Total Wrist Arthroplasty

Halim, Andrea; Weiss, Arnold‐Peter C.

doi:10.1016/j.jhsa.2016.12.004

Cited by 44 publications

(46 citation statements)

References 23 publications

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“…One solution may be to use an elliptical polyethylene cap which has a smaller radius for its major curvature. However, with that change, the joint would become closer to a ball‐and‐socket joint, which, accordingly, provides no torsional (supination‐pronation) stability and it is instructive to note such designs have been considered, but have been associated with high complication rates relative to other arthroplasty designs 1,2,9,60 . The mismatch of the orientation of the screw axis in the antidart‐thrower's motions (radial‐flexion to ulnar‐extension) between healthy wrists and TWA might also be resolvable with novel designs.…”

Section: Discussionmentioning

confidence: 99%

“…Total wrist arthroplasty (TWA) has a history as long as total knee and hip joint replacements 1 ; however, it has not demonstrated the same high survival rates 2‐4 . Although current TWA designs 5‐8 have improved over the past decade and have started to become a reliable option for some patients, 6 high complication rates are still a major issue 9‐11 . While the reasons for the complications following a TWA are debated, studies evaluating total joint replacements of the knee, shoulder, spine, and hip have shown that kinematic differences between the healthy and replaced joint motion can lead to implant and bone‐implant interface failures 12‐16 .…”

Section: Introductionmentioning

confidence: 99%

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Proximal‐distal shift of the center of rotation in a total wrist arthroplasty is more than twice of the healthy wrist

Akhbari

Morton

Shah

et al. 2020

Journal Orthopaedic Research

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Reproduction of healthy wrist biomechanics should minimize the abnormal joint forces that could potentially result in the failure of a total wrist arthroplasty (TWA). To date, the in vivo kinematics of TWA have not been measured and it is unknown if TWA preserves healthy wrist kinematics. Therefore, the purpose of this in vivo study was to determine the center of rotation (COR) for a current TWA design and to compare its location to the healthy wrist. The wrist COR for six patients with TWA and 10 healthy subjects were calculated using biplane videoradiography as the subjects performed various range‐of‐motion and functional tasks that included coupled wrist motions. An open‐source registration software, Autoscoper, was used for model‐based tracking and kinematics analysis. It was demonstrated that the COR was located near the centers of curvatures of the carpal component for the anatomical motions of flexion‐extension and radial‐ulnar deviation. When compared to healthy wrists, the COR of TWAs was located more distal in both pure radial deviation (P < .0001) and pure ulnar deviation (P = .07), while there was no difference in its location in pure flexion or extension (P = .99). Across all coupled motions, the TWA's COR shifted more than two times that of the healthy wrists in the proximal‐distal direction (17.1 vs 7.2 mm). We postulate that the mismatch in the COR location and behavior may be associated with increased loading of the TWA components, leading to an increase in the risk of component and/or interface failure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Proximal‐distal shift of the center of rotation in a total wrist arthroplasty is more than twice of the healthy wrist

Akhbari

Morton

Shah

et al. 2020

Journal Orthopaedic Research

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“…However, it can be an option for primary treatment of highly comminuted or unstable distal forearm fractures in elderly patients to avoid posttraumatic UPV ( Figure 11B) [68,83,84]. Care must be taken when using the Darrach's procedure in patients with rheumatoid arthritis, due to the natural course of the disease with progressive ulnar carpal translocation it can leads to severe complications such as migration of the lunate bone or dislocation of a total wrist arthroplasty (TWA) [85][86][87][88][89]. Noted that ulnar carpal translocation is also observed as a posttraumatic complication after fracture-dislocation injuries of the wrist in which the ulnar head is obtained, and, due to the unfamiliarity of this injury by treating physicians, this rare injury can mostly be investigated when comparing radiographs with the uninjured wrist were done such as described for the elbow joint as well [14,21,90].…”

Section: Discussionmentioning

confidence: 99%

Who introduced the "quadrangular-construct" modification of the Sauvé Kapandji procedure first? Case presentation and brief overview of literature with regard to general, specific and practicable aspects to primary trauma-related surgical treatment including possible salvage options at the distal radioulnar joint

