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Functional and Kinematic Analysis of a Wrist Radial Hemiarthrosplasty Design
Mayo Clinic, Materials and Structural Testing Core Laboratory, Rochester, MN, United States.
Mayo Clinic, Department of Orthopedic Surgery, Rochester, MN, United States.
Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Örebro University, School of Medical Sciences. Department of Hand Surgery.
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2018 (English)In: Journal of Musculoskeletal Research, ISSN 0218-9577, Vol. 21, no 1, article id 1850005Article in journal (Refereed) Published
Abstract [en]

Purpose: A biomechanical functional assessment was performed on a newly designed wrist hemiarthroplasty implant with aimed to identifying differences between the native wrist and wrist following the hemiarthroplasty procedure with (Hemi+PRC) and without a proximal row carpectomy (Hemi).

Methods: Six cadaveric wrists were mounted on a custom testing fixture and underwent a series of functional tests to investigate differences in range of motion, muscles moment arms, and axis of rotation between the intact and post-operative wrists. The tested movements included manually-driven flexion-extension, radial-ulnar deviation, dart throwers motion, and circumduction.

Results: The only significant change in range of motion was a decrease in flexion between the intact (77.75±14.40°) and both the Hemi (65.97±17.72°) and Hemi+PRC (60.08±17.18°) conditions. Minor differences in the mean position and variability of the axis of rotation's piercing point were identified. A statistically significant decrease in the flexion moment arm of the flexor carpi radialis was identified between the intact (16.1±2.6mm) and Hemi+PRC (14.0±3.4mm) conditions. Statistically significant decreases were also identified in the radial deviation moment arms of the extensor carpi radialis brevis' between the intact (15.3±7.8mm) and Hemi+PRC (7.3±12.5mm) conditions and the flexor carpi radialis' between the intact (15.3±3.2mm) and Hemi (12.0±5.7mm) conditions as well as in the ulnar deviation moment arm of the extensor carpi ulnaris between the intact (34.9±11.3mm) and Hemi (13.2±21.9mm) conditions.

Conclusions: While some statistically significant functional changes were identified between the native and hemiarthroplasty wrist, the findings suggest that post-operative function is equally acceptable in hemiarthroplasty with and without resection of the proximal carpal row. © 2018 World Scientific Publishing Company.

Place, publisher, year, edition, pages
World Scientific, 2018. Vol. 21, no 1, article id 1850005
Keywords [en]
Functional and kinematic analysis, Wrist, Wrist radial hemiarthroplasty design, article, carpal bone, flexor carpi radialis muscle, hemiarthroplasty, human, range of motion, rotation, ulna
National Category
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-77453DOI: 10.1142/S0218957718500057Scopus ID: 2-s2.0-85044274774OAI: oai:DiVA.org:oru-77453DiVA, id: diva2:1362269
Available from: 2019-10-18 Created: 2019-10-18 Last updated: 2019-10-25Bibliographically approved
In thesis
1. Hemi and total wrist arthroplasty
Open this publication in new window or tab >>Hemi and total wrist arthroplasty
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: To study implant survival and implant loosening following primary total wrist arthroplasty (TWA) using four different implants. To report outcome following wrist revision arthroplasty. To evaluate a new radial wrist hemi arthroplasty (RWHA) design clinically and biomechanically.

Method: The studies included 136 primary TWAs and 16 revision TWAs, both studies with prospectively collected data. Six fresh frozen cadaveric wrist specimen were used for biomechanical analysis. The RHWA was evaluated clinically in a pilot series of 20 cases.

Results: Total implant survival was 92% but with high frequency of implant loosening of surviving Re-Motion implants. None of the surviving Maestro implants were considered radiographically loose. Implant survival following revision arthroplasty was 75%, considerably lower than following primary TWAs. However, none of the patients with surviving revision implants had pain at rest and little or no pain in activity. The surgical procedure and placement of the RHWA was feasible. Overall, the kinematic and functional changes appeared acceptable compared to the native wrist. None of the patients underwent revision following RHWA but reoperation was performed in 7 patients on the indication of persistent pain. However, patients reported relief of pain and improvement of patient-reported outcome measures.

Conclusion: High long-term implant survival and no signs of radiographic loosening was found for the Maestro implant. However, the Maestro implant is no longer available on the market and we believe there is a need for new TWA designs. Revision arthroplasty is a valid option in the management of failed TWA. However, implant survival is lower than for primary TWAs and as many as 25% require additional surgery. Promising results were found using the new RHWA design but the implant needs modification before further testing.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2019. p. 83
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 198
Keywords
Rheumatoid arthritis, Wrist, Arthroplasty, Implant survival, Biomechanics
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-76146 (URN)978-91-7529-298-4 (ISBN)
Public defence
2019-11-22, Örebro universitet, Campus USÖ, hörsal C3, Södra Grev Rosengatan 32, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2019-09-06 Created: 2019-09-06 Last updated: 2019-10-25Bibliographically approved

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