Clinical Outcomes of Total Wrist Arthroplasty

doi:10.1016/j.jhsa.2012.05.016

The Journal of Hand Surgery

Volume 37, Issue 8, August 2012, Pages 1580-1584

https://doi.org/10.1016/j.jhsa.2012.05.016 Get rights and content

Purpose

Current indications for total wrist arthroplasty include patients with symptomatic end stage posttraumatic wrist arthritis, rheumatoid arthritis, and Kienböck disease, as an alternative to wrist arthrodesis. Arthroplasty may have advantage over arthrodesis because of the ability to retain motion. The purpose of this study was to evaluate the short-term clinical outcomes and complications of the Maestro Total Wrist System.

Methods

We report the results of a retrospective review of 23 total wrist prostheses implanted in 22 patients. We administered the visual analog pain scale and Mayo wrist and Disabilities of the Arm, Shoulder, and Hand questionnaires. We reviewed wrist motion, grip strength, radiographs, and complications.

Results

At a mean follow-up of 28 months (range, 4–55 mo), the Disabilities of the Arm, Shoulder, and Hand score and Mayo wrist score were 31 and 54, respectively. Mean pain scores improved from 8.0 to 2.2. The mean wrist flexion-extension arc was 90°. Radiographs revealed no evidence of prosthetic loosening. Grip strength averaged 60% of the strength of the opposite hand. Complications occurred in 7 of 23 patients. One failure occurred as a result of deep infection in a patient with prior intercarpal fusion, and was successfully converted to a wrist fusion.

Conclusions

Total wrist arthroplasty performed for pancarpal arthritis as an alternative to wrist arthrodesis can yield successful outcomes with low short-term failure rates.

Type of study/level of evidence

Therapeutic IV.

Section snippets

Materials and Methods

We obtained institutional review board authorization and performed a retrospective chart review on prospectively collected data for all patients who received a TWA from 2007 to 2011. Two fellowship-trained orthopedic hand surgeons at the same institution performed all procedures. The surgical indication for TWA was painful pancarpal arthritis in which wrist arthrodesis would be an alternative and in which proximal row carpectomy or 4-corner arthrodesis was not possible. If the radiolunate and

Results

At a mean follow-up of 28 months (range, 4–55 mo), we recorded range of motion, DASH, and Mayo wrist and visual analog pain scale scores (Table 1). Grip strength averaged 60% of the opposite hand. Table 2 lists the postoperative DASH and Mayo wrist scores, wrist range of motion, and visual analog pain scale scores separated by etiology. In addition, we obtained radiographs at each follow-up visit, which revealed no evidence of loosening or fractures.

The overall complication rate was 7 of 23

Discussion

Many reports exist regarding the efficacy of TWA. Cobb and Beckenbaugh¹³ reported on 52 cases using biaxial TWA. At 1 year after surgery, there was a statistical decrease in flexion and an increase in extension. Pain was reported as none in 75% of patients. Implant loosening was the most common complication (8 of 11 patients). The authors predicted that 1 in 5 implants would fail by 6 years.

Meuli and Fernandez¹⁴ presented their outcomes on 49 TWAs using the Meuli Wrist Prosthesis–third

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Cited by (57)

