scholarly journals Proximal Row Carpectomy with Total Scapoidectomy vs. Conventional Carpal Resection for ReMotion Total Wrist Arthroplasty

2021 ◽  
Vol 10 (9) ◽  
pp. 1865
Author(s):  
Stefan M. Froschauer ◽  
Matthias Holzbauer ◽  
Dietmar Hager ◽  
Oskar Kwasny ◽  
Dominik Duscher
Keyword(s):  
Grip Strength ◽  
Clinical Assessment ◽  
Complication Rates ◽  
Proximal Row Carpectomy ◽  
Prosthesis Implantation ◽  
Total Wrist Arthroplasty ◽  
Significant Difference ◽  
Flexion Extension ◽  
Wrist Arthroplasty

High complication rates in total wrist arthroplasty (TWA) still lead to controversy in the medical literature, and novel methods for complication reduction are warranted. In the present retrospective cohort study, we compare the outcomes of the proximal row carpectomy (PRC) method including total scaphoidectomy (n = 22) to the manufacturer’s conventional carpal resection (CCR) technique, which retains the distal pole of the scaphoid (n = 25), for ReMotion prosthesis implantation in non-rheumatoid patients. Mean follow-up was 65.8 ± 19.8 and 80.0 ± 28.7 months, respectively. Pre- and postoperative clinical assessment included wrist flexion-extension and radial-ulnar deviation; Disability of Arm, Shoulder, and Hand scores; and pain via visual analogue scale. At final follow-up, grip strength and satisfaction were evaluated. All complications, re-operations, and revision surgeries were noted. Clinical complications were significantly lower in the PRC group (p = 0.010). Radial impaction was detected as the most frequent complication in the CCR group (n = 10), while no PRC patients suffered from this complication (p = 0.0008). Clinical assessment, grip strength measurements, and the log rank test evaluating the re-operation as well as revision function showed no significant difference. All functional parameters significantly improved compared to preoperative values in both cohorts. In conclusion, we strongly recommend PRC for ReMotion prosthesis implantation.

scholarly journals A prospective study on outcome of function after proximal row carpectomy

2019 ◽  
Vol 6 (1) ◽  
pp. 44
Author(s):  
Chaitanya Gadi ◽  
S. M. Venugopal ◽  
Bhaskaranand Kumar ◽  
Karthik Gudaru
Keyword(s):  
Prospective Study ◽  
Grip Strength ◽  
Neuromuscular Disorders ◽  
Wrist Flexion ◽  
Proximal Row Carpectomy ◽  
Significant Difference ◽  
Post Traumatic ◽  
A Prospective Study ◽  
Traumatic Arthritis

<p class="abstract"><strong>Background:</strong> Proximal row carpectomy (PRC) is a procedure with varied indications. The purpose of this study was to evaluate functional outcomes with PRC in wrist flexion deformities, neuromuscular disorders and also post-traumatic wrist arthritis.</p><p class="abstract"><strong>Methods:</strong> A prospective study was performed on all patients who underwent PRC between April 2015 and December 2017, in BIRRD (T) hospital, Tirupati, Andhra Pradesh with a minimum follow up of 6 months. Outcome was assessed in terms of range of motion (ROM), grip strength, quick disabilities of the arm, shoulder, and hand (QDASH) score and pain score. Data was analyzed using the Student t-test.<strong></strong></p><p class="abstract"><strong>Results:</strong> Thirty-two patients underwent PRC of which 12 are neuromuscular disorders, 10 are wrist flexion deformities, 10 are post-traumatic wrist arthritis. On the final follow-up, significant improvement in ROM was observed in wrist flexion deformities and neuromuscular disorders, whereas grip strength and QDASH scores showed a significant difference in post-traumatic wrist arthritis. Pain was studied only in post-traumatic wrist arthritis, all were very much pleased with pain reduction.</p><p class="abstract"><strong>Conclusions:</strong> PRC is fairly a reliable procedure for all the indications in our study. We consider that PRC is a promising procedure in correcting wrist flexion deformities. Though there has been significant improvement in all the parameters for all the cases, we consider this procedure is best suited for post-traumatic arthritis group.</p>

Re-motion total wrist arthroplasty: 39 non-rheumatoid cases with a mean follow-up of 7 years

