reoperation and revision rate can be expected, and surgeons familiar with revision arthroplasty procedures should perform the surgery. Level of Evidence: Level II (Therapeutic).
Collapse
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
| | - Cathrine Myhre
- Division of Orthopaedic Surgery, Oslo University Hospital, 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
| |
Collapse
|
2
|
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).
Collapse
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
| |
Collapse
|
3
|
Holm-Glad T, Røkkum M, Röhrl SM, Roness S, Godang K, Reigstad O. A randomized controlled trial comparing two modern total wrist arthroplasties : improved function with stable implants, but high complication rates in non-rheumatoid wrists at two years. Bone Joint J 2022; 104-B:1132-1141. [PMID: 36177637 DOI: 10.1302/0301-620x.104b10.bjj-2022-0201.r2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To analyze the short-term outcome of two types of total wrist arthroplasty (TWA) in terms of wrist function, migration, and periprosthetic bone behaviour. METHODS A total of 40 patients suffering from non-rheumatoid wrist arthritis were enrolled in a randomized controlled trial comparing the ReMotion and Motec TWAs. Patient-rated and functional outcomes, radiological changes, blood metal ion levels, migration measured by model-based radiostereometric analysis (RSA), bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA), complications, loosening, and revision rates at two years were compared. RESULTS Patient-Rated Wrist and Hand Evaluation (PRWHE) scores, abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire scores, and pain improved similarly and significantly in both groups. Wrist motion improved significantly in the Motec group only, and forearm rotation in the ReMotion group only. Cobalt (Co) and chromium (Cr) blood ion levels were significantly higher in the metal-on-metal (MoM) Motec group than in the metal-on-polyethylene (MoP) ReMotion group. Mean total translation was 0.65 mm (95% confidence interval (CI) 0.26 to 1.12) and 0.27 mm (95% CI 0.14 to 0.47) for the ReMotion carpal and radial components, and 0.32 mm (95% CI 0.22 to 0.45) and 0.26 mm (95% CI 0.20 to 0.34) for the Motec metacarpal and radial components, respectively. Apart from dorsal and volar tilts, which were significantly higher for the radial ReMotion than for the Motec component, no significant differences in absolute migration occurred. BMD around the radial components never returned to baseline. Almost one-third of patients required reoperation due to complications. Two ReMotion implants were revised to Motec TWAs due to carpal component loosening, and three Motec MoM articulations were revised to metal-on-polyether ether ketone due to painful synovitis. CONCLUSION Both implants provided matched function and were stable at short-term follow-up, but with a high complication rate. This procedure should be restricted to specialist centres undertaking prospective analysis until its role is clarified.Cite this article: Bone Joint J 2022;104-B(10):1132-1141.
Collapse
Affiliation(s)
- Trygve Holm-Glad
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magne Røkkum
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stephan M Röhrl
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Siri Roness
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Kristin Godang
- Section of Specialized Endocrinology, Oslo University Hospital, Oslo, Norway
| | - Ole Reigstad
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Holm-Glad T, Godang K, Bollerslev J, Røkkum M, Reigstad O. Assessing Periprosthetic Bone in Total Wrist Arthroplasty: The Validity of DXA. J Clin Densitom 2021; 24:433-441. [PMID: 33172804 DOI: 10.1016/j.jocd.2020.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Dual-energy X-ray absorptiometry (DXA) can measure bone mineral density (BMD) around joint arthroplasties. DXA has never been used in total wrist arthroplasties (TWA). We investigated (1) whether BMD differs between 2 TWAs implanted in the same cadaver forearm, (2) the effect of forearm rotation and wrist extension on measured BMD around TWA in a cadaver, and (3) the precision of DXA in a cadaver and patients. METHODOLOGY One ROI around the distal and 1 and 3 ROIs (ROI1-3) around the proximal component were used. Ten DXA scans were performed on forearm and femur mode convertible to orthopedic knee mode without arthroplasty, with ReMotion, and with Motec TWA in one cadaver forearm. Ten scans with 5° increments from 90°-70° pronation and 0°-20° extension, were performed with Motec. Precision was calculated as coefficient of variation (CV%) and least significant change (LSC%) from cadaver scans and double examinations with femur mode converted to orthopedic knee mode in 40 patients (20 ReMotion, 20 Motec). RESULTS BMD was higher in all Motec than corresponding ReMotion ROIs (p < 0.05). BMD changed with 10° supination in the distal ROI and ROI1, and with 5° extension in the distal ROI (p < 0.05). In the cadaver the orthopedic knee mode was more precise than the forearm mode in 3 Motec ROIs (p < 0.05). In patients CV was 2.21%-3.08% in the distal ROI, 1.66%-2.01% in the proximal ROI, and 1.98%-2.87% with 3 ROIs. CONCLUSIONS DXA is feasible for BMD measurement around the proximal component using the orthopedic knee mode, but not the distal component of TWA.
