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Gruisen JAE, Schormans PMJ, Punt IM, Roth AK, van Kuijk SMJ, Poeze M, Hannemann PFW. Patient reported and functional outcome measures after surgical salvage procedures for posttraumatic radiocarpal osteoarthritis - a systematic review. BMC Musculoskelet Disord 2024; 25:453. [PMID: 38849773 PMCID: PMC11157883 DOI: 10.1186/s12891-024-07527-6] [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] [Received: 01/15/2024] [Accepted: 05/15/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Posttraumatic wrist osteoarthritis is an irreversible and often progressive condition. Many surgical treatments, used in (daily) practice, aim to relieve symptoms like pain and restore function. The aim of this systematic review is to assess the patient reported and functional outcomes of the most common surgical interventions in patients with posttraumatic wrist osteoarthritis. This overview can help clinicians select the best treatment and manage patient's expectations. METHODS A literature search was performed in Pubmed, Embase and Cochrane for articles published between 1990 and November 2022 according to the PRISMA guidelines. The study protocol has been registered in the PROSPERO database (CRD42017080427). Studies that describe patient reported outcomes (pain and Disability of Arm, Shoulder and Hand (DASH) -score) and functional outcomes (range of motion (ROM) and grip strength) after surgical intervention with a minimal follow-up of 1 year were included. The identified surgical procedures included denervation, proximal row carpectomy, interpositional- and total arthroplasty, and midcarpal-, radiocarpal- and total arthrodesis. The pre-and postoperative outcomes were pooled and presented per salvage procedure. RESULTS Data from 50 studies was included. Pain score improved after all surgeries except denervation. Flexion/extension decreased after radiocarpal arthrodesis, did not show significant changes after proximal row carpectomy, and improved for all other surgeries. DASH score improved after arthroplasty, proximal row carpectomy and midcarpal arthrodesis. Grip strength improved after interposition arthroplasty and partial arthrodesis. CONCLUSION Evidence from this review did not support the indication for denervation in this particular patient population. In patients with SLAC/SNAC II, proximal row carpectomy might be favourable to a midcarpal arthrodesis solely based on better FE ROM of the radiocarpal joint after proximal row carpectomy. In terms of radiocarpal mobility, total wrist arthroplasty might be preferred to radiocarpal arthrodesis in patients with osteoarthritis after a distal radius fracture. More uniform measurements of outcomes would improve the understanding of the effect of surgical treatments of the posttraumatic osteoarthritic wrist.
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Affiliation(s)
- Jane A E Gruisen
- Department of Trauma and Orthopedic Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Philip M J Schormans
- Department of Surgery, Amphia Hospital Breda, Molengracht 21, 4818 CK Breda, The Netherlands.
| | - Ilona M Punt
- Department of Trauma and Orthopedic Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Alex K Roth
- Department of Trauma and Orthopedic Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Sander M J van Kuijk
- Department of Klinische Epidemiologie en Medical Technology Assessment, Maastricht University, P.Debyelaan 25, Maastricht, 6229 HX, The Netherlands
| | - Martijn Poeze
- Department of Trauma and Orthopedic Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Pascal F W Hannemann
- Department of Trauma and Orthopedic Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
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Joyce TJ, Kandemir G, Warwick D, Brown DJ. Investigation of the short-term in vivo performance of metal-on-carbon fibre reinforced poly ether ether ketone Motec wrists: an explant analysis. J Hand Surg Eur Vol 2024:17531934241249919. [PMID: 38780046 DOI: 10.1177/17531934241249919] [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: 05/25/2024]
Abstract
Total wrist arthroplasty (TWA) aims to restore pain-free motion to diseased joints. One such TWA, the Motec, has demonstrated good results with acceptable complication rates. It has recently been suggested that the metal-on-carbon fibre reinforced poly ether ether ketone (Mo-CFR-PEEK) version of the Motec TWA be implanted instead of the metal-on-metal version. An explant analysis was undertaken on seven Motec Mo-CFR-PEEK TWAs, revised for a variety of reasons, after a mean time of 2 years in vivo. Compared to a new Motec implant, five of the explanted metal heads and three of the CFR-PEEK cups became smoother in vivo, suggesting self-polishing and negative skewness, indicating some material loss in vivo. Two explanted cups showed indentation marks on their rims and one of these was from component impingement with embedded metallic debris. In the short-term, the articulating surfaces of Motec Mo-CFR-PEEK TWAs did not show major damage.Level of evidence: IV.
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Affiliation(s)
- Thomas J Joyce
- School of Engineering, Newcastle University, Newcastle upon Tyne, UK
| | - Göksu Kandemir
- School of Engineering, Newcastle University, Newcastle upon Tyne, UK
| | | | - Daniel J Brown
- Faculty of Health and Life Science, University of Liverpool, Liverpool, UK
- Liverpool University Hospitals NHS FT, Liverpool, UK
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3
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Smith AM, Maling LC, Williamson M. Total wrist arthroplasty: commentary and opinions. J Hand Surg Eur Vol 2024; 49:115-118. [PMID: 37882664 DOI: 10.1177/17531934231209638] [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: 10/27/2023]
Abstract
Total wrist arthroplasty (TWA) is gaining interest as a management option for wrist arthritis. This review article summarizes the current evidence base for TWA, focusing on the performance and survivorship of fourth-generation implants. These appear to offer satisfactory patient-reported outcomes and survivorship over the medium term, but heterogeneity between implants and patient populations complicates data interpretation. We discuss issues facing TWA practice, including surgical competency, volume, implant development and stewardship. We acknowledge the need for further research on this topic and highlight a number of questions that need answering.