A Changing Landscape in the Surgical Management of Wrist Arthritis: An Analysis of National Trends From 2009 to 2019
2024, Journal of Hand Surgery
The purpose of this study was to analyze the trends in the annual volume and incidence of proximal row carpectomy (PRC), four-corner fusion (4CF), total wrist arthrodesis (TWF), and total wrist arthroplasty (TWA) from 2009 to 2019 in the United States.
The IBM Watson Health MarketScan databases were queried to identify annual case volumes for PRC, 4CF, TWF, and TWA from 2009 to 2019. The annual incidence of these procedures was then calculated based on the population estimates from the US Census Bureau. Trends in annual volume and incidence over the study period were evaluated using regression line analysis. Further subgroup analysis was conducted based on age and region.
From 2009 to 2019, the total case volumes for the four procedures increased by 3.4%, but the incidence decreased by 2.8%. However, PRC case volume and incidence trends significantly increased (38.2% and 29.7%, respectively), whereas 4CF remained constant. Conversely, the case volume and incidence of TWA significantly decreased (−52.2% and −54.5%, respectively), whereas TWF remained constant. When stratified by age, all four procedures decreased in the <45-year-old cohort (combined −35.1%) significantly for 4CF, TWF, and TWA. TWA decreased significantly in the <45-year-old and 45- to 65-year-old cohorts (53.6% and 63.2%, respectively). For age >65 years, the total case incidence increased by 98.9%, including a significant positive trend in TWF (175%).
Surgical management of wrist arthritis remains a controversial issue. However, PRC has gained recent support in the literature, and our results reflect this shift, even for the <45-year-old cohort. Furthermore, TWA declined, despite reports of positive early outcomes for fourth-generation implants.
Therapeutic II.
Clinical Outcomes of Total Wrist Arthroplasty in Patients With Rheumatoid Arthritis: Minimum 10-Year Follow-Up Study
2024, Journal of Hand Surgery
We developed a semiconstrained total wrist prosthesis that was used in a series of patients with rheumatoid arthritis. We previously reported favorable clinical outcomes for up to 5 years after surgery; however, the longer-term outcomes remain unclear. The objective of this study was to evaluate the clinical outcomes of this wrist prosthesis for the treatment of severe wrist rheumatoid arthritis during a minimum 10 years of follow-up.
From 2010 through 2012, total wrist arthroplasty using the semiconstrained total wrist arthroplasty device was performed in 20 wrists in 20 patients with rheumatoid arthritis (five men and 15 women). The mean patient age was 64 years (range, 50–84 years). Preoperative radiographs showed Larsen grade IV changes in 16 wrists and grade V changes in four wrists. Patients were evaluated clinically and radiologically before surgery, 5 years after surgery, and 10 years or more after surgery. Evaluated parameters were the visual analog scale for pain, range of motion, Figgie score, and Disabilities of the Arm, Shoulder, and Hand score.
The minimum 10-year follow-up clinical results (mean, 11.3 years) were available for all 14 surviving patients (three men and 11 women). Significant improvements in the mean visual analog scale for pain, Figgie score, and Disabilities of the Arm, Shoulder, and Hand score, compared with those before surgery, were maintained from 5 years after surgery to the final follow-up. The mean wrist flexion angle tended to slightly decrease at 5 years after surgery compared with that before surgery but remained similar from 5 years after surgery to the final follow-up. The increase in the mean wrist extension angle, compared with that before surgery, was maintained from 5 years after surgery to the final follow-up. Radiographic evaluation had already revealed implant loosening in five of the 19 wrists at 5 years after surgery, but there were no new cases of component loosening identified at the final follow-up.
Total wrist arthroplasty using the semiconstrained arthroplasty system achieves favorable clinical outcomes with no serious complications requiring revision for 10 years after surgery.
Therapeutic IV.
An overview of 3D printed metal implants in orthopedic applications: Present and future perspectives
2023, Heliyon
With the ability to produce components with complex and precise structures, additive manufacturing or 3D printing techniques are now widely applied in both industry and consumer markets. The emergence of tissue engineering has facilitated the application of 3D printing in the field of biomedical implants. 3D printed implants with proper structural design can not only eliminate the stress shielding effect but also improve in vivo biocompatibility and functionality. By combining medical images derived from technologies such as X-ray scanning, CT, MRI, or ultrasonic scanning, 3D printing can be used to create patient-specific implants with almost the same anatomical structures as the injured tissues. Numerous clinical trials have already been conducted with customized implants. However, the limited availability of raw materials for printing and a lack of guidance from related regulations or laws may impede the development of 3D printing in medical implants. This review provides information on the current state of 3D printing techniques in orthopedic implant applications. The current challenges and future perspectives are also included.
Total Wrist Arthroplasty With a New Design, 20 Cases With 8-Year Follow-Up
2023, Journal of Hand Surgery
Total wrist arthroplasty (TWA) is an established motion-preserving alternative to arthrodesis in the treatment of wrist arthritis, but post-TWA complications requiring additional surgery remain an issue. A new TWA design has been proposed. The purpose of this study was to report the outcome of a cohort study of 20 patients who underwent surgery using the new TWA design.
Patients were assessed before surgery and at 1, 2, and 8 years after surgery for visual analog scale (VAS) pain scores, wrist range of motion, hand grip strength, and patient-reported outcome measures (PROMs). Radiographic examination was conducted for evidence of prosthetic loosening. Reasons for revision were analyzed.
In total, 24 reoperations were performed, including 12 revisions in 6 patients. Patient-reported outcome measures improved significantly at the 2-year follow-up compared with preoperative values. Hand grip strength, wrist extension, and VAS pain scores improved significantly at the 2-year follow-up. No radiographic loosening of the components was observed, but backing out of the carpal screws was noted in 16 of the 20 cases.
