Total Wrist Arthroplasty

Weiss, Arnold‐Peter C.; Kamal, Robin N.; Shultz, Paul

doi:10.5435/00124635-201303020-00003

Cited by 13 publications

(31 citation statements)

References 35 publications

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“…[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Review articles, case reports, surgical techniques, and studies focusing on other operative treatments (wrist arthrodesis, silicone implant arthroplasty, interposition arthroplasty, or proximal row carpectomy) were excluded. The types of studies were retrospective (n=9), pre/post treatment (n=4), prospective (n=2), case series (n=1), registry (n=1), and meta-analysis (n=1).…”

Section: Reviewmentioning

confidence: 99%

“…] and the ReMotion total wrist system (Small Bone Innovations, Morrisville [PA], USA) have porous titanium-coated cobalt chrome components and ultra-high-molecular-weight polyethylene (UHMWPE) articular interfaces to provide better range of motion and reduce torque. 3 TWA enables long-term pain relief and improves overall function, 6 but most studies include small cohorts and poor evidence, and the procedure is associated with complications such as intraoperative fractures, tendon lacerations, wound problems, extensor tendon adhesions, wrist stiffness, wrist imbalance, distal radioulnar joint problems, prosthetic instability, implant loosening, and infection. 7 The revision rate for TWA is high, and thus the cost-effectiveness of TWA over wrist arthrodesis is questionable.…”

mentioning

confidence: 99%

“…], and the Universal total wrist implant (Kinetikos Medical, Carlsbad [CA], USA) have higher success rates but are also associated with similar complications. 3 The fourth-generation implants are mainly uncemented and have porous surfaces to enable osteointegration. 3 The Universal 2 total wrist implant system (Integra LifeSciences, Plainsboro [NJ], USA) [ Fig.…”

mentioning

confidence: 99%

“…3 The fourth-generation implants are mainly uncemented and have porous surfaces to enable osteointegration. 3 The Universal 2 total wrist implant system (Integra LifeSciences, Plainsboro [NJ], USA) [ Fig. ] and the ReMotion total wrist system (Small Bone Innovations, Morrisville [PA], USA) have porous titanium-coated cobalt chrome components and ultra-high-molecular-weight polyethylene (UHMWPE) articular interfaces to provide better range of motion and reduce torque.…”

mentioning

confidence: 99%

“…1 The first-generation implants use a Silastic spacer, with encouraging results for wrists with rheumatoid arthritis (RA), post-traumatic arthritis, and osteoarthritis, 2 but they are associated with osteolysis, subsidence, and implant fractures after 10 years. 3,4 The second-generation implants use a ball-and-socket or hemispherical design, 3 but the revision rate for the MWP III total wrist prosthesis (Zimmer, Warsaw [IN], USA) [ Fig. ] is high owing to mechanical and soft tissue problems.…”

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confidence: 99%

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Review Article: Total Wrist Arthroplasty

Nair

2014

J Orthop Surg (Hong Kong)

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were retrieved from the MEDLINE database using the key word 'total wrist arthroplasty'. In most studies, total wrist arthroplasty achieved improvement in pain and function over time. In a meta-analysis, the revision rate was 17% for third-generation implants. The survival rate was 92% for fourth-generation implants at 4 years. Complication rates ranged from 0% to 100% for third-generation implants and from 6% to 47% for fourth-generation implants. Results of total wrist arthroplasty vary greatly; longer-term studies are needed to determine its cost-effectiveness.

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Section: Reviewmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Review Article: Total Wrist Arthroplasty

Nair

2014

J Orthop Surg (Hong Kong)

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A Novel Computational Method for Evaluating Osteochondral Autografts in Distal Radius Reconstruction

Kollitz

Huang

Hsu

et al. 2014

Hand (New York, N,Y.)

