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Briotti J, Wilson S, Goh G, Lawson-Smith M. Wrist Arthrodesis Using the Medartis Carpometacarpal Joint Sparing Plate. Hand (N Y) 2024; 19:607-613. [PMID: 36541766 PMCID: PMC11141422 DOI: 10.1177/15589447221141474] [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: 12/24/2022]
Abstract
BACKGROUND Total wrist arthrodesis is a well-established surgical technique that provides reliable pain relief in patients with advanced wrist disease. Key limitations of existing plating systems include hardware pull-out, hardware failure, and nonunion. There is limited literature on the newer style carpometacarpal joint (CMCJ) sparing plating system, produced by Medartis. The objective of this study was to determine the long-term clinical and radiological outcomes of wrist arthrodesis with a CMCJ sparing wrist plate. METHODS This study retrospectively identified 23 wrist arthrodeses using the Medartis CMCJ sparing plate for review. This study assessed the outcomes of 18 unilateral wrist fusions and 1 bilateral wrist fusion. The study group consisted of 12 men and 5 women with an average age of 56 years (range: 29-82 years) with a mean follow-up period of 17 months. RESULTS At the time of follow-up, all patients' wrists had fused without postsurgical complication. The final grip strength in the operative hand was 28.2 kg/cm2, which was 87% of the contralateral side. The mean Quick Disabilities of the Arm, Shoulder, and Hand score at follow-up was 23.9, with all patients returning to daily living activities and work. Patients reported minimal pain (1.3/10), with almost all (17/18) satisfied with the outcome of the surgery and describing that they would recommend this procedure. CONCLUSION Our case series highlights that the Medartis wrist arthrodesis plate is a newer design that is a well-tolerated option for wrist arthrodesis based on clinical assessment, functional hand assessment, and patient satisfaction, when compared with the existing literature on traditional plating systems.
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Affiliation(s)
- Joshua Briotti
- Royal Perth Hospital, WA, Australia
- University of Notre Dame Australia, Fremantle, WA, Australia
| | | | | | - Matthew Lawson-Smith
- University of Notre Dame Australia, Fremantle, WA, Australia
- Fremantle Hospital, WA, Australia
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2
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Clementson M, Larsson S, Abramo A, Brogren E. Clinical and Patient-Reported Outcomes After Total Wrist Arthroplasty and Total Wrist Fusion: A Prospective Cohort Study with 2-Year Follow-up. JB JS Open Access 2024; 9:e23.00081. [PMID: 38196851 PMCID: PMC10773805 DOI: 10.2106/jbjs.oa.23.00081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
Background The functional benefits of total wrist arthroplasty (TWA) over total wrist fusion (TWF) are unknown. The purpose of this prospective cohort study was to compare TWA and TWF with respect to functional outcomes and activity limitations at up to 2 years postoperatively. Methods Between 2015 and 2020, we enrolled all adult patients undergoing TWA or TWF for the management of symptomatic end-stage wrist arthritis at 1 hand surgery department. The primary outcome was the Patient-Rated Wrist Evaluation (PRWE). The secondary outcomes were the visual analog scale (VAS) for pain at rest, on motion, and on loading; grip strength; Disabilities of the Arm, Shoulder and Hand (DASH); and range of motion. Patients completed questionnaires and were examined by the same physiotherapist at baseline and at 3, 6, 12, and 24 months postoperatively. Mixed-model analyses adjusting for age, diagnosis, the preoperative value of the dependent variable, and time since surgery were performed to compare differences in PRWE scores, VAS pain scores, and grip strength between TWA and TWF. Results Of the 51 patients who had been included at baseline, 47 (18 in the TWA group and 29 in the TWF group) responded to questionnaires and underwent examinations at up to 2 years postoperatively. At baseline, the 2 groups did not differ in terms of age, sex, diagnosis (inflammatory or noninflammatory arthritis), PRWE score, VAS pain score, grip strength, DASH score, or range of motion. No differences between the groups were found for the PRWE (β, -0.1; 95% confidence interval [CI], -14 to 13; p = 0.99), VAS pain at rest (β, -3.3; 95% CI, -15 to 9; p = 0.58), VAS pain on loading (β, -5.3; 95% CI, -22 to 11; p = 0.52), or grip strength (β, -0.02; 95% CI, -0.18 to 0.14; p = 0.80) on the adjusted mixed-model analyses. Conclusions Among patients with symptomatic end-stage wrist arthritis, those who underwent TWA did not demonstrate short-term outcomes, including patient-reported disability, pain, and grip strength, superior to those of patients who underwent TWF. These findings call into question the widespread use of TWA. Level of Evidence Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Martin Clementson
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Sara Larsson
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Antonio Abramo
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Elisabeth Brogren
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Translational Medicine, Lund University, Malmö, Sweden
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3
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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: 2] [Impact Index Per Article: 2.0] [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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Nasu Y, Nishida K, Natsumeda M, Nakahara R, Harada R, Ozaki T. Wrist arthrodesis combined with a bulk bone allograft for implant loosening after total wrist arthroplasty: A case report. Mod Rheumatol Case Rep 2023; 8:43-48. [PMID: 37572091 DOI: 10.1093/mrcr/rxad048] [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] [Received: 04/06/2023] [Revised: 07/11/2023] [Accepted: 08/08/2023] [Indexed: 08/14/2023]
Abstract
Total wrist arthroplasty (TWA) is a challenging procedure for wrist joints severely destroyed by rheumatoid arthritis. The most common postoperative complication of TWAs is the loosening of the carpal component. Revision surgeries for failed TWAs can be complicated owing to severe bone loss and concomitant soft-tissue problems. Here, we report a case (68-year-old woman with a history of rheumatoid arthritis for 24 years) of severe aseptic loosening of semi-constrained TWA and its salvage surgery. During the primary arthroplasty procedure, severe instability at the second through fifth carpometacarpal joints was observed and arthrodesis of these joints was required. The radiographs obtained 9 months after surgery showed loosening of the carpal component. Subsequently, she suffered a stroke, resulting in a loss of follow-up, and higher stress was loaded on her upper extremities during standing and walking. In the radiograph taken at her revisit 25 months after the primary surgery, the subsidence of the carpal component progressed and loosening of the radial component was observed. Total wrist arthrodesis was performed using a bulk bone allograft of the femoral head, combined with a penetrating Wrist Fusion Rod®. Rapid bone union was achieved without soft-tissue irritation. We conclude that wrist arthrodesis with a bulk bone allograft combined with an intramedullary nail is a reasonable option for failed total wrist arthroplasty.
