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Total Wrist Arthroplasty: A Single-Center Study of 219 Cases With 5-Year Follow-up
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Hand Surgery, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0002-5083-3591
Department of Anesthesiology and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
Örebro University, Örebro, Sweden. (Clinical Epidemiology and Biostatistics)
Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
2015 (English)In: Journal of Hand Surgery-American Volume, ISSN 0363-5023, E-ISSN 1531-6564, Vol. 40, no 12, p. 2380-2387Article in journal (Refereed) Published
Resource type
Text
Abstract [en]

Purpose: To assess implant survival and radiographic loosening after total wrist arthroplasty (TWA) operated at a single tertiary referral center in Sweden.

Methods: In a prospective cohort study, we evaluated 189 consecutive patients with a TWA(219 wrists). The wrists were implanted between 2002 and 2013. The primary end point was revision for any reason. The mean follow-up period was 7 years (range, 2-13 years). In addition, radiological examination was done for evidence of prosthetic loosening 5 years postoperatively. Implant survival was estimated using the Kaplan-Meier method. Secondary outcome measures included range of motion, visual analog scale pain scores, hand grip strength, and patient-related outcome measures.

Results: Cumulative implant survival after 8 years was 81% for Biax, 94% for Remotion, and 95% for Maestro implants. Radiographic loosening was present in 26% of wrists with the Biax design, 18% of those with Remotion, and 2% of those with Maestro. Visual analog scale pain scores and patient-related outcome scores improved significantly for all TWAs. Improved hand grip strength was noted for all TWAs except for the Universal 2. Range of motion improved somewhat, especially for the Biax and Maestro TWAs.

Conclusions: Good midterm to long-term results were achieved in patients undergoing TWA. Radiographic loosening did not necessarily correlate with implant survival rates, but rather to severe arthritic destruction of the wrist preoperatively. All TWA implants studied offered a high level of patient satisfaction.

Place, publisher, year, edition, pages
Saunders Elsevier, 2015. Vol. 40, no 12, p. 2380-2387
Keywords [en]
Osteoarthritis, rheumatoid arthritis, total wrist arthroplasty
National Category
Orthopaedics Surgery
Research subject
Orthopaedics; Surgery
Identifiers
URN: urn:nbn:se:oru:diva-47985DOI: 10.1016/j.jhsa.2015.09.016ISI: 000368270600009PubMedID: 26612635Scopus ID: 2-s2.0-84955472864OAI: oai:DiVA.org:oru-47985DiVA, id: diva2:900841
Note

Funding Agency:

Research Committee of the Örebro County Council

Available from: 2016-02-05 Created: 2016-02-05 Last updated: 2019-03-26Bibliographically approved
In thesis
1. Total wrist arthroplasty: A clinical, radiographic and biomechanical investigation
Open this publication in new window or tab >>Total wrist arthroplasty: A clinical, radiographic and biomechanical investigation
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: To study patient-related functional outcome measures, implant survival and radiographic loosening after total wrist arthroplasty (TWA) using four different implants. To evaluate a new TWA design biomechanically and clinically.

Methods: The studies included two cohort studies with prospectively collected data (n=206 and n=219), an anatomic and kinematic analysis in a cadaveric model and a pilot study (n=20).

Results: The Maestro TWA had a significantly greater improvement of radial/ulnar deviation than the Biax and Remotion TWAs. Summarized patientrelated functional outcome was significantly better for the Maestro than for the Remotion TWA. Cumulative implant survival after 8 years was 94% for Remotion, and 95% for Maestro implants. Radiographic loosening five years postoperatively was present in 26% of the Biax wrists, 18% of those with Remotion, and 2% of those with Maestro. Following TWA with the new implant design in a cadaveric model, there were no statistically significant changes compared to a native wrist regarding flexion, extension, radial deviation, the extension/radial deviation component of the dart-thrower’s motion, or the circumduction range of motion. Clinically, there was significant improvement of COPM, PRWE and VAS pain scores. Wrist extension and ulnar deviation improved, while grip strength remained largely unchanged.

Conclusions: TWA is a surgical procedure which may offer a high level of patient satisfaction. Implant design may affect patient-related functional outcome after TWA. Implant survival as well as the frequency of radiographic loosening differed considerably between the four types of implants and might be a result of different implant design. Kinematic analysis of the new TWA design suggests that a stable and functional wrist is achievable with this design. Surgical placement of the new total wrist implant was reproducible and the implant yielded good patient-related outcome measures in the short term. Since TWA is an evolving procedure, further studies are warranted in order to refine indications and the place for TWA in modern hand surgery.

Place, publisher, year, edition, pages
Örebro: Örebro university, 2016. p. 90
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 150
Keywords
Wrist, Arthroplasty, Rheumatoid, Biomechanics, Functional outcome, Implant survival
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-50040 (URN)978-91-7529-155-0 (ISBN)
Public defence
2016-10-07, Universitetssjukhuset, Bohmanssonsalen, Södra Grev Rosengatan, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2016-04-29 Created: 2016-04-29 Last updated: 2019-03-26Bibliographically approved

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Sagerfors, MarcusBrus, Ole

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