Schmidt¹,

Schmitz²,

Muradyan³

et al. 2017

Trauma Emerg Care

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A 26-year-old male sustained a left wrist injury after an occupational fall from height that was diagnosed as wrist sprain and treated conservatively by a plaster splint in another institution. Eight weeks after injury, the patient could be re-employed in his original occupation as a truck driver. Six years after injury, the patient came in our institution for the first time, and reported increasing pain in his left wrist accompanied with marked restriction of his left forearm's supination and pronation leading to the non-ability to carry out his occupational job 8 weeks previously. On clinical examination, there was pronounced dorsal subluxation of the ulnar head without any given possibilities for it manual closed reduction (i.e. static instability in transverse plane) ( Figure 1A). Posterior-anterior (PA) radiographs of both wrists showed no concomitant ulnar positiv variance (UPV) (i.e. no longitudinal instability) and no posttraumatic arthritic changes in the distal radioulnar joint (DRUJ), but the configuration of the ulnar styloid at the formerly injured left wrist could not be well assessed that suggested an additional rotation deformity of the ulnar head ( Figure 1B). Lateral radiographs of both wrist showed marked fixed subluxation of the ulnar head in dorsal direction (i.e. static instability in transverse plane) ( Figure 1C). Due to these findings, the Sauvé-Kapandji procedure, modified by creating a "quadrangularconstruct", was detected by us. At the preoperative radiographs of the left elbow in both planes there were no signs of any pre-existing degenerative changes with specific regard to the radiocapitellar joint.Intraoperatively, first, the 2 cm long ulna segment was excised typically proximal to the DRUJ, then a Kirschner-wire was drilled into the ulnar head parallel to the plane of the operation table on which the left forearm was positioned at terminal range of pronation (i.e. 90°) ( Figure 2A). After that, the ulnar head was rotated 90° perpendicular to the operation table's plane in dorsal direction using the formerly drilled Kirschner-wire, and so the neutral position of DRUJ could be achieved in which the arthrodesis had to be performed ( Figure 2B). Then, the cartilage of both corresponding surfaces in DRUJ was excised, and the DRUJ arthrodesis in neutral position was carried out using a 3.5 mm titanium malleolar screw, and the Kirschner-wire was removed. The next step included the several years later introduced "quadrangularconstruct" modification of the original Sauvé-Kapandji procedure: After decorticalization of the corresponding radius and ulna shafts proximal to the DRUJ arthrodesis and distal to resection plane of the ulna segment, the formerly excised ulna segment has been inserted transversely between both forearm bones and fixated with a second 3.5 mm titanium cortical screw through the ulna segment graft, and finally, complete restoration of rotation motion arc could be achieved ( Figures 2C-D). The correctly performed surgical procedure was confirmed intraoperatively by flu...

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“…P atients who undergo successful total wrist arthroplasty (TWA) for advanced wrist degeneration report a better ability to perform certain daily living activities [4,7], and cost-utility analyses suggest the intervention provides cost-effective value to patients [2]. Despite these benefits, TWA is less-frequently performed compared to total wrist arthrodesis [3,5,7].…”

mentioning

confidence: 99%

“…Despite these benefits, TWA is less-frequently performed compared to total wrist arthrodesis [3,5,7]. In 2015, 1765 total wrist arthrodeses were billed to Medicare, compared with only 410 TWAs [3]-a number that actually is trending down [4]. Many hand surgeons are reluctant to recommend TWA due to concerns regarding high complication rates and limited survivorship [3,5,7].…”

mentioning

confidence: 99%

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

Kennedy

2017

Clinical Orthopaedics &Amp; Related Research

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Total Wrist Arthroplasty

Cited by 44 publications

References 23 publications

Proximal‐distal shift of the center of rotation in a total wrist arthroplasty is more than twice of the healthy wrist

Proximal‐distal shift of the center of rotation in a total wrist arthroplasty is more than twice of the healthy wrist

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

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