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Affiliation(s)
- Yoshihisa Nasu
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Keiichiro Nishida
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | | | - Ryuichi Nakahara
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Ryozo Harada
- Department of Orthopaedic Surgery, Kurashiki Sweet Hospital, Kurashiki, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
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5
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Reiser D, Fischer P, Pettersson K, Wretenberg P, Sagerfors M. Total Wrist Arthroplasty With a New Design, 20 Cases With 8-Year Follow-Up. J Hand Surg Am 2023:S0363-5023(23)00446-X. [PMID: 37715756 DOI: 10.1016/j.jhsa.2023.08.004] [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: 05/02/2023] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE Total wrist arthroplasty (TWA) is an established motion-preserving alternative to arthrodesis in the treatment of wrist arthritis, but post-TWA complications requiring additional surgery remain an issue. A new TWA design has been proposed. The purpose of this study was to report the outcome of a cohort study of 20 patients who underwent surgery using the new TWA design. METHODS Patients were assessed before surgery and at 1, 2, and 8 years after surgery for visual analog scale (VAS) pain scores, wrist range of motion, hand grip strength, and patient-reported outcome measures (PROMs). Radiographic examination was conducted for evidence of prosthetic loosening. Reasons for revision were analyzed. RESULTS In total, 24 reoperations were performed, including 12 revisions in 6 patients. Patient-reported outcome measures improved significantly at the 2-year follow-up compared with preoperative values. Hand grip strength, wrist extension, and VAS pain scores improved significantly at the 2-year follow-up. No radiographic loosening of the components was observed, but backing out of the carpal screws was noted in 16 of the 20 cases. CONCLUSIONS The new TWA resulted in improved VAS pain scores, PROMs, wrist extension, and hand grip strength. The high frequency of reoperation is a concern, and modification of the implant is needed. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Daniel Reiser
- Department of Orthopedics and Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Per Fischer
- Department of Orthopedics and Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Kurt Pettersson
- Department of Orthopedics and Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Per Wretenberg
- Department of Orthopedics and Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Marcus Sagerfors
- Department of Orthopedics and Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
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6
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LoGiudice A, Awan H. Wrist Arthritis and Arthrodesis: Preserving Function, Minimizing Problems. Hand Clin 2023; 39:353-365. [PMID: 37453763 DOI: 10.1016/j.hcl.2023.04.001] [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: 07/18/2023]
Abstract
Wrist arthritis is a common condition with numerous causes and presentations. Several management options exist, and treatment should be individualized based on patient age, comorbidities, occupation, duration of symptoms, and failed treatment modalities. Arthroscopy and denervation are appealing because of shorter recovery time and preservation of motion, but duration of effectiveness varies between patients. Patients who fail these smaller procedures or those with pancarpal arthrosis are treated effectively with total wrist arthrodesis or total wrist arthroplasty in lower-demand patients. This article reviews causes and patterns of wrist arthritis and discusses treatment strategies aimed at preserving function and minimizing complications.
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Affiliation(s)
- Anthony LoGiudice
- Department of Orthopaedic Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Hisham Awan
- Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Road, Suite 3200, Columbus, OH 43212, USA.
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7
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Graham DJ, McCarron L, Phillips T, Sivakumar B. Range of motion required for Auslan: a biomechanical analysis. ANZ J Surg 2023; 93:1930-1934. [PMID: 37341153 DOI: 10.1111/ans.18542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/08/2023] [Accepted: 05/18/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Auslan is used by the Australian deaf community and relies heavily on hand, wrist, and elbow movement. Upper limb injury or dysfunction may require surgical intervention to alleviate pain and provide a stable skeleton for function, leading to partial or complete reduction in motion. The aim of this study was to assess the wrist, forearm, and elbow motion required to communicate via Auslan, to tailor optimal interventions in this population. METHODS A biomechanical analysis was conducted on two native Auslan communicators, who signed 28 pre-selected and common Auslan words and phrases. RESULTS Sagittal plane wrist and elbow motion was found to be of greater importance than axial plane forearm rotation. Relative elbow flexion and generous wrist motion was common for many of the words and phrases, while end-range elbow extension was not recorded. CONCLUSION The maintenance of wrist and elbow motion should be prioritized when selecting surgical interventions for patients who communicate using Auslan.
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Affiliation(s)
- David J Graham
- Department of Musculoskeletal Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- Australian Research Collaboration on Hands (ARCH), Gold Coast, Queensland, Australia
- Griffith University School of Medicine and Dentistry, Gold Coast, Queensland, Australia
- University of Queensland School of Medicine, Brisbane, Queensland, Australia
- Department of Orthopaedics, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Luke McCarron
- Department of Musculoskeletal Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- Occupational Therapy Department, Bond University, Bond Institute of Health and Sport, Gold Coast, Queensland, Australia
| | - Teresa Phillips
- Department of Orthopaedics, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Brahman Sivakumar
- Australian Research Collaboration on Hands (ARCH), Gold Coast, Queensland, Australia
- Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Department of Orthopaedic Surgery, Hornsby Ku-ring-gai Hospital, Sydney, New South Wales, Australia
- Department of Orthopaedic Surgery, Nepean Hospital, Sydney, New South Wales, Australia
- Discipline of Surgery, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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8
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Llopis E, Cerezal L, Auban R, Aguilella L, Piñal FD. Postoperative Imaging of the Wrist and Hand. Magn Reson Imaging Clin N Am 2022; 30:645-671. [DOI: 10.1016/j.mric.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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9
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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.
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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
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10
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Surgical management of osteoarthritis of the hand and wrist. J Hand Ther 2022; 35:418-427. [PMID: 35428565 DOI: 10.1016/j.jht.2022.01.001] [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: 02/03/2023]
Abstract
Osteoarthritis of the hand and wrist is common; varying disease manifestations and a spectrum of symptoms make it imperative to approach treatment strategies in an individualized fashion. In this review, attention is focused upon site specific diagnoses and indications for various surgical treatment strategies.
