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Ex vivo Mechanical Loading of Tendon
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Muscle Forces and Articular Loading Following In Vitro Total Wrist Arthroplasty.

Elizabeth Norman1,2, Emily Lalone1,2, Assaf Kadar2

  • 1Department of Biomedical Engineering, Western University, London, Ontario, Canada.

Journal of Wrist Surgery
|September 25, 2025
PubMed
Summary

Total wrist arthroplasty (TWA) shows increased extensor muscle forces and higher articular loading, particularly during extension and ulnar deviation. These biomechanical changes may explain the reduced longevity and early failure of TWA implants.

Keywords:
failure modesjoint loadingmuscle forcestotal wrist arthroplasty

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Area of Science:

  • Orthopedic Surgery
  • Biomechanics
  • Biomedical Engineering

Background:

  • Total wrist arthroplasty (TWA) is a treatment for end-stage wrist arthritis.
  • Current TWA longevity is inferior to hip and knee replacements.
  • Understanding TWA failure modes is crucial for improving implant survival.

Purpose of the Study:

  • To investigate muscle forces and articular loading after TWA.
  • To identify biomechanical factors contributing to TWA failure.

Main Methods:

  • Eight cadaveric wrists were used.
  • Active motion simulation (flexion-extension, radial/ulnar deviation) was performed.
  • A custom load-sensing TWA device was utilized in intact and TWA states.

Main Results:

  • Extensor muscle forces increased post-TWA during extension; flexor forces remained similar.
  • Articular loading was higher during extension than flexion.
  • Ulnar deviation exhibited greater loading than radial deviation.

Conclusions:

  • Increased muscle forces and carpal component loading post-TWA may lead to decreased longevity.
  • Altered biomechanics following TWA could be a key factor in early implant failure.
  • Further research into optimizing TWA biomechanics is warranted.