Collapse
Affiliation(s)
- Trygve Holm-Glad
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Kristin Godang
- Section of specialized endocrinology, Oslo University hospital, Oslo, Norway
| | - Jens Bollerslev
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Section of specialized endocrinology, Oslo University hospital, Oslo, Norway
| | - Magne Røkkum
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ole Reigstad
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
6
|
Cost-Effectiveness Analysis of Motion-Preserving Operations for Wrist Arthritis. Plast Reconstr Surg 2020; 146:588e-598e. [PMID: 33141535 DOI: 10.1097/prs.0000000000007260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The authors conducted a cost-effectiveness analysis to answer the question: Which motion-preserving surgical strategy, (1) four-corner fusion, (2) proximal row carpectomy, or (3) total wrist arthroplasty, used for the treatment of wrist osteoarthritis, is the most cost-effective? METHODS A simulation model was created to model a hypothetical cohort of wrist osteoarthritis patients (mean age, 45 years) presenting with painful wrist and having failed conservative management. Three initial surgical treatment strategies-(1) four-corner fusion, (2) proximal row carpectomy, or (3) total wrist arthroplasty-were compared from a hospital perspective. Outcomes included clinical outcomes and cost-effectiveness outcomes (quality-adjusted life-years and cost) over a lifetime. RESULTS The highest complication rates were seen in the four-corner fusion cohort: 27.1 percent compared to 20.9 percent for total wrist arthroplasty and 17.4 percent for proximal row carpectomy. Secondary surgery was common for all procedures: 87 percent for four-corner fusion, 57 percent for proximal row carpectomy, and 46 percent for total wrist arthroplasty. Proximal row carpectomy generated the highest quality-adjusted life-years (30.5) over the lifetime time horizon, compared to 30.3 quality-adjusted life-years for total wrist arthroplasty and 30.2 quality-adjusted life-years for four-corner fusion. Proximal row carpectomy was the least costly; the mean expected lifetime cost for patients starting with proximal row carpectomy was $6003, compared to $11,033 for total wrist arthroplasty and $13,632 for four-corner fusion. CONCLUSIONS The authors' analysis suggests that proximal row carpectomy was the most cost-effective strategy, regardless of patient and parameter level uncertainties. These are important findings for policy makers and clinicians working within a universal health care system.
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
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: 9] [Impact Index Per Article: 1.8] [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.
Collapse
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
| |
Collapse
|
9
|
Venter RG, Burger MC, Ikram A, Lamberts RP. Bony anatomy of the third metacarpal and relationship with the capitate: a computed tomography study. Surg Radiol Anat 2019; 41:1319-1324. [PMID: 31250137 DOI: 10.1007/s00276-019-02272-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 06/21/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to accurately establish the anatomical variability of the third metacarpal, its medullary canal, and the relationship with the capitate in the context of high rates of component loosening still seen in total wrist arthroplasty. METHODS CT scans of a 100 hands (age: 41 ± 14 years (range: 16-71 years); male/female ratio: 53/47) were studied to establish the detailed anatomy of the third metacarpal and the capitate. RESULTS Although the shape of the third metacarpal and the angles formed with the capitate were highly variable, the third metacarpal length was longer in males (p < 0.001), the proximal cortical bone was thicker (p < 0.001) and the sagittal metacarpal-capitate axis offset was greater (p = 0.01). A relationship was found between the total length of the metacarpal and the distance to the isthmus from the base (r = 0.63; p < 0.0001) which was unaffected by gender. No age-related relationships were significant. CONCLUSION The anatomy of the third metacarpal and capitate varies considerably more than has been alluded to in current wrist arthroplasty literature. Differences between males and females can likely be attributed to hand size. The distance of the isthmus from the base can be predicted from the total length of the metacarpal with a standard error of 1.9 mm.