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11
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Taljanovic MS, Omar IM, Weaver JS, Becker JL, Mercer DM, Becker GW. Posttreatment Imaging of the Wrist and Hand: Update 2022. Semin Musculoskelet Radiol 2022; 26:295-313. [PMID: 35654096 DOI: 10.1055/s-0042-1743538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Common indications for surgical procedures of the wrist and hand include acute fractures or fracture-dislocations; nonunited fractures; posttraumatic, degenerative, and inflammatory arthritides and tendinopathies; injuries to tendons, ligaments, and the triangular fibrocartilage complex; and entrapment neuropathies. Soft tissue or osseous infections or masses may also need surgical treatment. Several of these procedures require surgical hardware placement, and most entail clinical follow-up with periodic imaging. Radiography should be the first imaging modality in the evaluation of the postoperative wrist and hand. Computed tomography, magnetic resonance imaging, diagnostic ultrasonography, and occasionally nuclear medicine studies may be performed to diagnose or better characterize suspected postoperative complications. To provide adequate evaluation of postoperative imaging of the wrist and hand, the interpreting radiologist must be familiar with the basic principles of these surgical procedures and both the imaging appearance of normal postoperative findings as well as the potential complications.
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Affiliation(s)
- Mihra S Taljanovic
- Department of Medical Imaging, The University of Arizona, College of Medicine, Tucson, Arizona.,Department of Radiology, University of New Mexico, Albuquerque, New Mexico
| | - Imran M Omar
- Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Jennifer S Weaver
- Department of Radiology, University of New Mexico, Albuquerque, New Mexico
| | - Jennifer L Becker
- Department of Medical Imaging, The University of Arizona, College of Medicine, Tucson, Arizona
| | - Deana M Mercer
- Department of Orthopaedics and Rehabilitation, University of New Mexico, Albuquerque, New Mexico
| | - Giles W Becker
- Department of Orthopaedic Surgery, University of Arizona, Tucson, Arizona
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12
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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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13
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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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14
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Herren DB, Ishikawa H, Rizzo M, Ross M, Solomons M. Arthroplasty in the hand: what works and what doesn't? J Hand Surg Eur Vol 2022; 47:4-11. [PMID: 34018871 DOI: 10.1177/17531934211017703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This review describes the different possibilities for arthroplasties at the proximal interphalangeal joint, thumb carpometacarpal joint, distal radioulnar joint, metacarpophalangeal joint and the wrist. For each joint, the indication for arthroplasty is explained, the surgical technique with the suitable implant is described and a brief summary of the outcomes reported in the literature is given.
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Affiliation(s)
- Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | | | - Marco Rizzo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mark Ross
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Queensland, Australia
| | - Michael Solomons
- Department of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
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15
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Althoff AD, Reeves RA, Traven SA, Slone HS, Deal DN, Werner BC. Risk Factors for Infection Following Total Wrist Arthroplasty and Arthrodesis: An Analysis of 6641 Patients. Hand (N Y) 2021; 16:657-663. [PMID: 31808356 PMCID: PMC8461204 DOI: 10.1177/1558944719890036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Infection following wrist arthroplasty (WA) or wrist fusion (WF) is an uncommon but difficult complication often resulting in explantation and prolonged courses of antibiotics. The purposes of this study are to: (1) characterize the demographic trends of individuals undergoing WA and WF; (2) determine the incidence of postoperative infection; and (3) identify risk factors for postoperative infection. Methods: The PearlDiver database was used to query 100% Medicare Standard Analytic files from 2005 to 2014. Patients undergoing WA or radiocarpal WF were identified using Current Procedural Terminology (CPT) codes. Diagnosis for infection within 1 year of operative intervention was assessed by International Classification of Diseases, Ninth Revision codes or CPT codes related to infection. Multivariable logistic regression analyses were performed to evaluate the risk factors for postoperative infection. Results: Of the 6641 patients included, 1137 (17.1%) underwent arthroplasty and 5504 (82.9%) underwent arthrodesis. Within 1 year of the index procedure, 3.5% had a diagnosis of, or procedure for, postoperative infection (WA: n = 40 of 1137; WF: n = 192 of 5504). Risk factors for infection following WA include age >85, tobacco use, depression, diabetes mellitus, and chronic kidney disease. Risk factors following radiocarpal WF include male sex, age >85, body mass index <19 kg/m2, depression, diabetes mellitus, and chronic kidney disease. Posttraumatic origin of wrist arthritis was a risk factor for infection following both WA and WF. Conclusions: Infection following WA and WF is relatively uncommon in a nationally representative Medicare database cohort. Risk factors common to both WA and WF include age >85, depression, diabetes mellitus, chronic kidney disease, and posttraumatic arthritis.
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Affiliation(s)
| | | | | | | | | | - Brian C. Werner
- University of Virginia, Charlottesville, USA,Brian C. Werner, Department of Orthopaedic Surgery, University of Virginia, 1215 Lee Street, Charlottesville, VA 22908-0816, USA.
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16
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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.
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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
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17
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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: 2] [Impact Index Per Article: 0.7] [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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18
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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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19
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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: 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.
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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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20
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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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21
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D'Amore T, Ilyas AM. Technique for Failed Total Wrist Arthroplasty Conversion to a Total Wrist Arthrodesis with Allograft Interposition. J Hand Microsurg 2020; 15:80-84. [PMID: 36761054 PMCID: PMC9904980 DOI: 10.1055/s-0040-1721170] [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: 10/22/2022] Open
Abstract
The frequency of prosthetic total wrist arthroplasty continues to increase. With this increase comes the expected subsequent increase in need for revision or salvage procedures. The technique presented here involves the use of a cortical allograft interposition graft to restore bone stock and length for failed total wrist arthroplasty.
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Affiliation(s)
- Taylor D'Amore
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Asif M. Ilyas
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States,Address for correspondence Asif M. Ilyas, MD Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital925 Chestnut Street, Philadelphia, PA 19107United States
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22
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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.
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23
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Deng AD, Innocenti M, Arora R, Gabl M, Tang JB. Vascularized Small-Bone Transfers for Fracture Nonunion and Bony Defects. Clin Plast Surg 2020; 47:501-520. [PMID: 32892797 DOI: 10.1016/j.cps.2020.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Vascularized small-bone grafting is an efficient and often necessary surgical approach for nonunion or necrosis of several bones in particular sites of the body, including scaphoid, lunate, distal ulna, and clavicle. The medial femoral condyle is an excellent graft source that can be used in treating scaphoid, ulna, clavicle, or lower-extremity bone defects, including nonunion. Vascularized bone grafting to the small bones, particularly involving reconstruction of damaged cartilage surfaces, should enhance subchondral vascular supply and help prevent cartilage regeneration. Vascularized osteoperiosteal and corticoperiosteal flaps are useful for treating nonunion of long bones.
