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Clinical, radiographic and patient-perceived outcome after radial hemi-wrist arthroplasty of the wrist with a new implant. A pilot study
Örebro University, School of Medical Sciences. Department of Hand Surgery.
Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
(English)Manuscript (preprint) (Other academic)
National Category
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-77454OAI: oai:DiVA.org:oru-77454DiVA, id: diva2:1362270
Available from: 2019-10-18 Created: 2019-10-18 Last updated: 2019-10-18Bibliographically 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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