2019 ◽  
Vol 44 (9) ◽  
pp. 946-950 ◽  
Author(s):  
Stefan M. Froschauer ◽  
Maximilian Zaussinger ◽  
Dietmar Hager ◽  
Manfred Behawy ◽  
Oskar Kwasny ◽  
...  
Keyword(s):  
Radial Component ◽  
Visual Analogue Scale Pain ◽  
Wrist Flexion ◽  
Level Of Evidence ◽  
Pain Scores ◽  
Total Wrist Arthroplasty ◽  
Flexion Extension ◽  
Analogue Scale Pain ◽  
Wrist Arthroplasty

We evaluated the outcomes of the Re-motion total wrist arthroplasty in 39 non-rheumatoid patients. The mean follow-up was 7 years (range 3–12). Postoperative wrist flexion-extension and radial-ulnar deviation as well as the scores of the Disability of Arm Shoulder and Hand questionnaire and the visual analogue scale pain scores improved significantly. Complications occurred in 13 wrists, five of which required further surgery. The most frequent complication was impingement between the scaphoid and the radial implant (n = 5), which can be avoided by complete or almost complete scaphoid resection. Periprosthetic radiolucency developed around the radial component in three cases and three radial screws loosened. Despite the incidence of high implant survival in 38 of 39 wrists over 7 years (97%), the complication rate is not satisfying. Knowledge of the risk of complications and patient selection are essential when making the decision to choose wrist arthroplasty over arthrodesis. Level of evidence: IV

Total wrist arthroplasty: a systematic review of the evidence from the last 5 years

2014 ◽  
Vol 40 (5) ◽  
pp. 458-468 ◽  
Author(s):  
D. Yeoh ◽  
L. Tourret
Keyword(s):  
Range Of Motion ◽  
Survival Rates ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Total Wrist Arthroplasty ◽  
Functional Scores ◽  
Wrist Fusion ◽  
Wrist Arthroplasty

We reviewed evidence on total wrist replacement from the last 5 years. Eight articles met a minimum set standard. The results of 405 prostheses were available, including seven different manufacturers. The mean follow up was 2.3–7.3 years with an average age of 52–63. Rheumatoid arthritis was the indication in 42% of patients. Motec demonstrated the best post-operative DASH scores. Only Maestro achieved a defined functional range of motion post-operatively. Universal 2 displayed the highest survival rates (100% at 3–5 years), while Elos had the lowest (57% at 5 years). Biaxial had the highest complication rates (68.7%), while Remotion had the lowest (11%). Wrist arthroplasty preserves some range of motion. Functional scores improved and were maintained over the mid- to long-term. Complication rates were higher than wrist fusion, with reports of radiological loosening and osteolysis. The evidence does not support the widespread use of arthroplasty over arthrodesis, and careful patient selection is essential. Level of Evidence: III

scholarly journals Universal 2 Wrist Arthroplasty in Rheumatoid Arthritis

2017 ◽  
Vol 06 (03) ◽  
pp. 206-215 ◽  
Author(s):  
Giovanni Munz ◽  
Giulia Guidi ◽  
Massimo Ceruso ◽  
Sandra Pfanner
Keyword(s):  
Rheumatoid Arthritis ◽  
Pain Relief ◽  
Grip Strength ◽  
Visual Analogue Scale Pain ◽  
Level Of Evidence ◽  
Flexion Extension ◽  
The Mean ◽  
Wrist Arthroplasty

Purpose The aim of this study was to evaluate the mid- to long-term outcomes and complications in patients affected by rheumatic diseases treated with the Universal 2 (U2) total wrist arthroplasty (TWA). Methods We reviewed, in a retrospective, noncontrolled cohort study, 22 patients affected by rheumatoid arthritis (RA), who underwent U2 total wrist replacement between March 2003 and January 2014 for the treatment of 23 rheumatoid wrists with the aim of obtaining the remission of pain and a range of motion (ROM) useful for daily activities, according to the patients' demands, as an alternative to total wrist arthrodesis. The cohort of patients included 20 females and 2 males, with a mean age of 54.9 years. Residual pain, preoperative ROM, postoperative ROM increases, grip strength, radiographic changes, long-term complications, and reasons for revision or failures were evaluated. Results In this study, 22 patients were evaluated at a mean follow-up of 82.3 months (range: 2–12 years). All patients had good or complete pain relief, the mean visual analogue scale pain score was 0.82. The mean grip strength improved and postoperatively was 11 kg (Jamar). The mean total ROM of flexion–extension was 72.3 degrees; radial–ulnar deviation 24.9 degrees. The mean QuickDASH score of 49 and patient rate wrist/hand evaluation of 41.7 a revision surgical procedure in six cases (26%): in two cases, a carpal component revision procedure and in four cases, total implant failures requiring either conversion to a Swanson spacer or wrist joint fusion. Conclusion TWA provides pain relief, preserves motion, and improves function in severe degenerative RA. Our results at a mid- to long-term follow-up with the U2 prosthesis were encouraging and represent, when indicated, a valid alternative to fusion which is less appealing for RA patients. Level of Evidence Level of evidence is therapeutic IV.