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Affiliation(s)
- Ai Dong Deng
- Department of Hand Surgery, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong 226001, Jiangsu, China
| | - Marco Innocenti
- Plastic Surgery, University of Florence Careggi University Hospital, CTO, Largo Palagi 150139, Florence, Italy
| | - Rohit Arora
- Department of Trauma Surgery and Sports Medicine, Medical University Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Markus Gabl
- Department of Trauma Surgery and Sports Medicine, Medical University Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Jin Bo Tang
- Department of Hand Surgery, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong 226001, Jiangsu, China.
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24
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Kandemir G, Smith S, Schmidt I, Joyce TJ. Explant analysis of a Maestro™ wrist prosthesis and calculation of its lubrication regime. J Mech Behav Biomed Mater 2020; 110:103933. [PMID: 32957227 DOI: 10.1016/j.jmbbm.2020.103933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/31/2020] [Accepted: 06/10/2020] [Indexed: 10/23/2022]
Abstract
Explant analysis can provide key insights to understanding failures of artificial joints and thus how they might be improved for the ultimate benefit of patients. There are no previous reports of explant analysis of an artificial wrist joint. In this study, an explanted metal-on-polymer Maestro wrist was analysed both in macro and nanoscales to estimate its biotribological performance. The articulation was formed between a cobalt chromium carpal head and an ultrahigh molecular weight polyethylene bearing. The surface roughness values of its articulating surfaces and the backside of the articulation were measured. On average, the articulating surface roughness values were calculated as 0.06 ± 0.02 μm and 1.29 ± 0.63 μm for the cobalt chromium carpal head and ultrahigh molecular weight polyethylene bearing, respectively. Both surfaces had negative skewness, indicating a preponderance of valleys. On the articulating surface of the carpal head, light scratches were observed, and no impingement was observed throughout the component. The polymeric surface had a polished appearance. It had unidirectional scratches at the centre of the articulation, pits of different sizes on its articulating surface, and matt white subsurface regions. The backside of the UHMWPE bearing and the convex surface of the radial body that it was sitting on, were found to have average surface roughness values of 4.23 ± 0.69 μm and 5.57 ± 1.05 μm, respectively. The difference in the means was not significant (p > 0.05). Taking the articulating surface roughness values, the lubrication regime that the explanted Maestro wrist operated under in vivo was estimated for varying physiological conditions, i.e. varying loads, entraining velocities and lubricant viscosities. In every case considered, the explant was found to operate under boundary lubrication.
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Affiliation(s)
- Göksu Kandemir
- School of Engineering, Newcastle University, Newcastle Upon Tyne, UK.
| | - Simon Smith
- School of Engineering, Newcastle University, Newcastle Upon Tyne, UK
| | - Ingo Schmidt
- Department of Orthopaedics and Hand Surgery, Wutha-Farnroda, Germany
| | - Thomas J Joyce
- School of Engineering, Newcastle University, Newcastle Upon Tyne, UK
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25
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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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26
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Keuchel-Strobl T, Quadlbauer S, Jurkowitsch J, Rosenauer R, Hausner T, Leixnering M, Pezzei C. Salvage procedure after malunited distal radius fractures and management of pain and stiffness. Arch Orthop Trauma Surg 2020; 140:697-705. [PMID: 32193673 DOI: 10.1007/s00402-020-03369-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Indexed: 12/28/2022]
Abstract
Indications for surgical treatment of distal radius fractures (DRF) remain controversial in the literature, especially in elderly patients. Complication rates after operatively treated DRF are low and well documented. These include malunion, degenerative osteoarthritis in the radiocarpal joint and subsequently pain and impaired hand function. If conservative treatment fails then salvage procedures are necessary. This review summarizes the therapeutic options available to treat degenerative osteoarthritis after malunited distal radius fractures, regardless of the initial operative or conservative treatment.
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Affiliation(s)
- Tina Keuchel-Strobl
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria.
| | - S Quadlbauer
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, 1200, Vienna, Austria
| | - J Jurkowitsch
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - R Rosenauer
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, 1200, Vienna, Austria
| | - T Hausner
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, 1200, Vienna, Austria.,Department for Orthopedic Surgery and Traumatology, Paracelsus Medical University, 5020, Salzburg, Austria
| | - M Leixnering
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - Ch Pezzei
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
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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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Nunez FA, Wright L, Kilpatrick SE, Seitz WH. Revision Total Wrist Arthroplasty Due to Polyethylene Wear, Metallosis-Induced Carpal Tunnel Syndrome, Distal Ulnar Impingement, and Fourth Carpometacarpal Joint Pain: Case Report and Pitfalls to Avoid. Hand (N Y) 2020; 15:NP1-NP6. [PMID: 30417699 PMCID: PMC6966292 DOI: 10.1177/1558944718810863] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Total wrist arthroplasty (TWA) is indicated to alleviate pain secondary to arthritis while preserving wrist motion. Despite vigilant measures, TWAs are susceptible to complications. The current case illustrates an array of preventable complications which are addressed through operative technique in a revision setting. Case presentation: The patient was a 72-year-old man who presented with chronic pain at the fourth carpometacarpal joint (CMCJ) and distal radioulnar joint with paresthesias in the median nerve distribution. Surgery was undertaken to address the following complications secondary to a previous TWA: impingement of the native distal ulna on the prosthesis, carpal tunnel due to metallosis and polyethylene synovitis, loose carpal component, and prominent screw at the fourth CMCJ. Surgical correction included open carpal tunnel release with extensive flexor tenosynovectomy, distal ulna resection and implant arthroplasty with shortening, revision of carpal component with bone grafting, and shortening of the ulnar screw to avoid crossing the fourth CMCJ. Within 6 months of the procedure, the patient reported resolution of neuropathic symptoms and pain-free motion of the wrist. Discussion: Preventable complications associated with TWA are individually highlighted. In addition, we compare and contrast our approach and surgical technique to current reported literature. Overall, we provide education and guidance to avoid possible TWA pitfalls. Conclusion: With this case report, we hope to increase TWA knowledge with emphasis on the requirements of judicious patient selection, preoperative planning, meticulous surgical technique, and complication awareness for subsequent optimization of wrist function, stability, and durability.
