A randomized controlled trial comparing two modern total wrist arthroplasties

Abstract

Aims To analyze the short-term outcome of two types of total wrist arthroplasty (TWA) in terms of wrist function, migration, and periprosthetic bone behaviour. Methods A total of 40 patients suffering from non-rheumatoid wrist arthritis were enrolled in a randomized controlled trial comparing the ReMotion and Motec TWAs. Patient-rated and functional outcomes, radiological changes, blood metal ion levels, migration measured by model-based radiostereometric analysis (RSA), bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA), complications, loosening, and revision rates at two years were compared. Results Patient-Rated Wrist and Hand Evaluation (PRWHE) scores, abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire scores, and pain improved similarly and significantly in both groups. Wrist motion improved significantly in the Motec group only, and forearm rotation in the ReMotion group only. Cobalt (Co) and chromium (Cr) blood ion levels were significantly higher in the metal-on-metal (MoM) Motec group than in the metal-on-polyethylene (MoP) ReMotion group. Mean total translation was 0.65 mm (95% confidence interval (CI) 0.26 to 1.12) and 0.27 mm (95% CI 0.14 to 0.47) for the ReMotion carpal and radial components, and 0.32 mm (95% CI 0.22 to 0.45) and 0.26 mm (95% CI 0.20 to 0.34) for the Motec metacarpal and radial components, respectively. Apart from dorsal and volar tilts, which were significantly higher for the radial ReMotion than for the Motec component, no significant differences in absolute migration occurred. BMD around the radial components never returned to baseline. Almost one-third of patients required reoperation due to complications. Two ReMotion implants were revised to Motec TWAs due to carpal component loosening, and three Motec MoM articulations were revised to metal-on-polyether ether ketone due to painful synovitis. Conclusion Both implants provided matched function and were stable at short-term follow-up, but with a high complication rate. This procedure should be restricted to specialist centres undertaking prospective analysis until its role is clarified. Cite this article: Bone Joint J 2022;104-B(10):1132–1141.

Complication rates and modes of short and medium-term failure in Motec total wrist arthroplasty: an international cohort study

“…Our study did not see any difference in complication or revision rates with different articulations and, as such, our data do not support the statement by Holm-Glad et al. (2022) that recommended ‘discontinuing the use of MoM in TWA’ in favour of MoP; a statement which was based upon three cases of unclassified osteolysis, presumed but not proved to be the fault of the articulation in a series of 40 MoM implants.…”

“…Our reported complication rate of 19% compares favourably with a large single surgeon study by Reigstad and Rokkum (2018), with a reported 32% complication rate (35 in 110 Motec TWA). Our rates also compare well with a more recent randomized controlled trial comparing Motec TWA with another implant that had complication rates of 35% and revision rates of 15% for the Motec group (Holm-Glad et al., 2022). A systematic review of TWA complications found a 31% complication rate in arthroplasty cases over a range of generations and devices, though this complication rate dropped to 13% in later fourth-generation models (Berber et al., 2018).…”

A systematic review and network meta-analysis of outcomes after total wrist arthroplasty in inflammatory and non-inflammatory arthritis

“…The search yielded 1858 results. After screening and full-text review, 12 studies met the inclusion criteria (Figure 1) (Badge et al., 2016; Boeckstyns et al., 2013; Brinkhorst et al., 2018; Ferreres et al., 2011; Harlingen et al., 2011; Holm-Glad et al., 2022; Holzbauer et al., 2022; Honecker et al., 2019; Matsui et al., 2020; Reigstad et al., 2012, 2017; Rossello et al., 2022). Reigstad et al.…”

“…Online Figure S1 show the ROB scores for the included studies. There were five prospective studies, six retrospective studies and one RCT (note that the series by Holm-Glad et al. (2022) was an RCT, but the comparison arms were two different TWA implants; therefore, this was included and analysed as a prospective study using ROBINS-1).…”

“…In total, 10 studies reported DASH or Quick-DASH scores (Badge et al., 2016; Boeckstyns et al., 2013; Brinkhorst et al., 2018; Harlingen et al., 2011; Holm-Glad et al., 2022; Holzbauer et al., 2022; Honecker et al., 2019; Matsui et al., 2020; Reigstad et al., 2012, 2017). TWA was found to significantly improve DASH or Quick-DASH scores for both indications compared to preoperative baselines.…”