Proximal Row Carpectomy through a Palmar Approach

1998 ◽  
Vol 23 (3) ◽  
pp. 406-409 ◽  
Author(s):  
R. LUCHETTI ◽  
O. SORAGNI ◽  
T. FAIRPLAY
Keyword(s):  
Grip Strength ◽  
Slight Reduction ◽  
Wrist Flexion ◽  
Proximal Row Carpectomy ◽  
Ulnar Deviation ◽  
Dynamic Studies ◽  
Palmar Approach ◽  
Flexion Extension ◽  
Subchondral Sclerosis

From 1990 to 1994, nine proximal row carpectomies were done through a palmar approach. With an average follow-up of 20 months, seven of the nine patients were completely painfree. Average range of wrist flexion/extension remained unchanged, and average radial/ulnar deviation increased from 25° to 46°. All the patients demonstrated an increase in grip strength in the operated hand. Four cases showed a slight reduction in articular space and subchondral sclerosis in the radiocapitate articulation, in spite of good function. Dynamic studies demonstrated no sign of radiocarpal instability. All the patients were very satisfied with the results and returned to their previous work within 2 months, on average.

scholarly journals No Benefits of Combining Proximal Row Carpectomy With PIN Neurectomy for Wrist Disorders—A Comparative Study With Systematic Review of the Literature

2019 ◽  
Vol 27 (2) ◽  
pp. 130-134
Author(s):  
Mesut Tahta ◽  
Yener Aydin ◽  
Firat Erpala ◽  
Mehmet Yildiz ◽  
Izge Gunal ◽  
...  
Keyword(s):  
Systematic Review ◽  
Comparative Study ◽  
Review Of The Literature ◽  
Inclusion Criteria ◽  
Proximal Row Carpectomy ◽  
Ulnar Deviation ◽  
Significant Difference ◽  
Flexion Extension ◽  
Group 2

Background: Posterior interosseous nerve (PIN) resection in combination with proximal row carpectomy (PRC), is a preferred method in order to obtain rapid recovery. However, the contribution of such combination to results isn’t known well. Objectives: We performed a comparative study to evaluate the effects of PIN neurectomy for PRC and a systematic review of the literature was performed to identify whether such combination has an advantage. Methods: Patients with wrist diseases who underwent PRC were evaluated retrospectively. Patients without PIN neurectomy (group 1, n = 7) and with PIN neurectomy (group 2, n = 8) were compared in respect of mean age, follow-up, gender, Q-DASH, VAS, MAYO wrist scores, flexion–extension/radial–ulnar deviation range of motion at final follow-up. The MEDLINE database was searched for studies published between 2005 and 2015, as the second part of the study. The following keywords were used: “proximal,” “row,” “carpectomy.” Studies, which met the inclusion criteria, were evaluated in terms of such combination. Results: There were no significant difference between the groups in regard with age ( P = .463), follow-up period ( P = .728), the ranges of flexion–extension ( P = .431) and radio–ulnar deviation ( P = .689), Q-DASH ( P = .452), and MAYO scores ( P = .728). In the second part of the study, 12 studies met the inclusion criteria and none of them was specifically evaluating such combination. Only one study had specific comments on PRC with PIN neurectomy. Conclusion: According to our study (which, to our knowledge, was the first comparative study in the literature), we advocate not to combine PRC with PIN neurectomy for such an approach has no advantage.