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Affiliation(s)
| | - Lauren Wright
- Cleveland Clinic, Warrensville Heights,
OH, USA,Lauren Wright, Plastic and Reconstructive
Surgery, Cleveland Clinic-South Pointe Hospital, 20000 Harvard Road,
Warrensville Heights, OH 44122, USA.
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Froschauer SM, Zaussinger M, Hager D, Behawy M, Kwasny O, Duscher D. Re-motion total wrist arthroplasty: 39 non-rheumatoid cases with a mean follow-up of 7 years. J Hand Surg Eur Vol 2019; 44:946-950. [PMID: 31403876 DOI: 10.1177/1753193419866117] [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] [Indexed: 02/03/2023]
Abstract
We evaluated the outcomes of the Re-motion total wrist arthroplasty in 39 non-rheumatoid patients. The mean follow-up was 7 years (range 3-12). Postoperative wrist flexion-extension and radial-ulnar deviation as well as the scores of the Disability of Arm Shoulder and Hand questionnaire and the visual analogue scale pain scores improved significantly. Complications occurred in 13 wrists, five of which required further surgery. The most frequent complication was impingement between the scaphoid and the radial implant (n = 5), which can be avoided by complete or almost complete scaphoid resection. Periprosthetic radiolucency developed around the radial component in three cases and three radial screws loosened. Despite the incidence of high implant survival in 38 of 39 wrists over 7 years (97%), the complication rate is not satisfying. Knowledge of the risk of complications and patient selection are essential when making the decision to choose wrist arthroplasty over arthrodesis. Level of evidence: IV.
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Affiliation(s)
- Stefan M Froschauer
- Department for Trauma Surgery and Sports Traumatology, Medical Faculty, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria.,Maz - Microsurgical Training Center, Linz, Austria
| | - Maximilian Zaussinger
- Department for Trauma Surgery and Sports Traumatology, Medical Faculty, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
| | - Dietmar Hager
- Maz - Microsurgical Training Center, Linz, Austria.,Diakonissen Clinic, Linz, Austria
| | - Manfred Behawy
- Department for Trauma Surgery and Sports Traumatology, Medical Faculty, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
| | - Oskar Kwasny
- Department for Trauma Surgery and Sports Traumatology, Medical Faculty, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria.,Maz - Microsurgical Training Center, Linz, Austria
| | - Dominik Duscher
- Department for Trauma Surgery and Sports Traumatology, Medical Faculty, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria.,Maz - Microsurgical Training Center, Linz, Austria.,Department for Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technical University Munich, München, Germany
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30
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Cui Y, Li Z, Wan Q, Wang X, Li S, Ren Z, Wang Z, Yang F, Liu H, Wu D. [Clinical application of three-dimensional printed metal prosthesis in joint surgery]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:774-777. [PMID: 31198009 DOI: 10.7507/1002-1892.201901022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the application progress of three-dimensional (3D) printed metal prosthesis in joint surgery. Methods The related literature was extensively reviewed. The effectiveness of 3D printed metal prosthesis in treatment of joint surgery diseases were discussed and summarized, including the all key issues in prosthesis transplantation such as prosthesis stability, postoperative complications, bone ingrowth, etc. Results 3D printed metal prosthesis has good matching degree, can accurately reconstruct and restore joint function, reduce operation time, and achieve high patient satisfaction in short- and medium-term follow-up. Its application in joint surgery has made good progress. Conclusion The personalized microporous structure prostheses of different shapes produced by 3D printing can solve the problem of poor personalized matching of joints for special patients existing in traditional prostheses. Therefore, 3D printing technology is full of hope and will bring great potential to the reform of orthopedic practice in the future.
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Affiliation(s)
- Yutao Cui
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041, P.R.China
| | - Zuhao Li
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041, P.R.China
| | - Qian Wan
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041, P.R.China;Clinical Medical College of Jilin University, Changchun Jilin, 130041, P.R.China
| | - Xianggang Wang
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041, P.R.China;Clinical Medical College of Jilin University, Changchun Jilin, 130041, P.R.China
| | - Shengyang Li
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041, P.R.China
| | - Zhenxiao Ren
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041, P.R.China;Clinical Medical College of Jilin University, Changchun Jilin, 130041, P.R.China
| | - Zhonghan Wang
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041, P.R.China
| | - Fan Yang
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041, P.R.China
| | - He Liu
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041,
| | - Dankai Wu
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041,
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31
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Honecker S, Igeta Y, Al Hefzi A, Pizza C, Facca S, Liverneaux PA. Survival Rate on a 10-Year Follow-Up of Total Wrist Replacement Implants: A 23-Patient Case Series. J Wrist Surg 2019; 8:24-29. [PMID: 30723598 PMCID: PMC6358454 DOI: 10.1055/s-0038-1668152] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 06/29/2018] [Indexed: 10/28/2022]
Abstract
Background According to current literature, the estimated average survival rate for Remotion, the total wrist implants, is above 90% on an 8-year follow-up. We examined our series of Remotion to calculate its survival rate on a 10-year follow-up. Case Description A total of 23 cases of total wrist implants were reviewed. The case series included 22 patients, 18 females and 4 males, of an average age of 55 years. The case series included 19 inflammatory rheumatic diseases, 3 Kienböck disease, and 1 posttraumatic arthrosis. Conclusion The average survival rate of our case series was 95.7% on a 4-year follow-up, 91.3% on a 6-year follow-up, and 69% on a 10-year follow-up. On our review, the QuickDASH score, pain, wrist extension range of motion, and grip strength were improved postoperatively. No difference was shown between preoperative and postoperative values for wrist flexion, pronation, and supination. The case series included a septic case, treated by arthrodesis, and three total wrist implants displacements, two of which were treated by carpal implant, and the remaining one was treated by arthrodesis. Clinical Relevance The survival rate of the total wrist replacement implant Remotion was estimated to be 69%.
