Abstract:We developed an uncemented screw-shaped ball-and-socket wrist prosthesis and modified it during a decade of trails from 1996 to 2005. The final Motec® wrist prosthesis was launched in 2006. Since then we have used this prosthesis in 110 wrists (110 patients) from 2006 to 2018. This article reviews the design, functional outcomes, complications, clinical usefulness and possible future modifications of the Motec® wrist prosthesis.
“…Nevertheless, it can result in subsidence of the carpal plate in some cases (Figure 4). Nearly identical findings have since been reported with a metal-on-metal implant, the Motec (Reigstad et al., 2017, 2018). Figure 3.Periprosthetic osteolysis confined near to the joint 4 and 6 years after Re-motion arthroplasty.…”
Section: The Wristsupporting
confidence: 72%
“…Conversely, periprosthetic osteolysis (PPO) and subsidence of the carpal component still is a concern. PPO occurs with all types of wrist prostheses and has been described more systematically for the Biax (formerly DePuy, Warsaw, IN, USA), the Universal 2 (Integra, Plainsboro, NJ, USA), the Motec (Swemac, Linköping, Sweden) and the Re-motion (Boeckstyns, 2014; Cobb and Beckenbaugh, 1996; Kennedy et al., 2018, Pfanner et al., 2017; Reigstad et al., 2018). Guillaume Herzberg and myself (2014) made a specific analysis of the prevalence, location and natural history of PPO following Re-motion total wrist arthroplasty with precise measurements on serial radiographs of 44 consecutive patients.…”
I summarize my changing views and practices of arthroplasty in hand surgery over the past four decades. I recommend simple resection of the trapeziectomy for advanced arthritis of the first carpometacarpal joint, silicone implants for the metacarpophalangeal joints and the proximal interphalangeal joints, and the total wrist arthroplasty for advanced wrist arthritis and collapse. I also outline technical tips of these procedures.
“…Nevertheless, it can result in subsidence of the carpal plate in some cases (Figure 4). Nearly identical findings have since been reported with a metal-on-metal implant, the Motec (Reigstad et al., 2017, 2018). Figure 3.Periprosthetic osteolysis confined near to the joint 4 and 6 years after Re-motion arthroplasty.…”
Section: The Wristsupporting
confidence: 72%
“…Conversely, periprosthetic osteolysis (PPO) and subsidence of the carpal component still is a concern. PPO occurs with all types of wrist prostheses and has been described more systematically for the Biax (formerly DePuy, Warsaw, IN, USA), the Universal 2 (Integra, Plainsboro, NJ, USA), the Motec (Swemac, Linköping, Sweden) and the Re-motion (Boeckstyns, 2014; Cobb and Beckenbaugh, 1996; Kennedy et al., 2018, Pfanner et al., 2017; Reigstad et al., 2018). Guillaume Herzberg and myself (2014) made a specific analysis of the prevalence, location and natural history of PPO following Re-motion total wrist arthroplasty with precise measurements on serial radiographs of 44 consecutive patients.…”
I summarize my changing views and practices of arthroplasty in hand surgery over the past four decades. I recommend simple resection of the trapeziectomy for advanced arthritis of the first carpometacarpal joint, silicone implants for the metacarpophalangeal joints and the proximal interphalangeal joints, and the total wrist arthroplasty for advanced wrist arthritis and collapse. I also outline technical tips of these procedures.
“…Studies on long-term results are less frequent, although the publications have increased [10][11][12]. For rheumatics, the precarious bone situation with early onset of osteoporosis and the associated loss of bone mass and accompanying pathologies of the periarticular tissues limits the conditions for the long-term success of a wrist prosthesis [13][14][15]. Considering the worst-case scenario, the survival rate of the prosthesis after 6.9 years was 44%.…”
The wrist is among the predilection sites of over 90% of cases of rheumatoid arthritis (RA). In advanced cases, total wrist arthroplasty (TWA) is an alternative to arthrodesis. The aim of this study is to present the long-term results of the modular physiological wrist prosthesis (MPW®) and to match them in context with the results of a standard population survey. In a retrospective study with follow-up, patients with an MPW® endoprosthesis were evaluated concerning the clinical and radiological outcome, complications were reviewed (incidence and type), and conversion to wrist fusion was assessed. Patient function measurements included the Mayo wrist score, the patient-specific wrist test, and therefore the DASH score (arm, shoulder, and hand). Thirty-four MPW® wrist prostheses were implanted in 32 patients, including thirty primary implantations and four changes of the type of the endoprosthesis. Sixteen patients (18 prostheses) underwent clinical and radiological follow-up. The average follow-up time was 8.5 years (1 to 16). Poor results of the MPW prosthesis are caused by the issues of balancing with luxation and increased PE wear. Salvage procedures included revision of the TWA or fusion. In successful cases, the flexion and extension movement averaged 40 degrees. The grip force was around 2.5 kg. The common DASH score was 79 points, with limited and problematic joints of the upper extremity. The MPW wrist prosthesis offered good pain relief and functional movement in over 80% of cases. The issues of dislocation and increased PE wear prevent better long-term results, as do the joints affected. A follow-up study with fittings under a contemporary anti-rheumatic therapy with biologicals suggests increasing score results. Type of study/level of evidence: Case series, IV.
“…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%
“…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. Lastly, although modifying the joint's shape and the type of articulation might aid to simulate the biomechanics of the healthy wrist, future studies must evaluate their clinical success and patient's satisfaction.…”
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.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