The new TWA resulted in improved VAS pain scores, PROMs, wrist extension, and hand grip strength. The high frequency of reoperation is a concern, and modification of the implant is needed.
Therapeutic IV.
Results of interposition arthroplasty with the Amandys® pyrocarbon implant in rheumatoid wrist at a mean 5 years’ follow-up
2021, Hand Surgery and Rehabilitation
Management of severe joint involvement in rheumatoid wrist is controversial. The gold-standard is total wrist fusion, but total wrist replacement offers a motion-conserving alternative. The purpose of this study was to present the results of interposition arthroplasty with the Amandys® pyrocarbon implant in rheumatoid wrist. We performed a retrospective review of 28 arthroplasties for rheumatoid wrist arthritis. Eighteen females and 5 males were included, with a mean age of 55.7 years. Mean follow-up was 64 months. We measured range of motion, grip strength, and pain (on VAS). Function was evaluated preoperatively and at last follow-up with the DASH and PRWE scores. Mean range of motion in flexion–extension was maintained while mean inclination and rotational range of motion showed significant improvement. Mean grip strength increased from 10 kg to 17 kg. Mean pain score decreased from 6/10 to 2/10. Mean PRWE and QuickDASH scores decreased from 62/100 to 25/100 and from 62/100 to 36/100, respectively. Three patients underwent early reoperation to reposition a dislocated implant. No implants had to be removed. Amandys® pyrocarbon arthroplasty is a reliable alternative to total fusion or total replacement in rheumatoid wrist. Indications must be limited to well-aligned wrists with competent capsule-ligament structures.
La gestion des atteintes articulaires sévères du poignet rhumatoïde est controversée. Le traitement de référence est l’arthrodèse totale du poignet, mais la prothèse totale du poignet offre une alternative préservant les mobilités. Le but de cette étude était de présenter les résultats de l'arthroplastie d'interposition avec l'implant en pyrocarbone Amandys® sur les poignets rhumatoïdes. Nous avons effectué une revue rétrospective de 28 arthroplasties pour arthrite rhumatoïde du poignet. Dix-huit femmes et cinq hommes ont été inclus, avec un âge moyen de 55,7 ans. Le suivi moyen était de 64 mois. Nous avons mesuré les mobilités articulaires, la force de poigne, la douleur (EVA) et les scores DASH et PRWE en préopératoire et au dernier recul. Au dernier recul, l’arc de mobilité en flexion–extension était maintenu, alors que les arcs de mobilité en rotation et inclinaison étaient significativement augmentés. La force moyenne avait augmenté de 10 kg à 17 kg. Le score moyen de douleur avait diminué de 6/10 à 2/10 en postopératoire. Les scores moyens PRWE et QuickDASH étaient passés de 62/100 à 25/100 et de 62/100 à 36/100 respectivement. Trois patients avaient dû être réopérés précocement pour repositionnement de leur implant qui était instable. Aucun implant n'avait dû être retiré. Cette arthroplastie d’interposition en pyrocarbone est une alternative fiable à l'arthrodèse totale ou à la prothèse totale du poignet dans le traitement du poignet rhumatoïde. Les indications doivent être limitées à un poignet axé avec un appareil capsuloligamentaire compétent.
Explant analysis of a Maestro™ wrist prosthesis and calculation of its lubrication regime
2020, Journal of the Mechanical Behavior of Biomedical Materials
Citation Excerpt :
The functional range of motion of the natural wrist has been defined as 5° of flexion, 30° extension, 10° of radial deviation and 15° of ulnar deviation (Yeoh and Tourret, 2015). The Maestro™ wrist was found to be the only third-generation wrist that achieved this functional range of motion (Nydick et al., 2012) compared to other third-generation wrists such as the Universal, Universal 2, Biaxial, Remotion and Motec (Yeoh and Tourret, 2015). In addition, a 95% survivorship was recorded for the Maestro™ wrist at 8 years (Berber et al., 2018), whereas the mid-to long term survivorship of the Universal 2, Motec and the Remotion were 78%, 86% and 90% respectively (Schmidt, 2019).
Explant analysis can provide key insights to understanding failures of artificial joints and thus how they might be improved for the ultimate benefit of patients. There are no previous reports of explant analysis of an artificial wrist joint. In this study, an explanted metal-on-polymer Maestro wrist was analysed both in macro and nanoscales to estimate its biotribological performance. The articulation was formed between a cobalt chromium carpal head and an ultrahigh molecular weight polyethylene bearing. The surface roughness values of its articulating surfaces and the backside of the articulation were measured. On average, the articulating surface roughness values were calculated as 0.06 ± 0.02 μm and 1.29 ± 0.63 μm for the cobalt chromium carpal head and ultrahigh molecular weight polyethylene bearing, respectively. Both surfaces had negative skewness, indicating a preponderance of valleys. On the articulating surface of the carpal head, light scratches were observed, and no impingement was observed throughout the component. The polymeric surface had a polished appearance. It had unidirectional scratches at the centre of the articulation, pits of different sizes on its articulating surface, and matt white subsurface regions. The backside of the UHMWPE bearing and the convex surface of the radial body that it was sitting on, were found to have average surface roughness values of 4.23 ± 0.69 μm and 5.57 ± 1.05 μm, respectively. The difference in the means was not significant (p > 0.05). Taking the articulating surface roughness values, the lubrication regime that the explanted Maestro wrist operated under in vivo was estimated for varying physiological conditions, i.e. varying loads, entraining velocities and lubricant viscosities. In every case considered, the explant was found to operate under boundary lubrication.

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: A.V.H. receives royalties from, and has stock in, Upex and is a speaker for Biomet and Auxilium.

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Scientific articleClinical Outcomes of Total Wrist Arthroplasty

Purpose

Methods

Results

Conclusions

Type of study/level of evidence

Section snippets

Materials and Methods

Results

Discussion

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

Hand Clin

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

Scientific article
Clinical Outcomes of Total Wrist Arthroplasty