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Affiliation(s)
- Sophie Honecker
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Illkirch, France
| | - Yuka Igeta
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Illkirch, France
- Department of Orthopaedic Surgery, Juntendo University, Tokyo, Japan
| | - Ali Al Hefzi
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Illkirch, France
| | - Chiara Pizza
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Illkirch, France
| | - Sybille Facca
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Illkirch, France
| | - Philippe A. Liverneaux
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Illkirch, France
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32
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Li Z, Wang C, Li C, Wang Z, Yang F, Liu H, Qin Y, Wang J. What we have achieved in the design of 3D printed metal implants for application in orthopedics? Personal experience and review. RAPID PROTOTYPING JOURNAL 2018; 24:1365-1379. [DOI: 10.1108/rpj-10-2017-0205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
PurposeThis paper aims to review the latest applications in terms of three-dimensional printed (3DP) metal implants in orthopedics, and, importantly, the design of 3DP metal implants through a series of cases operated at The Second Hospital of Jilin University were presented.Design/methodology/approachThis paper is available to practitioners who are use 3DP implants in orthopedics. This review began with the deficiency of traditional prostheses and basic concepts of 3DP implants. Then, representative 3DP clinical cases were summarized and compared, and the experiences using customized prostheses and directions for future potential development are also shown.FindingsThe results obtained from the follow-up of clinical applications of 3DP implants show that the 3D designed and printed metal implants could exhibit good bone defect matching, quick and safe joint functional rehabilitation as well as saving time in surgery, which achieved high patient satisfaction collectively.Originality/valueSingle center experiences of 3DP metal implants design were shared and the detailed technical points between various regions were compared and analyzed. In conclusion, the 3DP technology is infusive and will present huge potential to reform future orthopedic practice.
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33
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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: 48] [Impact Index Per Article: 8.0] [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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34
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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.
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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
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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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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: 5] [Impact Index Per Article: 0.8] [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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What Are the Risk Factors and Complications Associated With Intraoperative and Postoperative Fractures in Total Wrist Arthroplasty? Clin Orthop Relat Res 2017; 475:2694-2700. [PMID: 28688019 PMCID: PMC5638735 DOI: 10.1007/s11999-017-5442-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 06/29/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Total wrist arthroplasty (TWA) can relieve pain and preserve some wrist motion in patients with advanced wrist arthritis. However, few studies have evaluated the risks and outcomes associated with periprosthetic fractures around TWAs. QUESTIONS/PURPOSES (1) What is the risk of intraoperative and postoperative fractures after TWAs? (2) What factors are associated with increased risk of intraoperative and postoperative fracture after TWAs? (3) What is the fracture-free and revision-free survivorship of TWAs among patients who sustained an intraoperative fracture during the index TWA? METHODS At one institution during a 40-year period, 445 patients underwent primary TWAs. Of those, 15 patients died before 2 years and 5 were lost to followup, leaving 425 patients who underwent primary TWAs with a minimum of 2-year followup. The primary diagnosis for the TWA included osteoarthritis ([OA] 5%), inflammatory arthritis (90%), and posttraumatic arthritis (5%). Indications for TWA included pancarpal arthritis combined with marked pain and loss of wrist function. The mean age of the patients was 57 years, BMI was 26 kg/m2, and 73% were females. Six different implants were used during the 40-year period. Mean followup was 10 years (range, 2-18 years). RESULTS Intraoperative fractures occurred in nine (2%) primary TWAs, while postoperative fractures occurred after eight (2%) TWAs. After analyzing demographics, comorbidities, and surgical factors, intraoperative fractures were found to be associated with only age at surgery (hazard ratio [HR], 1.10; 95% CI, 1.03-1.20; p = 0.006) and use of a bone graft (HR, 5.80; 95% CI, 1.18-23.08; p = 0.03). No factors were found to be associated with increased risk of postoperative fractures; specifically, intraoperative fracture was not associated with subsequent fracture development. The 5-, 10-, and 15-year Kaplan-Meier survival rates free of postoperative fracture were 99%, 98%, and 95%, respectively. The 5- and 10-year revision-free survival rates after intraoperative fracture were 88% and 88%, respectively, compared with 84% and 74% without an intraoperative fracture (p = 0.36). Furthermore, the survival-free of revision surgery rates for aseptic distal loosening at 5 and 10 years were 88% and 88%, respectively, compared with 93% and 87% without a fracture (p = 0.85). CONCLUSIONS Intraoperative fractures occur in approximately 2% of TWAs. These fractures do not appear to affect long-term implant survival or risk of fracture. Patient age and the need for bone graft were the only factors in the risk of intraoperative fractures. Postoperative fractures also occur in 2% of TWAs, but often result in revision surgery. LEVEL OF EVIDENCE Level III, therapeutic study.
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Traverso P, Wong A, Wollstein R, Carlson L, Ashmead D, Watson HK. Ten-Year Minimum Follow-Up of 4-Corner Fusion for SLAC and SNAC Wrist. Hand (N Y) 2017; 12:568-572. [PMID: 29091493 PMCID: PMC5669331 DOI: 10.1177/1558944716681949] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Scapholunate advanced collapse (SLAC) of the wrist is the most common degenerative condition of the wrist. Four-corner fusion (4CF) is performed as salvage surgery, though there is limited information on its long-term results. We hypothesized that 4CF is a durable surgery with good clinical long-term function. METHODS A retrospective chart review of patients undergoing 4CF as well as an interview and recent radiographs were obtained. Patients with a follow-up period of less than 10 years were excluded. Long-term evaluation included standard wrist radiographs, wrist range of motion, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Radiographs were evaluated and described by the Kellgren-Lawrence classification. RESULTS Four hundred eighty-nine wrists underwent a 4CF for SLAC wrist from 1982 to 2003. Twelve patients (15 wrists) were available for follow-up. Average age at surgery was 49.1 years (range, 25-67 years). Average follow-up postsurgery was 18 years (11-27). Scapholunate advanced collapse was the etiology in 13 wrists and scaphoid nonunion advanced collapse in 2 wrists. Average extension/flexion arc was 68.6° (0°-96°), and radial/ulnar deviation arc was 32.9° (0°-5°). QuickDASH scores averaged 7.8 (range, 0-32.5), with only 1 score above 16. Seventy-three percent of radiographs showed minimal to moderate joint destruction, and 27% showed severe joint destruction. CONCLUSIONS Scaphoid excision and 4CF remains a reliable procedure for patients with advanced wrist arthritis. Functional results were good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients. Patient satisfaction was high, and functional impairment was low.