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Affiliation(s)
- Andrew M Smith
- Trauma & Orthopaedics, Queen Elizabeth the Queen Mother Hospital, East Kent Hospitals University NHS Foundation Trust, Margate, UK
| | - Lucy C Maling
- Trauma & Orthopaedics, Queen Elizabeth the Queen Mother Hospital, East Kent Hospitals University NHS Foundation Trust, Margate, UK
| | - Mark Williamson
- Trauma & Orthopaedics, Queen Elizabeth the Queen Mother Hospital, East Kent Hospitals University NHS Foundation Trust, Margate, UK
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Chong HH, Zabaglo M, Asif A, Boksh K, Kulkarni K. A systematic review and network meta-analysis of outcomes after total wrist arthroplasty in inflammatory and non-inflammatory arthritis. J Hand Surg Eur Vol 2024; 49:17-24. [PMID: 37694836 DOI: 10.1177/17531934231199317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
This systematic review analysed the available evidence on the clinical outcomes of total wrist arthroplasty (TWA) in patients with inflammatory and non-inflammatory arthritis. After screening, 12 studies met the inclusion criteria. They involved 359 patients with 378 TWA implants. The results showed that TWA significantly improved Disabilities of the Arm, Shoulder and Hand (DASH)/Quick-DASH scores and pain visual analogue scale scores in both arthritis groups compared with preoperative values. However, there was no statistically significant difference in the outcome scores between the two groups. Three studies reported Patient-Rated Wrist Evaluation (PRWE) scores, and TWA significantly improved PRWE scores in non-inflammatory arthritis but not in inflammatory arthritis, with no significant difference in postoperative outcome scores between the two groups. Although the included studies have limitations, the review suggests that TWA may be a successful treatment for wrist pain in individuals with either inflammatory or non-inflammatory arthritis. However, further high-quality trials are needed to confirm these findings.
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Affiliation(s)
- Han Hong Chong
- Department of Trauma & Orthopaedic, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Mate Zabaglo
- Department of Trauma & Orthopaedic, Northampton General Hospital NHS Trust, Northampton, UK
| | - Aqua Asif
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Khalis Boksh
- Department of Trauma & Orthopaedic, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Kunal Kulkarni
- Department of Trauma & Orthopaedic, University Hospitals of Leicester NHS Trust, Leicester, UK
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5
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Redfern JAI, Mehta N, Farnebo S, McGuire D, Solomons M, Thomas Thorvaldson K, Estfan R, Brown DJ. Complication rates and modes of short and medium-term failure in Motec total wrist arthroplasty: an international cohort study. J Hand Surg Eur Vol 2024; 49:27-33. [PMID: 37684024 DOI: 10.1177/17531934231195689] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
The aim of this study was to analyse the short- and medium-term complications of the Motec total wrist arthroplasty (TWA). Identifying exact modes of failure and their causes should allow surgeons to avoid or mitigate these risks in the future. Retrospective analysis of prospectively collected data from six hand surgeons at five international centres provided details of 171 Motec TWAs. The mean follow-up was 5.8 years (range 18 months to 12 years). There were 33 (19%) complications within our cohort, with a revision rate of 8.2% (14 revisions). There was no difference in complication rates between metal-on-metal and metal-on-polymer articulations. Failure of osseointegration was the most common complication. Problems with soft tissue balancing, implant impingement related osteolysis, bony impingement and metacarpal fracture were found to be other preventable causes of failure in this series. Elimination of these preventable complications will improve survival rates for this implant.Level of evidence: IV.
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Affiliation(s)
- James A I Redfern
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Nisarg Mehta
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Simon Farnebo
- Department of Plastic Surgery, Hand Surgery, and Burns, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Duncan McGuire
- Martin Singer Hand Unit, Groote Schuur Hospital, Cape Town, South Africa
| | - Michael Solomons
- Martin Singer Hand Unit, Groote Schuur Hospital, Cape Town, South Africa
| | - K Thomas Thorvaldson
- Maitland Hospital, University of Newcastle clinical school, Maitland, NSW, Australia
| | - Rami Estfan
- Southend University Hospital, Mid and South Essex NHS Trust, Southend On Sea, UK
| | - Daniel J Brown
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
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Wu Y, Liu J, Kang L, Tian J, Zhang X, Hu J, Huang Y, Liu F, Wang H, Wu Z. An overview of 3D printed metal implants in orthopedic applications: Present and future perspectives. Heliyon 2023; 9:e17718. [PMID: 37456029 PMCID: PMC10344715 DOI: 10.1016/j.heliyon.2023.e17718] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 06/12/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
With the ability to produce components with complex and precise structures, additive manufacturing or 3D printing techniques are now widely applied in both industry and consumer markets. The emergence of tissue engineering has facilitated the application of 3D printing in the field of biomedical implants. 3D printed implants with proper structural design can not only eliminate the stress shielding effect but also improve in vivo biocompatibility and functionality. By combining medical images derived from technologies such as X-ray scanning, CT, MRI, or ultrasonic scanning, 3D printing can be used to create patient-specific implants with almost the same anatomical structures as the injured tissues. Numerous clinical trials have already been conducted with customized implants. However, the limited availability of raw materials for printing and a lack of guidance from related regulations or laws may impede the development of 3D printing in medical implants. This review provides information on the current state of 3D printing techniques in orthopedic implant applications. The current challenges and future perspectives are also included.