Results of Tri-Ligament Tenodesis: A Modified Brunelli Procedure in the Management of Scapholunate Instability

2006 ◽  
Vol 31 (1) ◽  
pp. 110-117 ◽  
Author(s):  
S. C. TALWALKAR ◽  
A. T. J. EDWARDS ◽  
M. J. HAYTON ◽  
JOHN H. STILWELL ◽  
I. A. TRAIL ◽  
...  
Keyword(s):  
Grip Strength ◽  
Visual Analogue Score ◽  
Contralateral Side ◽  
Range Of Movement ◽  
Scapholunate Instability ◽  
Early Results ◽  
Significant Difference ◽  
Flexion Extension ◽  
Static Instability

One hundred and sixty-two patients with a diagnosis of scapholunate instability underwent a modified Brunelli procedure over a 7-year period. One hundred and seventeen were assessed with the help of a questionnaire and, of these, 55 patients attended for clinical evaluation. The mean follow-up was 4 (1–8) years. There were 72 patients with dynamic scapholunate instability and 45 patients with static instability. The average age was 38 years. There were 50 males and 67 females. A total of 77 (62%) patients had no to mild pain with a mean visual analogue score of 3.67 (SD = 2.5). The loss in the arc of flexion–extension was due to a reduced range of flexion (mean loss 31%), while 80% of extension was maintained, compared with the contralateral side. The grip strength on the operated side was reduced by 20% of the non-operated side. There was no statistically significant difference ( P>0.05). in the range of movement or the grip strength between the static and dynamic group and patients with or without legal claims. Ninety (79%) patients were satisfied with the result of the surgery (good to excellent) and 88% of the patients felt that they would have the same surgery again. We feel that these results compare favourably with the early results published from this unit and recommend this procedure for dynamic and static scapholunate instability.

scholarly journals Ulnar Head or Total Distal Radioulnar Joint Replacement, Isolated and Combined with Total Wrist Arthroplasty: Midterm Results

2020 ◽  
Vol 09 (05) ◽  
pp. 411-416
Author(s):  
Robert Gvozdenovic ◽  
Michel Boeckstyns ◽  
Søren Merser
Keyword(s):  
Grip Strength ◽  
Distal Radioulnar Joint ◽  
Long Term Results ◽  
Midterm Results ◽  
Radioulnar Joint ◽  
Ulnar Head ◽  
Total Wrist Arthroplasty ◽  
Wrist Arthroplasty ◽  
Normally Distributed

Abstract Purpose Various implants have been described for ulnar head replacement (UHR) or for total replacement of the distal radioulnar joint (DRUJ). Many series are small and few reports on mid- or long-term results. This study is primarily aimed to report on the midterm results after ulnar head only and total DRUJ replacement using the uHead in the treatment of painful disorders of the DRUJ. The secondary aim of the study was to eventually assess the combination of UHR and total wrist arthroplasty (TWA). Materials and Methods We included 20 consecutive patients in whom an UHR with the uHead was performed at our institution between February 2005 and March 2017. There were 6 men and 14 women with mean age of 59 years (range: 36–80 years). The mean follow-up time was 5 years (range: 2–15 years). Data were recorded prospectively before operation and at follow-up examinations and entered in a registry. The patients were followed-up at 3 and 6 weeks and 3, 6, and 12 months postoperatively and thereafter annually. In five cases, the uHead was implanted simultaneously with a Remotion TWA. In four cases, a Remotion TWA had been implanted previously. Kaplan–Meier survival analysis was used to estimate the cumulative probability of remaining free of revision. A nonparametric Wilcoxon's signed-rank test was used for comparing data not normally distributed (qDASH [quick disabilities of the hand, shoulder, and arm] scores), and the paired parametric Student's t-test was used for normally distributed data (pain and visual analogue scale [VAS] scores, range of motion, and grip strength). Significance was set at a p-value of less than 0.05. Results Pain, grip strength, and the function improved significantly. Pain after surgery decreased with 50 points on the VAS score scale of 100, from 66 (mean), preoperatively (range: 16–97) to 16 (mean; range: 0–51), postoperatively, while grip strength nearly doubled from 12 KgF (mean; range: 4–22), before to 21 KgF (mean; range: 6–36), after the surgery. Patients function measured with qDASH scores improved from 56 (mean; range: 36–75), preoperatively to 19 (mean; range: 4–47), postoperatively. Wrist extension, flexion, and ulnar and radial deviation did not change to a clinically or statistically significant extend, neither did supination nor pronation improved after surgery. While three UHRs were revised early because of pain problems and/or unsatisfactory forearm rotation in two cases and infection in one, 17 had an uncomplicated postoperative course and these patients were satisfied with the results of the surgery at all the follow-ups. Due to limited number of cases, the calculation of significance in comparing combined cases with UHR only cases was abandoned. Conclusion Ulnar head arthroplasty (uHead) showed significant improvement in pain, grip strength, and the function of the patients with a painful disability of the DRUJ, without impairment on mobility on the midterm follow-up. The overall implant survival over the time and the complication rate was acceptable.