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Affiliation(s)
| | | | - Ronit Wollstein
- Technion–Israel Institute of Technology, Haifa, Israel,University of Pittsburgh Medical School, PA, USA,Ronit Wollstein, Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical School, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
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Anneberg M, Packer G, Crisco JJ, Wolfe S. Four-Year Outcomes of Midcarpal Hemiarthroplasty for Wrist Arthritis. J Hand Surg Am 2017; 42:894-903. [PMID: 28927881 DOI: 10.1016/j.jhsa.2017.07.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 07/02/2017] [Accepted: 07/26/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to review the average 4-year outcomes of a cohort of patients with wrist arthritis, treated by a single surgeon with a novel prosthetic hemiarthroplasty of the midcarpal joint. We hypothesized that midcarpal hemiarthroplasty would improve range of motion and grip strength of patients with wrist arthritis, with a complication profile comparable with that of alternative solutions for wrist arthritis. METHODS We reviewed a series of 20 patients treated with a midcarpal hemiarthroplasty at an average of 4 years following surgery. Patients were evaluated objectively with grip strength, wrist range of motion, serial radiographs, and subjectively surveyed with Disabilities of the Arm, Shoulder, and Hand (DASH) and Mayo scores. RESULTS Range of motion increased by a mean 33° in flexion-extension and 10° in radial-ulnar deviation compared with preoperative range of motion. Mean grip strength improved to 20.8 kg from 14.1 kg, and Mayo and DASH scores also significantly improved. Three patients had a manipulation under anesthesia for stiffness. One patient required open reduction internal fixation of an unstable fourth carpometacarpal joint after falling. Two patients were revised to a total wrist arthroplasty and 1 to a wrist fusion. CONCLUSIONS Midcarpal hemiarthroplasty provides improved wrist range of motion, grip strength, and patient-reported outcome scores compared with preoperative values, with a complication profile comparable with that of other surgical options for patients with wrist arthritis. Advantages of midcarpal arthroplasty include retention of the native distal carpal row, preservation of midcarpal motion, as well as the option for conversion to a total wrist arthroplasty should revision be required. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Marie Anneberg
- Southend University Hospital, NHS Foundation Trust, Westcliff-on-Sea, United Kingdom
| | - Greg Packer
- Southend University Hospital, NHS Foundation Trust, Westcliff-on-Sea, United Kingdom
| | - Joseph J Crisco
- Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI
| | - Scott Wolfe
- Weill Medical College of Cornell University, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
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Abstract
The results of wrist arthroplasty for severely destroyed and painful wrists are generally good in pain reduction, increased grip strength, and upper limb function. The wrist range of motion is usually preserved but not improved. Implant survival seems better than it was with earlier implant designs; however, there are problems of carpal component loosening. Patient selection plays an important role, requiring experience, careful patient information, and discussing the pros and cons of arthroplasty and partial or total wrist arthrodesis.
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Pfanner S, Munz G, Guidi G, Ceruso M. Universal 2 Wrist Arthroplasty in Rheumatoid Arthritis. J Wrist Surg 2017; 6:206-215. [PMID: 28725502 PMCID: PMC5515620 DOI: 10.1055/s-0037-1598637] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/06/2017] [Indexed: 10/20/2022]
Abstract
Purpose The aim of this study was to evaluate the mid- to long-term outcomes and complications in patients affected by rheumatic diseases treated with the Universal 2 (U2) total wrist arthroplasty (TWA). Methods We reviewed, in a retrospective, noncontrolled cohort study, 22 patients affected by rheumatoid arthritis (RA), who underwent U2 total wrist replacement between March 2003 and January 2014 for the treatment of 23 rheumatoid wrists with the aim of obtaining the remission of pain and a range of motion (ROM) useful for daily activities, according to the patients' demands, as an alternative to total wrist arthrodesis. The cohort of patients included 20 females and 2 males, with a mean age of 54.9 years. Residual pain, preoperative ROM, postoperative ROM increases, grip strength, radiographic changes, long-term complications, and reasons for revision or failures were evaluated. Results In this study, 22 patients were evaluated at a mean follow-up of 82.3 months (range: 2-12 years). All patients had good or complete pain relief, the mean visual analogue scale pain score was 0.82. The mean grip strength improved and postoperatively was 11 kg (Jamar). The mean total ROM of flexion-extension was 72.3 degrees; radial-ulnar deviation 24.9 degrees. The mean QuickDASH score of 49 and patient rate wrist/hand evaluation of 41.7 a revision surgical procedure in six cases (26%): in two cases, a carpal component revision procedure and in four cases, total implant failures requiring either conversion to a Swanson spacer or wrist joint fusion. Conclusion TWA provides pain relief, preserves motion, and improves function in severe degenerative RA. Our results at a mid- to long-term follow-up with the U2 prosthesis were encouraging and represent, when indicated, a valid alternative to fusion which is less appealing for RA patients. Level of Evidence Level of evidence is therapeutic IV.
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Affiliation(s)
- Sandra Pfanner
- Unit of Surgery and Reconstructive Microsurgery of the Hand, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Giovanni Munz
- Unit of Surgery and Reconstructive Microsurgery of the Hand, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Giulia Guidi
- Guidi Hand Rehabilitation Center, Florence, Italy
| | - Massimo Ceruso
- Unit of Surgery and Reconstructive Microsurgery of the Hand, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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Hinds RM, Capo JT, Rizzo M, Roberson JR, Gottschalk MB. Total Wrist Arthroplasty Versus Wrist Fusion: Utilization and Complication Rates as Reported by ABOS Part II Candidates. Hand (N Y) 2017. [PMID: 28644942 PMCID: PMC5484443 DOI: 10.1177/1558944716668846] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of this study was to assess national trends in the utilization and complication rates of total wrist arthroplasty (TWA) and total wrist fusion (WF) as identified via review of the American Board of Orthopedic Surgery (ABOS) Part II candidate database. METHODS The ABOS Part II candidate database is a collection of cases reported by candidates of the ABOS Part II board certification oral exam. The ABOS database was queried for all TWA and WF cases performed from 2005 to 2014. Linear regression analyses were used to assess trends in procedure utilization. Treatment diagnoses, patient characteristics, and reported complications were also compared between the 2 treatment cohorts. RESULTS No significant increases in the proportion of candidates performing TWA or WF, number of TWA or WF cases, nor the number of TWA or WF cases performed per candidate performing those procedures were noted during the study period. Significantly less TWA cases were performed when compared with WF cases (68 vs 327; P = .006). Patients undergoing TWA were significantly older ( P = .005), more likely female ( P < .001), and more likely to have a diagnosis of osteoarthritis ( P = .003) than patients undergoing WF. There were no significant differences in complication rates, including postoperative infection, nerve palsy, or rate of secondary surgery, between the TWA and WF cohorts. CONCLUSIONS Utilization of both TWA and WF has remained unchanged among emerging career orthopedic surgeons. Although WF is performed nearly 5 times more frequently than TWA, our short-term findings suggest that TWA compares favorably with WF.