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Affiliation(s)
- Yuanhao Wu
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jieying Liu
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Lin Kang
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jingjing Tian
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xueyi Zhang
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jin Hu
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yue Huang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Fuze Liu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Hai Wang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Zhihong Wu
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
- Beijing Key Laboratory for Genetic Research of Bone and Joint Disease, Beijing, China
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Zijlker HJA, Ritt MJPF, Beumer A. Fourth-Generation Total Wrist Arthroplasty: A Systematic Review of Clinical Outcomes. J Wrist Surg 2022; 11:456-464. [PMID: 36339074 PMCID: PMC9633149 DOI: 10.1055/s-0041-1735840] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
Background The purpose of total wrist arthroplasty is to reduce pain and maintain mobility in a painful destructed wrist. First-, second-, and third-generation total wrist arthroplasties have shown unacceptable outcomes with high failure rates. In 2004, the fourth-generation total wrist implants were introduced to address the clinical problems encountered in the previous generations of total wrist implants. Methods Outcomes and complications of fourth-generation total wrist implants were systematically reviewed in the literature (2004-present), including the Universal 2, ReMotion, Freedom, Motec, and Maestro total wrist implants. Results The literature search yielded 114 papers, of which 18 (990 implants) were included in this systematic review. The quality of evidence was low. All implants effectively reduced pain and improved functionality of the wrist. The Motec wrist implant demonstrated the highest survival rate at 10 year follow-up (86%). Conclusion This systematic review suggests a substantial improvement of quality in fourth-generation total wrist arthroplasty.
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Affiliation(s)
- Hero Jan Aeilko Zijlker
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Annechien Beumer
- Department of Orthopaedic Surgery, Upper Limb Unit, Amphia Hospital, Breda, The Netherlands
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
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Eschweiler J, Li J, Quack V, Rath B, Baroncini A, Hildebrand F, Migliorini F. Total Wrist Arthroplasty-A Systematic Review of the Outcome, and an Introduction of FreeMove-An Approach to Improve TWA. Life (Basel) 2022; 12:411. [PMID: 35330163 PMCID: PMC8951379 DOI: 10.3390/life12030411] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 01/11/2023] Open
Abstract
The Swanson silicone prosthesis was one of the first devices to realize total wrist arthroplasty (TWA). It has been used regularly since the early 1960s. This systematic review of the literature evaluated the status quos of TWA. The present study was conducted according to the PRISMA guidelines. A literature search was made in Medline, PubMed, Google Scholar, and the Cochrane Library databases. The focus of the present study was on implant survivorship and related functional outcomes. Data from 2286 TWA (53 studies) were collected. Fifteen studies were included for the analysis of implant survivorship. Fifteen studies were included for the analysis of pain. Twenty-eight studies were included for the analysis of the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Grip strength was tracked in 16 studies. The range of motion (RoM) was evaluated in 46 studies. For supination and pronation, 18 articles were available. Despite some methodological heterogeneities, TWA may be effective and safe in pain reduction and improving function and motion. There is still a range for a future improvement of the procedure.
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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.)
| | - 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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Reigstad O, Holm-Glad T, Korslund J, Grimsgaard C, Thorkildsen R, Røkkum M. High re-operation and complication rates 11 years after arthrodesis of the wrist for non-inflammatory arthritis. Bone Joint J 2019; 101-B:852-859. [PMID: 31256671 DOI: 10.1302/0301-620x.101b7.bjj-2018-0943.r4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Plate and screw fixation has been the standard treatment for painful conditions of the wrist in non-rheumatoid patients in recent decades. We investigated the complications, re-operations, and final outcome in a consecutive series of patients who underwent wrist arthrodesis for non-inflammatory arthritis. PATIENTS AND METHODS A total of 76 patients, including 53 men and 23 women, with a mean age of 50 years (21 to 79) underwent wrist arthrodesis. Complications and re-operations were recorded. At a mean follow-up of 11 years (2 to 18), 63 patients completed questionnaires, and 57 attended for clinical and radiological assessment. RESULTS Of the 76 patients, 46 (60.5%) had complications, resulting in 65 re-operations, mainly related to the plate and screws. In the 63 patients who completed the questionnaires, the mean Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) score was 36 (0 to 91), the mean Patient-Rated Wrist and Hand Evaluation (PRWHE) score was 40 (0 to 96), and 14 patients (22%) reported no wrist pain. Grip strength, pinch strength, and pronation and supination were significantly reduced compared with the contralateral forearm. The outcome was worse in patients who had previously undergone surgery to the wrist, and those with complications. A total of 13 are awaiting further re-operations, giving a total re-operation rate of 63% (40/63). CONCLUSION We observed complications and re-operations throughout the follow-up period and therefore consider wrist arthrodesis to be more complicated than previously assumed. Many of the patients never got used to or accepted their stiff wrists and reported a substantial reduction in function and residual pain. Motion-sparing surgery should be offered prior to wrist arthrodesis. Cite this article: Bone Joint J 2019;101-B:852-859.