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Background We describe a novel computational method for assessing the fit of an osteochondral graft. We applied our software to five normal wrist computed tomography (CT) scans to determine the fit of the scaphoid to the lunate fossa of the distal radius. Methods CT scans of five wrists were digitally rendered. The capitate facet of the scaphoid was fit to the lunate fossa of the distal radius using custom software based on the iterative closest point (ICP) algorithm. This approach iteratively determines the optimal position of a model surface to minimize the sum of squares of distances from all points on a target surface. The fit of the two surfaces was reported by calculating the mean residual distance (MRD) between each point on one surface and its nearest neighbor on the other. Results The MRD for the five subjects was found to be 0.25 mm, with 82.8-98.3 % of the articular surfaces within 0.5 mm of each other. Conclusions We have developed a software algorithm for comparing two articular surfaces to test fit for a proposed joint reconstruction. The software is versatile and may be applied to any bony surface to identify new graft donor sites. The fit assessment renders a richer, three-dimensional understanding of the fit of the graft as compared to traditional twodimensional assessments.Level of Evidence: Decision analysis, Level V

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What Are the Risk Factors and Complications Associated With Intraoperative and Postoperative Fractures in Total Wrist Arthroplasty?

Wagner

Srnec

Mehrotra

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Total wrist arthroplasty (TWA) can relieve pain and preserve some wrist motion in patients with advanced wrist arthritis. However, few studies have evaluated the risks and outcomes associated with periprosthetic fractures around TWAs. Questions/purposes (1) What is the risk of intraoperative and postoperative fractures after TWAs? (2) What factors are associated with increased risk of intraoperative and postoperative fracture after TWAs? (3) What is the fracture-free and revision-free survivorship of TWAs among patients who sustained an intraoperative fracture during the index TWA? Methods At one institution during a 40-year period, 445 patients underwent primary TWAs. Of those, 15 patients died before 2 years and 5 were lost to followup, leaving 425 patients who underwent primary TWAs with a minimum of 2-year followup. The primary diagnosis for the TWA included osteoarthritis ([OA] 5%), inflammatory arthritis (90%), and posttraumatic arthritis (5%). Indications for TWA included pancarpal arthritis combined with marked pain and loss of wrist function. The mean age of the patients was 57 years, BMI was 26 kg/m 2 , and 73% were females. Six different implants were used during the 40-year period. Mean followup was 10 years (range, 2-18 years). Results Intraoperative fractures occurred in nine (2%) primary TWAs, while postoperative fractures occurred after eight (2%) TWAs. After analyzing demographics, comorbidities, and surgical factors, intraoperative fractures were found to be associated with only age at surgery (hazard ratio [HR], 1.10; 95% CI, 1.03-1.20; p = 0.006) and use of a bone graft (HR, 5.80; 95% CI, p = 0.03). No factors were found to be associated with increased risk of postoperative fractures; specifically, intraoperative fracture was not associated with subsequent fracture development. The 5-, 10-, and 15-year KaplanMeier survival rates free of postoperative fracture were 99%, 98%, and 95%, respectively. The 5-and 10-year revision-free survival rates after intraoperative fracture were 88% and 88%, respectively, compared with 84% and 74% without an intraoperative fracture (p = 0.36). Furthermore, the survival-free of revision surgery rates for aseptic distal loosening at 5 and 10 years were 88% and 88%, respectively, compared with 93% and 87% without a fracture (p = 0.85). Conclusions Intraoperative fractures occur in approximately 2% of TWAs. These fractures do not appear to affect long-term implant survival or risk of fracture. Patient age and the need for bone graft were the only factors in the risk of intraoperative fractures. Postoperative fractures also occur in 2% of TWAs, but often result in revision surgery.

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Total Wrist Arthroplasty

Cited by 13 publications

References 35 publications

Review Article: Total Wrist Arthroplasty

Review Article: Total Wrist Arthroplasty

A Novel Computational Method for Evaluating Osteochondral Autografts in Distal Radius Reconstruction

What Are the Risk Factors and Complications Associated With Intraoperative and Postoperative Fractures in Total Wrist Arthroplasty?

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