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

Abstract

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.

Total Wrist Arthroplasty for Posttraumatic Wrist Osteoarthritis: A Cohort Study Comparing Three Indications

“…In this regard, we advocated for the PRC implantation technique, especially in SLAC and SNAC wrists. Thereby, radial impaction syndrome can be significantly reduced [ 13 ] and issues related to the sclerotic deformed scaphoid can be prevented due to its total removal. Recent advances in TWA’s implant design and materials have massively improved the initially high complication rates [ 24 ].…”

“…All patients received TWA using the ReMotion Total Wrist System (Stryker, Kalamazoo, Michigan). Several cases were already included in our previous study reporting non-rheumatoid patients [ 6 ] as well as the study comparing the PRC technique to the conventional carpal resection method [ 13 ]. One level IV surgeon performed the former ( Figure 1 b) and two other level IV surgeons performed the latter technique [ 14 ].…”

Wrist Hemiarthroplasty for Complex Intraarticular Distal Radius Fracture in a Patient with Manifest Osteoporosis

“…Therefore, the proximal row was completely removed to prevent the patient from reoperations due to carpal OA. Although we could prove in a previous study that PRC is a reliable surgical technique for total wrist arthroplasty [14], we decided against implanting the carpal component of the ReMotion prosthesis due to the patient's manifest osteoporosis. According to the World Health Organization, osteoporosis is defined as a metabolic bone disease characterized by low bone mass and microarchitectural deterioration of bone tissue causing progredient bone fragility and a higher risk for fracture [21].…”

“…Thus, we decided to perform a WHA as secondary surgery, which was finally performed 3 months after the initial trauma or first surgery, respectively. Our technique included a common dorsal approach and a PRC was performed as the first step [14]. Afterwards, the distal carpal row presented with an intact cartilage layer, while the joint surface of the distal radius was completely destroyed and palmarly dislocated.…”

Safety and efficacy of a novel three-dimensional printed microporous titanium prosthesis for total wrist arthroplasty in the treatment of end-stage wrist arthritis

“…This represented a significant improvement over previous generation. In this context, studies have reported better results with the fourth generation of artificial wrist joints (Bidwai et al, 2013;Froschauer et al, 2021). In contrast to wrist fusion, TWA preserves wrist mobility and provides effective pain relief (Fischer et al, 2020;Berber et al, 2020;Matsui et al, 2020;Zhu et al, 2021).…”