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Affiliation(s)
- O Reigstad
- Hand and Microsurgery Department, Division of Orthopaedic Surgery, Oslo University Hospital, OUS-Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - T Holm-Glad
- Hand and Microsurgery Department, Division of Orthopaedic Surgery, Oslo University Hospital, OUS-Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - J Korslund
- Hand and Microsurgery Department, Division of Orthopaedic Surgery, Oslo University Hospital, OUS-Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - C Grimsgaard
- Hand and Microsurgery Department, Division of Orthopaedic Surgery, Oslo University Hospital, OUS-Rikshospitalet, Oslo, Norway
| | - R Thorkildsen
- Hand and Microsurgery Department, Division of Orthopaedic Surgery, Oslo University Hospital, OUS-Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - M Røkkum
- Hand and Microsurgery Department, Division of Orthopaedic Surgery, Oslo University Hospital, OUS-Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Venter RG, Burger MC, Ikram A, Lamberts RP. Bony anatomy of the third metacarpal and relationship with the capitate: a computed tomography study. Surg Radiol Anat 2019; 41:1319-1324. [PMID: 31250137 DOI: 10.1007/s00276-019-02272-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 06/21/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to accurately establish the anatomical variability of the third metacarpal, its medullary canal, and the relationship with the capitate in the context of high rates of component loosening still seen in total wrist arthroplasty. METHODS CT scans of a 100 hands (age: 41 ± 14 years (range: 16-71 years); male/female ratio: 53/47) were studied to establish the detailed anatomy of the third metacarpal and the capitate. RESULTS Although the shape of the third metacarpal and the angles formed with the capitate were highly variable, the third metacarpal length was longer in males (p < 0.001), the proximal cortical bone was thicker (p < 0.001) and the sagittal metacarpal-capitate axis offset was greater (p = 0.01). A relationship was found between the total length of the metacarpal and the distance to the isthmus from the base (r = 0.63; p < 0.0001) which was unaffected by gender. No age-related relationships were significant. CONCLUSION The anatomy of the third metacarpal and capitate varies considerably more than has been alluded to in current wrist arthroplasty literature. Differences between males and females can likely be attributed to hand size. The distance of the isthmus from the base can be predicted from the total length of the metacarpal with a standard error of 1.9 mm.
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Affiliation(s)
- Rudolph G Venter
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Clinical Building, 4th Floor, Tygerberg Campus, Tygerberg, Cape Town, 7505, South Africa
| | - Marilize C Burger
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Clinical Building, 4th Floor, Tygerberg Campus, Tygerberg, Cape Town, 7505, South Africa
| | - Ajmal Ikram
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Clinical Building, 4th Floor, Tygerberg Campus, Tygerberg, Cape Town, 7505, South Africa
| | - Robert P Lamberts
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Clinical Building, 4th Floor, Tygerberg Campus, Tygerberg, Cape Town, 7505, South Africa.
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11
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Giwa L, Siddiqui A, Packer G. Motec Wrist Arthroplasty: 4 Years of Promising Results. J Hand Surg Asian Pac Vol 2018; 23:364-368. [PMID: 30282544 DOI: 10.1142/s2424835518500388] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Motec cementless modular metal-on-metal ball-and-socket wrist arthroplasty is an implant with promising intermediate results. An alternative to primary wrist fusion, total wrist arthroplasty is an option for active patients, who wish to retain their wrist function. It is indicated in cases of degenerative osteoarthritis, post-traumatic arthritis and rheumatoid (inflammatory) arthritis. METHODS A prospective review of patient demographics, pre and post-operative Disabilities of the Arm Shoulder and Hand (DASH), MAYO scores, range of movements and grip strengths. All complications in follow up were recorded across the 4 year period. RESULTS 25 implants on 23 patients over 5.5 years, mean age 61; 8 females and 15 male. 10 patients with SLAC, 3 SNAC, 5 inflammatory and 7 patients with generalized osteoarthritis. The patients showed significant improvements of MAYO and DASH scores post-operatively, as well as the flexion/extension arc and grip strengths. There was just one case of implant loosening- the radial screw after a wound infection, which was revised with a longer screw. Two implants were converted to Motec fusion due to pain. One implant was dislocated and relocated. The remaining patients have had good wrist function. Only 6 patients were unable to return to work. CONCLUSIONS Similar to published studies, this series shows the Motec implant to be a good motion preserving alternative to total wrist fusion.
