Uncemented
total wrist arthroplasty performed with third generation
implants in patients with arthritis showed a 7% revision rate at 5 years,
according to a study presented by Robin Kamal, MD, at the
2011 Annual Meeting of the American Society for Surgery of the
Hand.
“Our study shows that because the revision rate is so low with the
uncemented use of newer generation
total wrist implants, potentially, total wrists could be used
to treat severe arthritis of the wrist over a wrist fusion, because [total
wrists] allow patients to have wrist motion,” Kamal said.
Chart review
Kamal and colleagues at Rhode Island Hospital retrospectively reviewed
the charts of 30 patients who underwent total wrist arthroplasty performed by
senior surgeon and study researcher, Arnold-Peter C. Weiss, MD, using the third
generation Universal 2 implant (Integra; Plainsboro, N.J.).
The study group had an average age of 58 years and included 27 women and
three men, according to the study abstract. Patients indicated for surgery had
rheumatoid arthritis, juvenile rheumatoid arthritis, psoriatic arthritis or
post-traumatic arthritis. The dominant wrist was the wrist affected in 57% of
patients.
|
The
5-year follow-up radiographs and clinical images of a patient who underwent a
total wrist arthroplasty are shown here.
Images: Kamal R |
The group included 27 primary procedures and three revisions of
previously cemented total wrist replacements. For the revision procedures, the
surgeon first removed all the cement and original implant before performing an
uncemented total wrist arthroplasty using the third generation device.
Postoperatively, the patients were casted for 4 weeks and then underwent hand
therapy.
The average follow-up was 5.1 years, “which is the longest
follow-up for uncemented” total wrist arthroplasty, according to Kamal.
Follow-up revealed that patients had 40° active flexion and 28°
extension. Radiographs showed that eight patients had evidence of lucency along
the carpal component and two patients showed lucency along the radial
component. Two patients required revision for carpal implant loosening.
Further study needed
Although some patients in the study reported mild pain, most had no
pain. In addition, all of the patients were satisfied.
“We found we had no dislocations and our revision rate was 7%,
which is relatively low compared to prior studies that have reviewed total
wrist arthroplasties,” Kamal said.
Work remains to determine the long-term efficacy of uncemented total
wrist arthroplasty, according to Kamal, but questions still posit whether they
are more effective than wrist fusion.
“Our study suggests that uncemented total wrist arthroplasties have
a low revision rate and may be a better alternative than wrist fusion. However,
more long-term studies and randomized controlled trials need to be completed to
discern the advantages and disadvantages as well as patient-reported outcomes
of total wrist arthroplasty,” Kamal said. – by Renee Blisard
Reference:
- Cone EB, Kamal R, Weiss AC. Uncemented total wrist arthroplasty:
Long-term results. Paper #59. Presented at the 2011 Annual Meeting of the
American Society for Surgery of the Hand. Sept. 8-10. Las Vegas.
- Robin Kamal, MD, can be reached at the Department of Orthopedics,
Rhode Island Hospital, 593 Eddy St., Providence, RI 02903; 401-444-4000; email:
robin_kamal@brown.edu.
- Disclosure: Kamal has no relevant financial disclosures.