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Ex vivo Mechanical Loading of Tendon
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Tendon Force and Range of Motion Changes After In Vitro Total Wrist Replacement
Gaurav G Mookerjee1, Frederick W Werner1, Walter H Short1
1Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY.
The Journal of Hand Surgery
|December 24, 2024
Summary
Total wrist replacement (TWR) increases tendon forces and decreases wrist range of motion, even with advanced designs. Further modifications are needed to improve TWR biomechanics and patient outcomes.
Area of Science:
- Orthopedic surgery
- Biomechanics
- Biomedical engineering
Background:
- Total wrist replacement (TWR) aims to restore wrist function.
- Contemporary TWR designs seek to improve upon previous generations.
- Understanding the biomechanical impact of TWR is crucial for design and surgical improvements.
Purpose of the Study:
- To assess changes in tendon forces required for wrist motion after TWR.
- To evaluate alterations in passive range of wrist motion post-TWR.
- To investigate the biomechanical consequences of a modern TWR design.
Main Methods:
- Utilized eight fresh frozen cadaver arms.
- Employed a wrist joint simulator to perform five distinct wrist motions.
- Compared peak tendon forces and range of motion before and after TWR implantation.
Main Results:
- Significant increases in extensor tendon forces were observed post-TWR.
- The force in the extensor carpi radialis longus more than doubled in four motions.
- A significant decrease in range of motion for flexion, extension, and radial deviation was noted, alongside distal carpal shift.
Conclusions:
- Even fourth-generation TWR designs result in increased wrist tendon forces.
- Reduced range of motion and distal carpal displacement may be linked to implant positioning or biomechanical properties.
- Further advancements in TWR design and surgical techniques are necessary to optimize wrist kinematics and function.
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