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Affiliation(s)
- L Giwa
- * Department of Orthopaedics, Southend University Hospital, Southend, UK
| | - A Siddiqui
- † Department of Plastic & Reconstructive Surgery, Countess of Chester Hospital, Chester, UK
| | - G Packer
- * Department of Orthopaedics, Southend University Hospital, Southend, UK
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12
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Kennedy JW, Ross A, Wright J, Martin DJ, Bransby-Zachary M, MacDonald DJ. Universal 2 total wrist arthroplasty: high satisfaction but high complication rates. J Hand Surg Eur Vol 2018. [PMID: 29519175 DOI: 10.1177/1753193418761513] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED The Universal 2 total wrist arthroplasty is intended to alleviate wrist pain and restore function. There is limited evidence regarding its success and safety. We report outcomes in 48 wrists of 46 patients with Universal 2 arthroplasty between 2006 and 2014. We recorded range of motion of the operated wrist, patient satisfaction, complication and revision rates, and radiological appearances of the wrists with mean follow-up of 7 years (3.5 to 11 years). We found a significant improvement in DASH scores after surgery, with active range of wrist motion being 33° flexion and 24° extension. Thirty-nine patients would undergo the procedure again if he had similar wrist problems. Twenty-three patients had loosening of at least one component of the implant. Complications were found in 13 wrists; seven underwent revision. We conclude that the Universal 2 arthroplasty produces significant improvements in DASH scores and high levels of satisfaction of the patients. However, the surgery has a high complication rate. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- John W Kennedy
- Department of Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | - Andrew Ross
- Department of Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | - Jonathan Wright
- Department of Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | - David J Martin
- Department of Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | | | - Duncan J MacDonald
- Department of Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
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Brinkhorst ME, Selles RW, Dias JJ, Singh HP, Feitz R, Moojen TM, Hovius SER. Results of the Universal 2 Prosthesis in Noninflammatory Osteoarthritic Wrists. J Wrist Surg 2018; 7:121-126. [PMID: 29576917 PMCID: PMC5864496 DOI: 10.1055/s-0037-1606258] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
Background/Purpose Many treatment options are available for wrist osteoarthritis, with the objective of decreasing pain and preserving function. In later stages when midcarpal and radiocarpal osteoarthritis occur, two choices remain: total wrist arthrodesis or total wrist arthroplasty. The purpose of this study is to present the short-term functional changes following total wrist arthroplasty with the Universal 2 total wrist system (Integra Life Sciences) in patients with noninflammatory wrist osteoarthritis. Patients and Methods Patients with severe noninflammatory wrist osteoarthritis were assessed preoperatively, 6 and 12 months after surgery using a range of motion, grip strength, pain, and the disabilities of the arm, shoulder, and hand (DASH) score. The additional assessment was performed after 1 year for a range of motion using a biaxial electrogoniometer, grip strength, DASH, and the Michigan hand questionnaire. Results All range of motion directions and grip strength did not change from preoperative values. The DASH score improved from 53 preoperatively to 14 during latest follow-up. Median patients' satisfaction score decreased with approximately 20 points during the last follow-up. Conclusion The relatively good DASH score combined with the partly maintained wrist range of motion indicates that reconstruction with the Universal 2 total wrist prosthesis should be considered in patients with end-stage noninflammatory wrist osteoarthritis. Level of Evidence Level IV, therapeutic study.
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Affiliation(s)
- M. E. Brinkhorst
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - R. W. Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - J. J. Dias
- Department of Orthopaedic Surgery, University Hospitals of Leicester NHS Trust, Infirmary Square, United Kingdom
| | - H. P. Singh
- Department of Orthopaedic Surgery, University Hospitals of Leicester NHS Trust, Infirmary Square, United Kingdom
| | - R. Feitz
- Xpert Clinic, Hilversum, The Netherlands
| | | | - S. E. R. Hovius
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands
- Xpert Clinic, Hilversum, The Netherlands
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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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15
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Reigstad O, Holm-Glad T, Bolstad B, Grimsgaard C, Thorkildsen R, Røkkum M. Five- to 10-Year Prospective Follow-Up of Wrist Arthroplasty in 56 Nonrheumatoid Patients. J Hand Surg Am 2017; 42:788-796. [PMID: 28844772 DOI: 10.1016/j.jhsa.2017.06.097] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 05/31/2017] [Accepted: 06/14/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The goal of the study was to evaluate the clinical and radiological outcomes of a cementless wrist arthroplasty with minimum 5-year follow-up in nonrheumatoid patients. METHODS Fifty-seven (40 male) patients with end-stage arthritis changes received an uncemented ball-and-socket total wrist arthroplasty (Motec Wrist). Function was evaluated before surgery and at yearly follow-ups. Visual analog scale at rest and activity, quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), active range of motion (AROM), and grip-strength were recorded. Standardized radiographs were taken to assess osteolysis, loosening, and subsidence. RESULTS Fifty-six patients were followed for a mean of 8 years (SD, 2 years). Eight wrists were reoperated with arthrodesis (4) or a new arthroplasty (4) owing to distal component loosening (3), infection (2), pain/fixed malposition (2), or proximal and distal component loosening (1). One radiocarpal dislocation was reduced closed and remained stable. Improved QuickDASH score and visual analog scale pain score both at rest and during activity were found at the last follow-up, as well as increased AROM (97° vs 126°) and grip strength (21 kg vs 24 kg). The radiological follow-up demonstrated loosening in 2 wrists. Thirty-five patients were working at surgery (17 manual labor) and 27 (11 manual labor) at follow-up. The 10-year Kaplan-Meyer survival of the implants was 86% for revision for any cause; 2 additional arthroplasties are loose (but not revised), giving a survival rate of 82% if these are revised prior to 10 years of observation. CONCLUSIONS An uncemented total wrist arthroplasty can provide long-lasting unrestricted hand function in young and active patients. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Ole Reigstad
- Orthopaedic Department, Hand- and Microsurgical Unit, University Hospital of Oslo, Oslo, Norway.