Dynamic assessment of the wrist after total wrist arthroplasty

2017 ◽  
Vol 42 (6) ◽  
pp. 573-579 ◽  
Author(s):  
H.P. Singh ◽  
D. Bhattacharjee ◽  
J.J. Dias ◽  
I. Trail
Keyword(s):  
Grip Strength ◽  
Dynamic Assessment ◽  
Hand Function ◽  
Normal Volunteer ◽  
Total Wrist Arthroplasty ◽  
Flexion Extension ◽  
Patient Reported ◽  
Function Test ◽  
Sollerman Hand Function Test ◽  
Wrist Arthroplasty

Our aim was to assess the outcome in patients with total wrist arthroplasty performed for end stage wrist osteoarthritis. We analysed the ranges of motion of operated and un-operated wrists using a flexible electrogoniometer during the Sollerman hand function test. We assessed grip strength with a digital dynamometer and completed patient reported outcome scores more than one year post-operatively. We reviewed 12 patients with a mean age of 64 (range 48–82) years. The flexion-extension arc was 72% and radioulnar deviation arc was 53% of the un-operated side but the total range of motion (area of circumduction) was 43% of the un-operated side and only 20% of the circumduction in age and gender-matched normal volunteers. Peak grip strength was 68% of the un-operated side. The patients reported good outcome with mean Michigan Hand Questionnaire (MHQ) scores of 56 (range 25–84) and mean Patient Evaluation Measure (PEM) scores of 39 (range 20–68). Patients completed the activities of Sollerman hand function test in twice the time (6 min) as required for a normal volunteer (2.8 min). The circumduction ellipses were narrow and central with limited radio-ulnar deviation and small mean areas of motion during activities of daily living.

Motec Wrist Arthroplasty: 4 Years of Promising Results

2018 ◽  
Vol 23 (03) ◽  
pp. 364-368 ◽  
Author(s):  
L. Giwa ◽  
A. Siddiqui ◽  
G. Packer
Keyword(s):  
Patient Demographics ◽  
Total Wrist Arthroplasty ◽  
Metal On Metal ◽  
Flexion Extension ◽  
Post Traumatic ◽  
Wrist Fusion ◽  
Wrist Function ◽  
Traumatic Arthritis ◽  
Wrist Arthroplasty

Background: The Motec cementless modular metal-on-metal ball-and-socket wrist arthroplasty is an implant with promising intermediate results. An alternative to primary wrist fusion, total wrist arthroplasty is an option for active patients, who wish to retain their wrist function. It is indicated in cases of degenerative osteoarthritis, post-traumatic arthritis and rheumatoid (inflammatory) arthritis. Methods: A prospective review of patient demographics, pre and post-operative Disabilities of the Arm Shoulder and Hand (DASH), MAYO scores, range of movements and grip strengths. All complications in follow up were recorded across the 4 year period. Results: 25 implants on 23 patients over 5.5 years, mean age 61; 8 females and 15 male. 10 patients with SLAC, 3 SNAC, 5 inflammatory and 7 patients with generalized osteoarthritis. The patients showed significant improvements of MAYO and DASH scores post-operatively, as well as the flexion/extension arc and grip strengths. There was just one case of implant loosening- the radial screw after a wound infection, which was revised with a longer screw. Two implants were converted to Motec fusion due to pain. One implant was dislocated and relocated. The remaining patients have had good wrist function. Only 6 patients were unable to return to work. Conclusions: Similar to published studies, this series shows the Motec implant to be a good motion preserving alternative to total wrist fusion.

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