Can total wrist arthroplasty be an option in the treatment of the severely destroyed posttraumatic wrist?
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ABSTRACT:
SUBMITTER: Boeckstyns ME
PROVIDER: S-EPMC3826242 | biostudies-other | 2013 Nov
REPOSITORIES: biostudies-other
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Project description:We present two case reports of successful primary shortening of the forearm and total wrist arthroplasty (TWA) using the new angle-stable Maestro Wrist Reconstructive System (WRS) for treatment of highly comminuted distal radius fracture in selected autonomous patients. In a 56-year-old male patient with adequate bone stock, insertion of the noncemented Maestro WRS was combined with ulnar shortening osteotomy. In an 84-year-old female patient with poor osteoporotic bone stock, insertion of the radial cemented Maestro WRS was combined with ulnar head resection. Both patients could resume their work without additional surgery after TWA. At the 1-year follow-up, there were no changes in position of either implant without signs of loosening, no impingement, and no instability of the distal radioulnar joint or the distal ulna stump. All clinical parameters (DASH score, pain through VAS, and grip strength) were satisfactory. Both patients reported that they would have the same procedure again. Further experience is needed to validate this concept.
| S-EPMC4603322 | biostudies-literature
Project description:Background and Literature Review Periprosthetic osteolysis (PPO) after second- or third-generation total wrist arthroplasty (TWA), with or without evident loosening of the implant components, has previously been reported in the literature, but rarely in a systematic way. Purpose The purpose of this study was to analyze the prevalence, location, and natural history of PPO following a TWA and to determine whether this was associated with prosthetic loosening. Patients and Methods We analyzed 44 consecutive cases in which a RE-MOTION TWA (Small Bone Innovations Inc., Morrisville, PA, USA) had been done. Results We found significant periprosthetic radiolucency (more than 2 mm in width) at the radial component side in 16 of the cases and at the carpal component side in 7. It developed gradually juxta-articularly around the prosthetic components regardless of the primary diagnosis, and seemed to stabilize in most patients after 1-3 years. In a small percentage of the patients, the periprosthetic area of bone resorption was markedly larger. In general, radiolucency was not related to evident loosening of the implant components, and only five carpal components and one radial had subsided or tilted. Conclusion Periprosthetic loosening is frequent following a TWA. In our series it was not necessarily associated with implant loosening and seemed to stabilize within 3 years. Close and continued observation is, however, recommended. Level of Evidence Therapeutic IV.
| S-EPMC4078145 | biostudies-other
Project description:Treatment of severely destroyed rheumatoid wrists with total wrist arthroplasty or total wrist arthrodesis relies on patient and surgeon preferences rather than rigorous prospective outcomes data. The purpose of this study is to develop a decision analytic model of arthroplasty and arthrodesis in rheumatoid arthritis (RA) using utility values obtained from a random sample of hand surgeons.A utility survey using a time trade-off design was administered to 175 members of the American Society for Surgery of the Hand. Based on the results of the survey, the utility values that surgeons assign to health states associated with arthroplasty and arthrodesis and their complications were calculated. By combining utility values with complication rates in the published literature, we developed a decision tree to calculate the expected quality-adjusted life years (QALYs) for each procedure compared to living with a painful RA wrist.Based on surgeon preferences, living for 30 years with a painful, poorly functioning RA wrist (utility = 0.54) is associated with 16.2 QALYs. Treatment with arthroplasty (utility = 0.85) is associated with 25.5 QALYs, a gain of 9.3 QALYs over nonsurgical management. Arthrodesis (utility = 0.82) is associated with 24.6 QALYs, a gain of 8.4 QALYs over nonsurgical management. Arthroplasty is associated with a small incremental increase in QALYs (0.9) compared to arthrodesis.Based on utility scores, hand surgeons feel that living with a painful, poorly functioning RA wrist for 30 years is worth approximately half as many years with a painless, well-functioning wrist. The outcomes for arthroplasty and arthrodesis are valued more than nonsurgical management. On the basis of its higher expected gain in QALYs, arthroplasty should be the preferred treatment. The minimal increase in utility for arthroplasty over arthrodesis suggests however, that surgeons do not view arthroplasty as superior to arthrodesis.Economic and decision analysis IV.