| | - Trygve Holm-Glad
- Orthopaedic Department, Hand- and Microsurgical Unit, University Hospital of Oslo, Oslo, Norway
| | - Bjørg Bolstad
- Physiotherapy Unit, Department for Clinical Service, University Hospital of Oslo, Oslo, Norway
| | - Christian Grimsgaard
- Orthopaedic Department, Hand- and Microsurgical Unit, University Hospital of Oslo, Oslo, Norway
| | - Rasmus Thorkildsen
- Orthopaedic Department, Hand- and Microsurgical Unit, University Hospital of Oslo, Oslo, Norway
| | - Magne Røkkum
- Orthopaedic Department, Hand- and Microsurgical Unit, University Hospital of Oslo, Oslo, Norway
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16
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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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17
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Singh HP, Bhattacharjee D, Dias JJ, Trail I. Dynamic assessment of the wrist after total wrist arthroplasty. J Hand Surg Eur Vol 2017; 42:573-579. [PMID: 28196435 DOI: 10.1177/1753193417690472] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Our aim was to assess the outcome in patients with total wrist arthroplasty performed for end stage wrist osteoarthritis. We analysed the ranges of motion of operated and un-operated wrists using a flexible electrogoniometer during the Sollerman hand function test. We assessed grip strength with a digital dynamometer and completed patient reported outcome scores more than one year post-operatively. We reviewed 12 patients with a mean age of 64 (range 48-82) years. The flexion-extension arc was 72% and radioulnar deviation arc was 53% of the un-operated side but the total range of motion (area of circumduction) was 43% of the un-operated side and only 20% of the circumduction in age and gender-matched normal volunteers. Peak grip strength was 68% of the un-operated side. The patients reported good outcome with mean Michigan Hand Questionnaire (MHQ) scores of 56 (range 25-84) and mean Patient Evaluation Measure (PEM) scores of 39 (range 20-68). Patients completed the activities of Sollerman hand function test in twice the time (6 min) as required for a normal volunteer (2.8 min). The circumduction ellipses were narrow and central with limited radio-ulnar deviation and small mean areas of motion during activities of daily living.
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Affiliation(s)
- H P Singh
- 1 Department of Orthopaedic Surgery, Leicester General Hospital, UK
| | - D Bhattacharjee
- 1 Department of Orthopaedic Surgery, Leicester General Hospital, UK
| | - J J Dias
- 1 Department of Orthopaedic Surgery, Leicester General Hospital, UK
| | - I Trail
- 2 Wrightington Hospital, Wigan, UK
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18
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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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19
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Abstract
Arthritis of the wrist is a painful disabling condition that has various causes and presentations. The traditional treatment has been a total wrist fusion at a price of the elimination of movement. However, forms of treatment which allow the preservation of movement are now preferred. Modern arthroplasties of the wrist are still not sufficiently robust to meet the demands of many patients, nor do they restore normal kinematics of the wrist. A preferable compromise may be selective excision and partial fusion of the wrist using knowledge of the aetiology and pattern of degenerative change to identify which joints can be sacrificed and which can be preserved. This article provides an overview of the treatment options available for patients with arthritis of the wrist and an algorithm for selecting an appropriate surgical strategy.
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Affiliation(s)
- J S Logan
- University Hospital Southampton, Southampton SO16 6UY, UK
| | - D Warwick
- Musculoskeletal Research Unit, University Hospital Southampton and University of Southampton, Southampton SO16 6UY, UK
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20
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Yeoh D, Tourret L. Total wrist arthroplasty: a systematic review of the evidence from the last 5 years. J Hand Surg Eur Vol 2015; 40:458-68. [PMID: 24963082 DOI: 10.1177/1753193414539796] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 05/25/2014] [Indexed: 02/03/2023]
Abstract
We reviewed evidence on total wrist replacement from the last 5 years. Eight articles met a minimum set standard. The results of 405 prostheses were available, including seven different manufacturers. The mean follow up was 2.3-7.3 years with an average age of 52-63. Rheumatoid arthritis was the indication in 42% of patients. Motec demonstrated the best post-operative DASH scores. Only Maestro achieved a defined functional range of motion post-operatively. Universal 2 displayed the highest survival rates (100% at 3-5 years), while Elos had the lowest (57% at 5 years). Biaxial had the highest complication rates (68.7%), while Remotion had the lowest (11%). Wrist arthroplasty preserves some range of motion. Functional scores improved and were maintained over the mid- to long-term. Complication rates were higher than wrist fusion, with reports of radiological loosening and osteolysis. The evidence does not support the widespread use of arthroplasty over arthrodesis, and careful patient selection is essential.
