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An anatomic and kinematic analysis of a new total wrist arthroplasty design
Materials and Structural Testing Core Laboratory, Mayo Clinic, Rochester, Minnesota.
Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Örebro University, School of Medical Sciences. Department of Hand Surgery.
Materials and Structural Testing Core Laboratory, Mayo Clinic, Rochester, Minnesota.
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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. Vol. 4, no 2, 121-127 p.
Keyword [en]
Arthroplasty, rheumatoid, total wrist, joint, biomechanics
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-52145DOI: 10.1055/s-0035-1549288PubMedID: 25945297OAI: oai:DiVA.org:oru-52145DiVA: diva2:970451
Available from: 2016-09-13 Created: 2016-09-13 Last updated: 2016-09-21Bibliographically 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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