"Off label" use of the ReMotionTM total wrist for treatment of advanced stage of post-traumatic pancarpal wrist osteoarthritis: Report of two cases and review of literature

Abstract

The ReMotion total wrist is one 3rd generation implant which is current in use. Mid-to long-term outcomes regarding its survivorship revealed satisfying results. However, this implant has a design-related issue resulting in development of painful radial-side impingement. We present two cases involving two modified implantation techniques ((1) complete removal of scaphoid accompanied by partial cement augmentation of the radial-side fixation screw for carpal component, and (2) positioning of both fixation screws for carpal component into the scaphoid adjacent to the capitate peg without crossing the carpometacarpal joins) which could be able to avoid this specific complication. However, such an "off label" use in the absence of a larger number of patients and further biomechanical investigations can only be used in single cases currently.

Total Wrist Replacement: State of the Art, Challenges and Pitfalls: A Comparative Review

“…For TWR only in a single case report at a short-term follow-up was reported about that in the literature ("off label" use), and further studies are needed to validate this concept (Figure 7) [76]. If the deteriorated radial deviation with the Universal2 / Freedom is also accompanied by a painful radial impingement is unknown to the author of this article content.…”

“…Historically, metallosis was found to be the most important cause for loosening with the metal-on-metal gliding implants [42]. However, it is also be observed in individual cases with the use of the 3rd generation types caused by micromotions at the interface between the (non-locking) fixation screws and the bone with or without loosening of the carpal components (Figures 8 and 9), impingement between the carpal plates and the surrounding carpal bones often presented primarily as carpal tunnel syndrome, or impingement between the radial TWR component and an additional UHR with a metal head [56][57][58]76,[80][81][82][83]. Recently, there is a consensus in the literature that the main cause for a failed 3rd generation type is mechanical imbalance of its carpal components, and secondarily followed by metallosis and PE wear (Figure 9) [32][33][34]58,63].…”