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Affiliation(s)
- D Yeoh
- Brighton and Sussex University Hospital, Brighton, UK
| | - L Tourret
- Brighton and Sussex University Hospital, Brighton, UK
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21
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Reigstad O, Thorkildsen R, Grimsgaard C, Melhuus K, Røkkum M. Undersøkelse og behandling av brudd og pseudartrose i skafoid. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2015; 135:1138-42. [DOI: 10.4045/tidsskr.14.1256] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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22
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Reigstad O, Røkkum M. Wrist arthroplasty: where do we stand today? A review of historic and contemporary designs. ACTA ACUST UNITED AC 2014; 19:311-22. [PMID: 24875525 DOI: 10.1142/s0218810414300034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Earlier generations of wrist arthroplasty were limited to low demand patients. Bone fixation problems, excessive wear, and adverse designs resulting in loosening, imbalance, and dislocation led to the withdrawal of a number of models. Contemporary wrist prostheses aim at replacing wrist arthrodesis in the majority of patients with radiocarpal destruction, including high demand cases. Contraindications are wrist imbalance, insufficient soft tissue, or bone stock and infection. Various designs, fixation principles, bearing materials, and articulations have been employed. Some of the devises (RE-MOTION™, Motec(®)) demonstrate promising short- to midterm results, and calls for cautious optimism.
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Affiliation(s)
- Ole Reigstad
- Hand- and Microsurgery Section, Orthopedic Department, OUS-Rikshospitalet, Box 4950 Nydalen, N-0424 Oslo, Norway
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23
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Boeckstyns MEH, Toxvaerd A, Bansal M, Vadstrup LS. Wear particles and osteolysis in patients with total wrist arthroplasty. J Hand Surg Am 2014; 39:2396-404. [PMID: 25227599 DOI: 10.1016/j.jhsa.2014.07.046] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/22/2014] [Accepted: 07/23/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether the amount of polyethylene debris in the interphase tissue between prosthesis and bone in patients with total wrist arthroplasty correlated with the degree of periprosthetic osteolysis (PPO); and to investigate the occurrence of metal particles in the periprosthetic tissue, the level of chrome and cobalt ions in the blood, and the possible role of infectious or rheumatoid activity in the development of PPO. METHODS Biopsies were taken from the implant-bone interphase in 13 consecutive patients with total wrist arthroplasty and with at least 3 years' follow-up. Serial annual radiographs were performed prospectively for the evaluation of PPO. We collected blood samples for white blood cell count, C-reactive protein, and metallic ion level. RESULTS A radiolucent zone of greater than 2 mm was observed juxta-articular to the radial component in 4 patients and at the carpal component in 3. The magnitude of the radiolucent zone tended to level out over time. We observed subsidence of the implant in 3 patients on the carpal side and in none on the radial side. The amount of polyethylene and metallic debris was generally small and did not correlate with the width of the radiolucent zone. The blood levels of chrome and cobalt ions were normal. There was no evidence of infectious or rheumatoid activity. CONCLUSIONS Polyethylene wear has been accepted as a major cause of osteolysis in total hip arthroplasty, and metallic debris has also been cited to be an underlying cause. However, our hypothesis that polyethylene debris correlated with the degree of PPO could not be confirmed. Also, metallic debris and infectious or rheumatoid activity did not correlate with PPO. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic I.
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Affiliation(s)
- Michel E H Boeckstyns
- Clinic of Hand Surgery, Gentofte Hospital, University of Copenhagen, Denmark, NY; Department of Pathology, Herlev Hospital, University of Copenhagen, Denmark, NY; Department of Pathology, Hospital for Special Surgery, New York, NY.
| | - Anders Toxvaerd
- Clinic of Hand Surgery, Gentofte Hospital, University of Copenhagen, Denmark, NY; Department of Pathology, Herlev Hospital, University of Copenhagen, Denmark, NY; Department of Pathology, Hospital for Special Surgery, New York, NY
| | - Manjula Bansal
- Clinic of Hand Surgery, Gentofte Hospital, University of Copenhagen, Denmark, NY; Department of Pathology, Herlev Hospital, University of Copenhagen, Denmark, NY; Department of Pathology, Hospital for Special Surgery, New York, NY
| | - Lars Soelberg Vadstrup
- Clinic of Hand Surgery, Gentofte Hospital, University of Copenhagen, Denmark, NY; Department of Pathology, Herlev Hospital, University of Copenhagen, Denmark, NY; Department of Pathology, Hospital for Special Surgery, New York, NY
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24
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A scoping review of disabilities of the arm, shoulder, and hand scores for hand and wrist conditions. J Hand Surg Am 2014; 39:2472-80. [PMID: 25227601 DOI: 10.1016/j.jhsa.2014.07.050] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 07/28/2014] [Accepted: 07/29/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the variability of reported baseline Disabilities of the Arm, Shoulder, and Hand (DASH) scores for non-acute hand and wrist conditions. We hypothesized that DASH scores for evaluation of hand and wrist pathology would provide a map of scores that would correspond to severity. In addition to providing a catalog of DASH scores for various upper extremity pathologies, we hypothesized that this review would support the validity of the DASH instrument. METHODS A literature search was performed using 3 databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials) from the earliest available date through January 1, 2013. Search terms included "DASH" and "hand" and combinations of conditions found in the initial search. The search was restricted to studies with baseline DASH scores and DASH scores for isolated conditions, and written in the English language. RESULTS Our search identified 1,770 citations; 136 full-text articles were reviewed and 85 studies were included in the scoping review. This provided 100 DASH scores mapped for 24 different diagnoses. Most articles (67%) included chronic conditions for inflammatory or degenerative pathologies rather than posttraumatic disorders. Posttraumatic DASH score reporting ranged from 4 months to 11 years after injury, and final outcome scores varied among studies assessing the same pathology. The greatest variation and highest scores were for de Quervain tendinitis (range, 29-93) and scapholunate advance collapse (range, 17-89). These scores indicated higher disability in de Quervain tendinitis and wrist osteoarthritis compared with conditions such as thumb amputation and upper extremity replantation. CONCLUSIONS Substantial variation in the DASH scores and methodology was found and indicates a need for further study of the DASH to allow for standardized interpretation. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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25
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Abstract
Conversion of a failed total wrist arthroplasty to arthrodesis can be difficult. A custom-made titanium alloy peg was constructed to enable arthrodesis with the original arthroplasty components in situ. Two out of three patients were especially challenging cases with little bone available. Bony union was achieved in 2 to 3 months. The peg simplified a difficult revision situation and gave good, predictable results at follow-up.
