Biaxial total wrist replacement in patients with rheumatoid arthritis

Takwale, V. J.; Nuttall, D.; Trail, I. A.; Stanley, John

doi:10.1302/0301-620x.84b5.12276

Cited by 65 publications

(36 citation statements)

References 15 publications

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“…Five of the replacements were revised or fused because of loosening, and an additional 9 showed radiographic signs of loosening [25]. Another short-term study of 16 Biax wrists showed good-to-excellent results in 69% at a mean 25-month follow-up.…”

Section: Resultsmentioning

confidence: 97%

Total Wrist Arthroplasty

Anderson

Adams

2005

Hand Clinics

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Section: Resultsmentioning

confidence: 97%

Total Wrist Arthroplasty

Anderson

Adams

2005

Hand Clinics

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“…TWA is an established alternative that preserves some motion and improves patient satisfaction. Particularly in patients with bilateral disease, patients with a TWA on one side and arthrodesis on the other preferred the side with the arthroplasty [13]. However, historically TWA has been associated with a high number of complications and concerns regarding survivorship [1,4,6,7,[9][10][11][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

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

Wagner

Srnec

Mehrotra

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Total wrist arthroplasty (TWA) can relieve pain and preserve some wrist motion in patients with advanced wrist arthritis. However, few studies have evaluated the risks and outcomes associated with periprosthetic fractures around TWAs. Questions/purposes (1) What is the risk of intraoperative and postoperative fractures after TWAs? (2) What factors are associated with increased risk of intraoperative and postoperative fracture after TWAs? (3) What is the fracture-free and revision-free survivorship of TWAs among patients who sustained an intraoperative fracture during the index TWA? Methods At one institution during a 40-year period, 445 patients underwent primary TWAs. Of those, 15 patients died before 2 years and 5 were lost to followup, leaving 425 patients who underwent primary TWAs with a minimum of 2-year followup. The primary diagnosis for the TWA included osteoarthritis ([OA] 5%), inflammatory arthritis (90%), and posttraumatic arthritis (5%). Indications for TWA included pancarpal arthritis combined with marked pain and loss of wrist function. The mean age of the patients was 57 years, BMI was 26 kg/m 2 , and 73% were females. Six different implants were used during the 40-year period. Mean followup was 10 years (range, 2-18 years). Results Intraoperative fractures occurred in nine (2%) primary TWAs, while postoperative fractures occurred after eight (2%) TWAs. After analyzing demographics, comorbidities, and surgical factors, intraoperative fractures were found to be associated with only age at surgery (hazard ratio [HR], 1.10; 95% CI, 1.03-1.20; p = 0.006) and use of a bone graft (HR, 5.80; 95% CI, p = 0.03). No factors were found to be associated with increased risk of postoperative fractures; specifically, intraoperative fracture was not associated with subsequent fracture development. The 5-, 10-, and 15-year KaplanMeier survival rates free of postoperative fracture were 99%, 98%, and 95%, respectively. The 5-and 10-year revision-free survival rates after intraoperative fracture were 88% and 88%, respectively, compared with 84% and 74% without an intraoperative fracture (p = 0.36). Furthermore, the survival-free of revision surgery rates for aseptic distal loosening at 5 and 10 years were 88% and 88%, respectively, compared with 93% and 87% without a fracture (p = 0.85). Conclusions Intraoperative fractures occur in approximately 2% of TWAs. These fractures do not appear to affect long-term implant survival or risk of fracture. Patient age and the need for bone graft were the only factors in the risk of intraoperative fractures. Postoperative fractures also occur in 2% of TWAs, but often result in revision surgery.

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“…[3][4][5] Total wrist arthroplasty has also been found to be unsuitable for severe joint malformation, chronic subluxion, and collapse of the carpal bone. 6 It is clear that optimum treatments are required for each stage of RA joint destruction.…”

Section: Introductionmentioning

confidence: 99%

Motion analysis of the wrist joints in patients with rheumatoid arthritis

et al. 2007

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We investigated the characteristics of the wrist joint motion in patients with rheumatoid arthritis (RA), using a biaxial flexible goniometer. Wrist joint range of motion and velocity were measured on the dominant hand in RA patients (n = 22) and normal individuals (n = 5). We investigated flexion-extension (FE) task, radial-ulnar deviation (RUD) task, and functional motion tasks, such as writing letters or unscrewing the lid of a jar. In normal individuals, there was cooperative coupling of FE and RUD during wrist movement, and this coupling motion was essential for normal wrist movements. On the other hand, in RA patients, wrist joint range of motion was restricted at various degrees, with reduced joint motion velocity that was severe on RUD. Functional wrist motion tasks indicated circumductive movement with both FE and RUD in normal individuals, whereas the direction of movement was limited in RA patients, and results revealed failure of cooperative coupling of FE and RUD. Our results indicate that disturbed coupling of FE and RUD results in difficulties in the cooperative movements and have great influence on the daily activities in RA wrist joint.

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Biaxial total wrist replacement in patients with rheumatoid arthritis

Cited by 65 publications

References 15 publications

Total Wrist Arthroplasty

Total Wrist Arthroplasty

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

Motion analysis of the wrist joints in patients with rheumatoid arthritis

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