| S-EPMC4410850 | biostudies-literature
Project description:Purpose There is a lack of quantitative research that describes the alignment and, more importantly, the effects of malalignment on total wrist arthroplasty (TWA). The main goal of this pilot study was to assess the alignment of TWA components in radiographic images and compare them with measures computed by three-dimensional analysis. Using these measures, we then determined if malalignment is associated with range of motion (ROM) or clinical outcomes (PRWHE, PROMIS, QuickDash, and grip strength). Methods Six osteoarthritic patients with a single type of TWA were recruited. Radiographic images, computed tomography images, and clinical outcomes of the wrists were recorded. Using posteroanterior and lateral radiographs, alignment measurements were defined for the radial and carpal components. Radiographic measurements were validated with models reconstructed from computed tomography images using Bland-Altman analysis. Biplanar videoradiography (<1mm and <1 degree accuracy) was used to capture and compute ROM of the TWA components. Linear regression assessed the associations between alignment and outcomes. Results Radiographic measures had a 95% limit-of-agreement (mean difference ± 1.96 × SD) of 3 degrees and 3mm with three-dimensional values, except for the measures of the carpal component in the lateral view. In our small cohort, wrist flexion-extension and radial-ulnar deviation were correlated with volar-dorsal tilt and volar-dorsal offset of the radial component and demonstrated a ROM increase of 3.7 and 1.6 degrees per degree increase in volar tilt, and 10.8 and 4.2 degrees per every millimeter increase in volar offset. The carpal component's higher volar tilt was also associated with improvements in patient-reported pain. Conclusions We determined metrics describing the alignment of TWA, and found the volar tilt and volar offset of the radial component could potentially influence the replaced wrist's ROM. Clinical Relevance TWA component alignment can be measured reliably in radiographs, and may be associated with clinical outcomes. Future studies must evaluate its role in a larger cohort.
| S-EPMC8328540 | biostudies-literature
Project description:BackgroundAllogenic blood transfusions increase the risk of multiple complications. We evaluated the influence of restricting transfusions in adults with osteoarthritis that underwent total hip or knee arthroplasty (THA/TKA) with severe postoperative anemia.Material and methodsPatients that underwent THA/TKA for osteoarthritis with postoperative hemoglobin (Hb) ≤ 8 g/dl were retrospectively identified. We evaluated characteristics and adverse postoperative outcomes of patients not transfused and compared them to those of patients who received postoperative transfusion. Adverse outcomes were 90-day readmission, reoperation, infection, and falls, as well as inpatient cardiovascular events and deaths.ResultsOne thousand eighty-seven patients meeting inclusion criteria underwent THA and TKA. The 399 patients (36.7%) who did not undergo transfuion were younger (67.4 vs 69.5 years, P = .008), healthier (American Society of Anesthesiologist ≤ 2: 64.2% vs 56%, P = .006), comprised a lower proportion of cardiovascular disease patients (13.8% vs 24.7%, P < .001), a lower proportion of patients with Medicare/Medicare Managed Care (57.2% vs 65.5%, P = .05), received tranexamic acid more frequently (66.4% vs 52.9%, P < .01), had a shorter procedure time (92.7 vs 103.1, P < .01), a lower postoperative drop in Hb (4.0 vs 4.2 g/dl, P = .022), a later drop in Hb (2.6 vs 2.2 days, P = .003), and a shorter length of stay (3.5 vs 4.8, P < .01). TKA patients underwent transfusion more frequently than THA patients (67.5% vs 59%, P = .004). There were no postoperative deaths. Adverse events were similar between the 2 groups.ConclusionFindings suggest that younger and healthier patients that have lower Hb later during their hospital stay need not undergo transfusion solely based on Hb levels. Routine transfusion triggers can be avoided even in more anemic patients.
| S-EPMC8924318 | biostudies-literature
Project description:Background Total wrist arthroplasty (TWA) is a viable surgical treatment for disabling wrist arthritis. While current designs are a notable improvement from prior generations, radiographic loosening and failures remain a concern. Purpose The purpose of this investigation is to evaluate a new total wrist arthroplasty design kinematically. The kinematic function of a native, intact cadaveric wrist was compared with that of the same wrist following TWA. Method Six, fresh-frozen wrist cadaveric specimens were utilized. Each wrist was fixed to an experimental table and its range of motion, axis of rotation, and muscle moment arms were calculated. The following tendons were attached to the apparatus to drive motion: extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), extensor carpi ulnaris (ECU), flexor carpi radialis (FCR), flexor carpi ulnaris (FCU), and abductor pollicis longus (APL). The wrist was then manually moved along a guide by an experimenter through a series of motions including flexion-extension, radial-ulnar deviation, and circumduction. The experiment was then performed on the specimen following implantation of the TWA. Results Following the TWA procedure, there were statistically significant decreases in the ulnar deviation and the flexion/ulnar deviation component of dart throw ranges of motion. There were no statistically significant changes in flexion, extension, radial deviation, the extension/radial deviation component of the dart thrower motion, or the circumduction range of motion. Conclusions Kinematic analysis of the new TWA suggests that a stable, functional wrist is achievable with this design. Clinical Relevance While appreciating the limitations of a cadaveric study, this investigation indicates that the TWA design studied merits study in human populations.