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Affiliation(s)
- Richard M. Hinds
- New York University Hospital for Joint Diseases, New York City, USA,Richard M. Hinds, Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York University, 301 East 17th Street, New York, NY 10003, USA.
| | - John T. Capo
- New York University Hospital for Joint Diseases, New York City, USA
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Reigstad O, Holm-Glad T, Thorkildsen R, Grimsgaard C, Røkkum M. Successful conversion of wrist prosthesis to arthrodesis in 11 patients. J Hand Surg Eur Vol 2017; 42:84-89. [PMID: 27789811 DOI: 10.1177/1753193416674929] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED From 2001 to 2015, 11 wrists in 11 patients with osteoarthritis of the wrist had failed wrist arthroplasties, which were subsequently converted to arthrodesis using intercalated corticocancellous autograft from the iliac crest and fixation with an arthrodesis plate or a customized peg. Clinical and radiological bone union was achieved in all the operated wrists. At final follow-up of ten patients after 6 years, they had a substantial reduction in pain and improvement in daily function and grip strength compared with those before arthrodesis. We conclude from outcomes of this series that the conversion to arthrodesis after failed wrist arthroplasty is worthwhile and reliably improve wrist function over failed wrist arthroplasty. The results suggest that the patients who will have wrist arthroplasty can be assured that in case of failure the conversion to arthrodesis will produce outcomes comparable with those after primary arthrodesis. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- O Reigstad
- Orthopaedic Department, University Hospital of Oslo, Oslo, Norway
| | - T Holm-Glad
- Orthopaedic Department, University Hospital of Oslo, Oslo, Norway
| | - R Thorkildsen
- Orthopaedic Department, University Hospital of Oslo, Oslo, Norway
| | - C Grimsgaard
- Orthopaedic Department, University Hospital of Oslo, Oslo, Norway
| | - M Røkkum
- Orthopaedic Department, University Hospital of Oslo, Oslo, Norway
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Reproducibility of X-rays and CT arthrography in SLAC, SNAC, SCAC wrists. HAND SURGERY & REHABILITATION 2016; 35:393-400. [DOI: 10.1016/j.hansur.2016.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 06/10/2016] [Accepted: 08/06/2016] [Indexed: 11/20/2022]
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Warwick D. Commentary on Unacceptable failure of the PI2 ® implant. J. van Aaken, N. Holzer, L. Wehrli, F. Delaquaize, I. A. Gonzalez and J. Y. Beaulieu. J Hand Surg Eur. 2016, 41: 917-22. J Hand Surg Eur Vol 2016; 41:923-924. [PMID: 28071200 DOI: 10.1177/1753193416659795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- D Warwick
- University of Southampton and University Hospital, Southampton, UK
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Melamed E, Marascalchi B, Hinds RM, Rizzo M, Capo JT. Trends in the Utilization of Total Wrist Arthroplasty versus Wrist Fusion for Treatment of Advanced Wrist Arthritis. J Wrist Surg 2016; 5:211-216. [PMID: 27468371 PMCID: PMC4959903 DOI: 10.1055/s-0036-1571841] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 01/04/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Total wrist arthroplasty (TWA) provides the requisite range of motion to accomplish activities of daily living, especially for low-demand patients with bilateral wrist arthritis. However, there are no large epidemiologic studies to evaluate nationwide trends of TWA and wrist fusion (WF). QUESTIONS/PURPOSES To analyze data collected from the National Inpatient Sample (NIS) to compare utilization, demographic, and outcome data among patients undergoing TWA versus total WF. We hypothesized that utilization rates of TWA have significantly increased over the prior decade in the United States. METHODS NIS data from 2001 to 2010 were reviewed. Procedures were identified by ICD-9-CM codes 81.73 (TWA) and 81.25 (WF). Utilization rates, primary treatment diagnoses, patient demographic and medical comorbidity data, and procedure costs were compared between TWA and WF. RESULTS There was a decrease in the number of procedures per year for TWA, while the number of WF remained relatively unchanged. There was, however, a transient increase in the frequency of TWA procedures performed from 2005 to 2008, following a decline in 2005. Patients with traumatic arthritis were more likely to receive WF. Rheumatoid patients were more likely to receive TWA. Patients receiving TWA tended to be older, female, be insured by Medicare, have a greater comorbidity burden, and have rheumatologic disease. CONCLUSION WF was performed nearly four times more frequently than TWA. A trend was demonstrated toward a decreasing number of TWA being implanted, and in patients with more underlying comorbidities. TWA was associated with a higher hospitalization charge, which may be expected given the higher implant costs associated with arthroplasty. LEVEL OF EVIDENCE Level II, prognostic study.
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Affiliation(s)
- Eitan Melamed
- Division of Hand Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Bryan Marascalchi
- Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, New York, New York
| | - Richard M. Hinds
- Division of Hand Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Marco Rizzo
- Division of Hand Surgery, Department of Orthopedics, Mayo Clinic, Rochester, Minnesota
| | - John T. Capo
- Division of Hand Surgery, NYU Hospital for Joint Diseases, New York, New York
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Abstract
Total wrist arthroplasty (TWA) provides a motion-preserving alternative to total wrist arthrodesis for low-demand patients with debilitating pancarpal arthritis. The earlier generation total wrist implants had high complication and failure rates. Advances in prosthetic design have contributed to improved clinical outcomes and implant survivorship. The current fourth-generation implants allow for expansion of indications for TWA. Careful patient selection remains critical; patients with high-demand lifestyles and poor bone stock may not be candidates. Long-term studies on implant survival and patient outcomes are critical for the current generation total wrist implants in assessing their long-term value compared with total wrist arthrodesis.
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