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Affiliation(s)
- Ole Reigstad
- Hand- and microsurgery section, Orthopedic Department, OUS-Rikshospitalet, Oslo, Norway
| | - Magne Røkkum
- Hand- and microsurgery section, Orthopedic Department, OUS-Rikshospitalet, Oslo, Norway
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26
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Abstract
Background and Literature Review Periprosthetic osteolysis (PPO) after second- or third-generation total wrist arthroplasty (TWA), with or without evident loosening of the implant components, has previously been reported in the literature, but rarely in a systematic way. Purpose The purpose of this study was to analyze the prevalence, location, and natural history of PPO following a TWA and to determine whether this was associated with prosthetic loosening. Patients and Methods We analyzed 44 consecutive cases in which a RE-MOTION TWA (Small Bone Innovations Inc., Morrisville, PA, USA) had been done. Results We found significant periprosthetic radiolucency (more than 2 mm in width) at the radial component side in 16 of the cases and at the carpal component side in 7. It developed gradually juxta-articularly around the prosthetic components regardless of the primary diagnosis, and seemed to stabilize in most patients after 1-3 years. In a small percentage of the patients, the periprosthetic area of bone resorption was markedly larger. In general, radiolucency was not related to evident loosening of the implant components, and only five carpal components and one radial had subsided or tilted. Conclusion Periprosthetic loosening is frequent following a TWA. In our series it was not necessarily associated with implant loosening and seemed to stabilize within 3 years. Close and continued observation is, however, recommended. Level of Evidence Therapeutic IV.
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Affiliation(s)
| | - Guillaume Herzberg
- Wrist Surgery Unit, Department of Orthopedics, Claude Bernard Lyon University, Herriot Hospital, Lyon, France
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Boeckstyns MEH, Herzberg G, Sørensen AI, Axelsson P, Krøner K, Liverneaux PA, Obert L, Merser S. Can total wrist arthroplasty be an option in the treatment of the severely destroyed posttraumatic wrist? J Wrist Surg 2013; 2:324-329. [PMID: 24436837 PMCID: PMC3826242 DOI: 10.1055/s-0033-1357759] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background Severely destroyed posttraumatic wrists are usually treated by partial or total wrist fusion or proximal row carpectomy. The indications for and longevity of total wrist arthroplasty (TWA) are still unclear. Case Description The aim of this study was to analyze a series in which one last-generation total wrist arthroplasty was used as a salvage procedure for wrists with severe arthritis due to traumatic causes. The data were prospectively recorded in a web-based registry. Seven centers participated. Thirty-five cases had a minimum follow-up time of 2 years. Average follow-up was 39 (24-96) months. Pain had improved significantly at follow-up, mobility remained unchanged. The total revision rate was 3.7%, and the implant survival was 92% at 4-8 years. Literature Review Very few studies have described specific results after TWA in posttraumatic cases and almost none using classical "third-generation" implants. The number of cases and the follow-up in the published series are small. Clinical Relevance Although painful posttraumatic wrists with severe joint destruction can be salvaged by partial or total fusion, we found that, evaluated at short- to midterm, total wrist arthroplasty can be an alternative procedure and gives results that are comparable to those obtained in rheumatoid cases. Level IV Case series.
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Affiliation(s)
| | - Guillaume Herzberg
- Wrist Surgery Unit, Department of Orthopaedics, Claude Bernard Lyon University, Herriot Hospital, Lyon, France
| | - Allan Ibsen Sørensen
- Section of Hand Surgery, Sahlgrenska Hospital, Gothenburg, Sweden
- Section of Hand Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Peter Axelsson
- Section of Hand Surgery, Sahlgrenska Hospital, Gothenburg, Sweden
| | - Karsten Krøner
- Section of Hand Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Laurent Obert
- Hand Surgery Unit, Orthopaedic Department, Besançon University, Besançon, France
| | - Søren Merser
- Technical University of Denmark, Lyngby, Denmark
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