| S-EPMC4408131 | biostudies-other
Project description:Conversion of a failed total wrist arthroplasty to arthrodesis can be difficult. A custom-made titanium alloy peg was constructed to enable arthrodesis with the original arthroplasty components in situ. Two out of three patients were especially challenging cases with little bone available. Bony union was achieved in 2 to 3 months. The peg simplified a difficult revision situation and gave good, predictable results at follow-up.
| S-EPMC4117691 | biostudies-other
Project description:One of the contraindications to patella resurfacing in total knee arthroplasty is a thin and severely eroded 'deficient' patella. However, such patients often present with severe patellofemoral joint arthritis, patellar lateral subluxation, and patella maltracking, which can only be treated effectively with resurfacing. While various treatments have been proposed, options remain limited. Here we introduce a method of patella reconstruction using four 2.7-mm titanium cortical screws crossing each other into the inner shell of the patella. This provides a scaffold onto which bone cement and any standard polyethylene patellar component can be fixed. Postoperatively, the patient had no anterior knee pain, no patella maltracking, and no component loosening. Advantages of this technique include minimization of extensor disruption, low costs, easy accessibility, reproducibility, and improved mechanical strength.
| S-EPMC10665651 | biostudies-literature
Project description:Ischaemic preconditioning is a method of protecting tissue against ischaemia-reperfusion injury. It is an innate protective mechanism that increases a tissue's tolerance to prolonged ischaemia when it is first subjected to short burst of ischaemia and reperfusion. It is thought to provide this protection by increasing the tissue's tolerance to ischaemia, therby reducing oxidative stress, inflammation and apoptosis in the preconditioned tissue. We used microarrays to investigate the genomic response induced by ischaemic preconditioning in muscle biopsies taken from the operative leg of total knee arthroplasty patients in order to gain insight into the ischaemic preconditioning mechanism. Patients undergoing primary knee arthroplasty were randomised to control and treatment (ischaemic preconditioning) groups. Patients in the treatment group received a preconditioning stimulus immediately prior to surgery. The ischaemic preconditioning stimulus consisted of three five-minute periods of tourniquet insufflation on the lower operative limb, interrupted by five minute periods of reperfusion. All patients had a tourniquet applied to the lower limb after the administration of spinal anaesthesia, as per normal protocol for knee arthroplasty surgery. Muscle biopsies were taken from the quadriceps muscle of the operative knee at the immediate onset of surgery (T0) and at 1 hour into surgery (T1). Total RNA was extracted from biospies of four control and four treatment patients and hybridised to the Affymetrix Human U133 2.0 chip.
2010-04-12 | E-GEOD-21164 | biostudies-arrayexpress
Project description:PURPOSE:Posttraumatic arthritis (PTA) may develop years after acetabular fracture, hindering joint function and causing significant chronic musculoskeletal pain. Given the delayed onset of PTA, few studies have assessed outcomes of delayed total hip arthroplasty (THA) in acetabular fracture patients. This study systematically reviewed the literature for outcomes of THA in patients with PTA and prior acetabular fracture. METHODS:Pubmed, EMBASE, SCOPUS, and Cochrane library were searched for articles containing the keywords "acetabular", "fracture", "arthroplasty", and "post traumatic arthritis" published between 1995 and August 2017. Studies with less than 10 patients, less than 2 years of follow-up, conference abstracts, and non-English language articles were excluded. Data on patient demographics, surgical characteristics, and outcomes of delayed THA, including implant survival, complications, need for revision, and functional scores, was collected from eligible studies. RESULTS:With 1830 studies were screened and data from 10 studies with 448 patients were included in this review. The median patient age on date of THA was 51.5 years, ranging from 19 to 90 years. The median time from fracture to THA was 37 months, with a range of 27-74 months. Mean follow-up times ranged from 4 to 20 years. The mean Harris hip scores (HHS) improved from 41.5 pre-operatively, to 87.6 post-operatively. The most prevalent postoperative complications were heterotopic ossification (28%-63%), implant loosening (1%-24%), and infection (0%-16%). The minimum 5-year survival of implants ranged from 70% to 100%. Revision rates ranged from 2% to 32%. CONCLUSION:Despite the difficulties associated with performing THA in patients with PTA from previous acetabular fracture (including soft tissue scarring, existing hardware, and acetabular bone loss) and the relatively high complication rates, THA in patients with PTA following prior acetabular fracture leads to significant improvement in pain and function at 10-year follow-up. Further high quality randomized controlled studies are needed to confirm the outcomes after delayed THA in these patients.
| S-EPMC6033725 | biostudies-literature