Collapse
Affiliation(s)
- Rudolph G Venter
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Clinical Building, 4th Floor, Tygerberg Campus, Tygerberg, Cape Town, 7505, South Africa
| | - Marilize C Burger
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Clinical Building, 4th Floor, Tygerberg Campus, Tygerberg, Cape Town, 7505, South Africa
| | - Ajmal Ikram
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Clinical Building, 4th Floor, Tygerberg Campus, Tygerberg, Cape Town, 7505, South Africa
| | - Robert P Lamberts
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Clinical Building, 4th Floor, Tygerberg Campus, Tygerberg, Cape Town, 7505, South Africa.
| |
Collapse
|
10
|
Holm-Glad T, Reigstad O, Tsukanaka M, Røkkum M, Röhrl SM. High precision and accuracy of model-based RSA for analysis of wrist arthroplasty. J Orthop Res 2018; 36:3053-3063. [PMID: 29873422 DOI: 10.1002/jor.24063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/03/2018] [Indexed: 02/04/2023]
Abstract
Radiostereometric analysis (RSA) is a method for measuring micromotion in joint arthroplasties. RSA has never been used in total wrist arthroplasties. We evaluated: (i) the precision of model-based RSA in total wrist arthroplasties measured in a phantom model and in patients; (ii) the number of bone markers necessary to ensure the precision; and (iii) the accuracy of model-based RSA in a phantom model. Reverse engineered models of radial and carpal/metacarpal components of two wrist arthroplasties (ReMotion® and Motec®) were obtained by laser scanning. Precision and accuracy of each arthroplasty were analyzed with regards to translation and rotation along the three coordinate axes. Precision was analyzed in 10 phantom and 30 clinical double examinations for each arthroplasty, and was expressed by a repeatability coefficient. The precision of different numbers and configurations of bone markers in the phantom model were compared. Accuracy was tested in a phantom model where the implants were attached to a micrometer, and was defined as the mean difference between measured and true migration. In the phantom model the precision for translations ranged from 0.03 to 0.14 mm and for rotations from 0.18 to 1.52°. In patients the precision for translations ranged from 0.06 to 0.18 mm, and for rotations from 0.32 to 2.18°. Less than four bone markers resulted in inferior precision. Accuracy ranged from -0.06 to 0.04 mm, and from -0.38 to -0.01°. Y-rotations could not be obtained from the Motec® due to rotational symmetry about the longitudinal axis. We conclude that model-based RSA in total wrist arthroplasties is precise, accurate, and feasible to use for clinical evaluation of micromotion in wrist arthroplasties. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3053-3063, 2018.
Collapse
Affiliation(s)
- Trygve Holm-Glad
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ole Reigstad
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Masako Tsukanaka
- 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
| | - Stephan M Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Reigstad O, Holm-Glad T, Bolstad B, Grimsgaard C, Thorkildsen R, Røkkum M. Five- to 10-Year Prospective Follow-Up of Wrist Arthroplasty in 56 Nonrheumatoid Patients. J Hand Surg Am 2017; 42:788-796. [PMID: 28844772 DOI: 10.1016/j.jhsa.2017.06.097] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 05/31/2017] [Accepted: 06/14/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The goal of the study was to evaluate the clinical and radiological outcomes of a cementless wrist arthroplasty with minimum 5-year follow-up in nonrheumatoid patients. METHODS Fifty-seven (40 male) patients with end-stage arthritis changes received an uncemented ball-and-socket total wrist arthroplasty (Motec Wrist). Function was evaluated before surgery and at yearly follow-ups. Visual analog scale at rest and activity, quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), active range of motion (AROM), and grip-strength were recorded. Standardized radiographs were taken to assess osteolysis, loosening, and subsidence. RESULTS Fifty-six patients were followed for a mean of 8 years (SD, 2 years). Eight wrists were reoperated with arthrodesis (4) or a new arthroplasty (4) owing to distal component loosening (3), infection (2), pain/fixed malposition (2), or proximal and distal component loosening (1). One radiocarpal dislocation was reduced closed and remained stable. Improved QuickDASH score and visual analog scale pain score both at rest and during activity were found at the last follow-up, as well as increased AROM (97° vs 126°) and grip strength (21 kg vs 24 kg). The radiological follow-up demonstrated loosening in 2 wrists. Thirty-five patients were working at surgery (17 manual labor) and 27 (11 manual labor) at follow-up. The 10-year Kaplan-Meyer survival of the implants was 86% for revision for any cause; 2 additional arthroplasties are loose (but not revised), giving a survival rate of 82% if these are revised prior to 10 years of observation. CONCLUSIONS An uncemented total wrist arthroplasty can provide long-lasting unrestricted hand function in young and active patients. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Ole Reigstad
- Orthopaedic Department, Hand- and Microsurgical Unit, University Hospital of Oslo, Oslo, Norway.
