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Patient related functional outcome after total wrist arthroplasty: a single center study of 206 cases
Örebro University, School of Medical Sciences. Department of Hand Surgery.
Örebro University, School of Medical Sciences. Department of Anesthesiology and Intensive Care.ORCID iD: 0000-0001-6128-7752
Clinical Epidemiology and Biostatistics Unit, Örebro University, Örebro, Sweden.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
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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. Vol. 20, no 1, 81
Keyword [en]
Arthroplasty, Rheumatoid, Total Wrist, Joint
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-52144DOI: 10.1142/S0218810415500112PubMedID: 25609279ScopusID: 2-s2.0-84941743295OAI: oai:DiVA.org:oru-52144DiVA: diva2:970443
Available from: 2016-09-13 Created: 2016-09-13 Last updated: 2016-12-05Bibliographically 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. 90 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 150
Keyword
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: 2016-09-14Bibliographically approved

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