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

Stefan M Froschauer,Oskar Kwasny,Dietmar Hager,Matthias Holzbauer,Dominik Duscher

doi:10.3390/jcm10091865

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.

Highlights

The first prostheses for total wrist arthroplasty (TWA) were developed in the 1960s, while the ReMotion prosthesis, with its release in 2002, is one of the most recent implant types [1]
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
Most studies containing outcomes of TWA were conducted on rheumatoid patients, because rheumatoid arthritis initially represented the major indication for this procedure

Summary

Introduction

The first prostheses for total wrist arthroplasty (TWA) were developed in the 1960s, while the ReMotion prosthesis, with its release in 2002, is one of the most recent implant types [1]. Most studies containing outcomes of TWA were conducted on rheumatoid patients, because rheumatoid arthritis initially represented the major indication for this procedure. TWA is increasingly used for non-rheumatoid indications. One of the design surgeons of the ReMotion prosthesis, already emphasized in his original surgical description that “osteoarthritis is a good indication”, and TWA “surpasses that of 4-corner fusion and scaphoid excision” in posttraumatic arthritis [1]. Regarding ReMotion TWA, the overall perception and potential drawbacks discussed in the literature might be caused by the predominance of rheumatoid patients. There are few articles [4,5,6] involving results of subcohorts with non-rheumatoid patients, while our previous study is—to the best of our knowledge—the first study solely including patients suffering from primary and posttraumatic arthritis

Methods

Results

Discussion

Conclusion