| | - Trygve Holm-Glad
- Orthopaedic Department, Hand- and Microsurgical Unit, University Hospital of Oslo, Oslo, Norway
| | - Bjørg Bolstad
- Physiotherapy Unit, Department for Clinical Service, University Hospital of Oslo, Oslo, Norway
| | - Christian Grimsgaard
- Orthopaedic Department, Hand- and Microsurgical Unit, University Hospital of Oslo, Oslo, Norway
| | - Rasmus Thorkildsen
- Orthopaedic Department, Hand- and Microsurgical Unit, University Hospital of Oslo, Oslo, Norway
| | - Magne Røkkum
- Orthopaedic Department, Hand- and Microsurgical Unit, University Hospital of Oslo, Oslo, Norway
| |
Collapse
|
13
|
Update on the operative treatment of scapholunate instability for radiologists. II. Salvage procedures, total wrist arthrodesis, and total wrist arthroplasty. Skeletal Radiol 2017; 46:1031-1040. [PMID: 28547205 DOI: 10.1007/s00256-017-2671-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/25/2017] [Accepted: 05/02/2017] [Indexed: 02/02/2023]
Abstract
Scapholunate (SL) instability is the most common form of carpal instability. Imaging (especially radiography) plays an important role in the staging, management, and postoperative follow-up of SL instability. In the final stage of SL instability, known as scapholunate advanced collapse, progressive degenerative changes occur at the carpal level. The goals of this article are to review the surgical options available for addressing the different stages of scapholunate advanced collapse, along with an emphasis on normal postoperative imaging and complications associated with each surgical option.
Collapse
|
14
|
Schmidt I. Does Total Wrist Arthroplasty for Treatment of Posttraumatic Wrist Joint Osteoarthritis in Young Patients Always Lead to Restriction of High-demand Activities of Daily Living? Case Report and Brief Review of Recent Literature. Open Orthop J 2017; 11:439-446. [PMID: 28660002 PMCID: PMC5470063 DOI: 10.2174/1874325001711010439] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 03/28/2017] [Accepted: 04/22/2017] [Indexed: 11/22/2022] Open
Abstract
Background: Posttraumatic ulnar carpal translocation is a very rare condition that is caused either by fracture-dislocation injury or by purely ligamentous injury of the wrist. Its prognosis is poor and development of posttraumatic pancarpal wrist joint osteoarthritis is inevitable, and options for treatment are total wrist fusion or total wrist arthroplasty. Methods: A 24-year-old male sustained a fracture-related injury in his left wrist that was accompanied with a second ligamentous distorsion-related injury 1 year later in the same wrist. Seven years after first injury, a posttraumatic pancarpal wrist joint osteoarthritis has developed that was caused by posttraumatic ulnar carpal translocation. The patient was treated by total wrist arthroplasty with use of the MaestroTM Wrist Reconstructive System. Results: With our patient, it is unclear whether posttraumatic ulnar carpal translocation occurred either as result of the first fracture-related injury or as result of the second ligamentous distorsion-related injury or as result of both injuries. The 31-year-old patient could be reemployed completely in his original occupation as a mechanic for big agriculture machines and load his wrist with more than 10 pounds. In order to preserve motion, the patient reported that he would undergo the same total wrist arthroplasty a second time were it necessary. Conclusion: We report on a young male receiving total wrist arthroplasty and resulting in good restoration of his high-demand claims in activities of daily living, respectively. However, it cannot be concluded that total wrist arthroplasty is to be preferred generally over total wrist fusion in young patients. Essential prerequisite for this motion-preserving procedure is the compliance of patients.
Collapse
Affiliation(s)
- Ingo Schmidt
- SRH Poliklinik Gera GmbH, Straße des Friedens 122, 07548 Gera, Germany
| |
Collapse
|
15
|
An Unusual and Complicated Course of a Giant Cell Tumor of the Capitate Bone. Case Rep Orthop 2016; 2016:3705808. [PMID: 27847665 PMCID: PMC5099473 DOI: 10.1155/2016/3705808] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/09/2016] [Accepted: 10/09/2016] [Indexed: 12/21/2022] Open
Abstract
A 51-year-old female patient presented with a carpal giant cell tumor (GCT) of the right capitate bone. The lesion was initially misdiagnosed as having an osteomyelitis. First, the diagnosis of a benign GCT was confirmed by histological examination. Second, an intralesional curettage and packing of the cavity with cancellous iliac crest bone grafts combined with a fusion of the third carpometacarpal (CMC III) joint were carried out. Third, due to a secondary midcarpal osteoarthritis and a secondary scaphoid nonunion, the CMC III joint fusion plate was removed and the midcarpal joint completely excised. Fourth, in the absence of recurrence of GCT, a four-corner fusion (4CF) with a corticocancellous iliac crest bone graft and complete excision of the scaphoid bone had to be performed. Fifth, a total wrist arthroplasty (TWA) was performed due to hardware failure of 4CF with migration of a headless compression screw into radiocarpal joint which led to erosion of articular surface of the distal radius. At the 3-year follow-up that includes a 1-year follow-up after TWA, there was no recurrence of GCT, and the TWA was not failed. The patient reported that she would have the motion-preserving TWA again.
Collapse
|