New concept for total wrist replacement

Abstract

Wrist prostheses have never achieved the sort of clinical outcomes found with those of hips and knees. We have developed a novel uncemented modular wrist prosthesis with screw fixation, metal-on-metal coupling, and ball-and-socket articulation. Eight patients admitted for wrist arthrodesis to treat primary or secondary osteoarthritis (not rheumatoid) were operated on. The prosthesis reduced the amount of bone removed and spared the distal radioulnar joint. After 7 to 9 years we found that the fixed centre of the ball-and-socket articulation provided good stability and mobility, and relief of pain and grip strength were satisfactory. We saw no luxations, metacarpal fractures or cut-outs, or mechanical failures of the implants. Two distal screws loosened (revised with new distal screws), and one early inflammation and one late infection occurred (revised to arthrodesis). We propose modifications to the implant with reduction in the diameter of the screws and the height of the threads, and rounding of the distal tip. The technique should include release of the third carpometacarpal joint, alignment of the capitate and the third metacarpal, and arthrodesis of the joint with bone chips.

Systematic Review of Total Wrist Arthroplasty and Arthrodesis in Wrist Arthritis

“…1. Of the remaining 43 articles, 17 studies reported wrist arthrodesis outcomes, 3,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] 24 reported the outcomes from wrist arthroplasty, [9][10][11][12][13][14][15][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52] and 2 undertook a retrospective matched cohort review of arthroplasty versus arthrodesis. 4,5 Results ►Table 1 summarizes the overall patient demographics.…”

“…26 Of the arthroplasty studies, seven were prospective in nature. 13,37,38,44,45,47,51 A variety of wrist arthrodesis techniques were described in the studies and are summarized in ►Table 2. In rheumatoid arthritis patients, Rush pin and staples were commonly used employing the technique widely advocated by Mannerfelt and Malsten.…”

Review Article: Total Wrist Arthroplasty

“…In addition to the meta-analysis for second-and third-generation implants, 7 this review added 8 new studies of fourth-generation implants, 6,8,9,12,13,16,22,23 3 new studies of third-generation implants, 14,15,17 and one long-term registry study. 18 TWA tends to fail earlier than hip or knee arthroplasties, but TWA has better short-term outcome.…”

“…extension, flexion, ulnar deviation, radial deviation, pronation, and supination) and grip strength, based on several wrist scoring systems. 6,[8][9][10][11][12][13][14][15][16][17][19][20][21][22][23] Eight studies used the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire or its shortened version. 9,12,[14][15][16][17]22,23 The DASH questionnaire consists of 30 items related to activities of daily living and symptoms.…”

Designing and Prototyping of New Device for Scapholunate Ligament Repair

“…Both were pioneers in this research. More recently Amit Gupta [11] and Astor Reigstad, et al [12] continued in this direction using more novelty concepts of total wrist implants. L. Filan, et al [13] analyzed the Herbet screw used to repair a scaphoid bone fracture.…”