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Total wrist arthroplasty: A clinical, radiographic and biomechanical investigation
Örebro University, School of Medical Sciences.
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. , 90 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 150
Keyword [en]
Wrist, Arthroplasty, Rheumatoid, Biomechanics, Functional outcome, Implant survival
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-50040ISBN: 978-91-7529-155-0 (print)OAI: oai:DiVA.org:oru-50040DiVA: diva2:924789
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: 2016-09-14Bibliographically approved
List of papers
1. Patient related functional outcome after total wrist arthroplasty: a single center study of 206 cases
Open this publication in new window or tab >>Patient related functional outcome after total wrist arthroplasty: a single center study of 206 cases
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2015 (English)In: Hand Surgery, ISSN 0218-8104, Vol. 20, no 1, 81Article in journal (Refereed) Published
Abstract [en]

Objectives: To prospectively evaluate patient related outcome measures after total wrist arthroplasty (TWA) using four different total wrist implants operated at a single referral center in Sweden.

Methods: 206 primary TWAs were assessed preoperatively and after one year postoperatively with respect to the following eight outcome measures: Range of motion (flexion/extension, radial/ulnar deviation, pronation/supination), hand grip strength, Canadian Occupational Performance Measure (COPM), performance and satisfaction, Visual Analog Scale (VAS) pain scores at rest and in activity.

Results: The Maestro TWA had a significantly greater improvement of radial/ulnar deviation than the Biax and Remotion TWAs. COPM performance and satisfaction improved more for the Maestro and Universal 2 prostheses than the Biax and Remotion.

Conclusions All four TWAs offer reduced VAS-scores and improved COPM-scores with preserved hand grip strength and somewhat improved range of motion. The Maestro TWA performed favorably compared to the Remotion TWA. Implant design may affect patient related outcome.

Place, publisher, year, edition, pages
Singapore: World Scientific Publishing, 2015
Keyword
Arthroplasty, Rheumatoid, Total Wrist, Joint
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-52144 (URN)10.1142/S0218810415500112 (DOI)25609279 (PubMedID)2-s2.0-84941743295 (Scopus ID)
Available from: 2016-09-13 Created: 2016-09-13 Last updated: 2017-03-20Bibliographically approved
2. Total Wrist Arthroplasty: A Single-Center Study of 219 Cases With 5-Year Follow-up
Open this publication in new window or tab >>Total Wrist Arthroplasty: A Single-Center Study of 219 Cases With 5-Year Follow-up
2015 (English)In: Journal of Hand Surgery-American Volume, ISSN 0363-5023, E-ISSN 1531-6564, Vol. 40, no 12, 2380-2387 p.Article in journal (Refereed) Published
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
Keyword
Osteoarthritis, rheumatoid arthritis, total wrist arthroplasty
National Category
Orthopedics Surgery
Research subject
Orthopaedics; Surgery
Identifiers
urn:nbn:se:oru:diva-47985 (URN)10.1016/j.jhsa.2015.09.016 (DOI)000368270600009 ()26612635 (PubMedID)2-s2.0-84955472864 (Scopus ID)
Note

Funding Agency:

Research Committee of the Örebro County Council

Available from: 2016-02-05 Created: 2016-02-05 Last updated: 2017-03-24Bibliographically approved
3. An anatomic and kinematic analysis of a new total wrist arthroplasty design
Open this publication in new window or tab >>An anatomic and kinematic analysis of a new total wrist arthroplasty design
Show others...
2015 (English)In: Journal of wrist surgery, ISSN 2163-3916, E-ISSN 2163-3924, Vol. 4, no 2, 121-127 p.Article in journal (Other academic) Published
Abstract [en]

Background: Total wrist arthroplasty (TWA) is a viable surgical treatment for disabling wrist arthritis. While current designs are a notable improvement from prior generations, radiographic loosening and failures remain a concern.

Purpose: The purpose of this investigation is to evaluate a new total wrist arthroplasty design kinematically. The kinematic function of a native, intact cadaveric wrist was compared with that of the same wrist following TWA.

Method: Six, fresh-frozen wrist cadaveric specimens were utilized. Each wrist was fixed to an experimental table and its range of motion, axis of rotation, and muscle moment arms were calculated. The following tendons were attached to the apparatus to drive motion: extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), extensor carpi ulnaris (ECU), flexor carpi radialis (FCR), flexor carpi ulnaris (FCU), and abductor pollicis longus (APL). The wrist was then manually moved along a guide by an experimenter through a series of motions including flexion-extension, radial-ulnar deviation, and circumduction. The experiment was then performed on the specimen following implantation of the TWA.

Results: Following the TWA procedure, there were statistically significant decreases in the ulnar deviation and the flexion/ulnar deviation component of dart throw ranges of motion. There were no statistically significant changes in flexion, extension, radial deviation, the extension/radial deviation component of the dart thrower motion, or the circumduction range of motion.

Conclusions: Kinematic analysis of the new TWA suggests that a stable, functional wrist is achievable with this design.

Clinical Relevance: While appreciating the limitations of a cadaveric study, this investigation indicates that the TWA design studied merits study in human populations.

Place, publisher, year, edition, pages
New York: Thieme Medical Publishers, 2015
Keyword
Arthroplasty, rheumatoid, total wrist, joint, biomechanics
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-52145 (URN)10.1055/s-0035-1549288 (DOI)25945297 (PubMedID)
Available from: 2016-09-13 Created: 2016-09-13 Last updated: 2017-03-15Bibliographically approved
4. Clinical, radiographical and functional evaluation of a new total wrist implant: A pilot study
Open this publication in new window or tab >>Clinical, radiographical and functional evaluation of a new total wrist implant: A pilot study
(English)Manuscript (preprint) (Other academic)
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-52146 (URN)
Available from: 2016-09-13 Created: 2016-09-13 Last updated: 2016-09-21Bibliographically approved

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