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Total wrist arthroplasty. Experience with a noncemented wrist prosthesis
1Department of Orthopedic Surgery, Lindenhof Hospital, University of Berne, Switzerland.
Clinical Orthopaedics and Related Research
|October 6, 1997
Summary
Cementless total wrist prostheses can achieve solid osseointegration when components are correctly placed in patients with adequate bone stock. This technique shows promising results, though careful patient selection and surgical technique are crucial for optimal outcomes.
Area of Science:
- Orthopedic Surgery
- Biomaterials Engineering
- Musculoskeletal Research
Background:
- The development of total wrist prostheses aims to restore function and alleviate pain in patients with severe wrist arthritis or instability.
- Early prostheses often relied on cement fixation, which carried risks of loosening and bone resorption.
- An improved cementless total wrist prosthesis was developed in 1986 to address these limitations.
Purpose of the Study:
- To evaluate the clinical outcomes and osseointegration of a cementless total wrist prosthesis.
- To identify factors influencing the success and complications of this prosthesis.
Main Methods:
- Thirty-eight cementless total wrist prostheses were implanted in 33 patients between 1986 and the study period.
- Follow-up ranged from 3 to 9.5 years (average 5.5 years).
- Outcomes assessed included patient satisfaction, pain levels, daily activity performance, range of motion, grip strength, and radiographic evidence of osseointegration and complications.
Main Results:
- Solid osseointegration was achieved in most cases without cement, provided prosthetic components were accurately placed in solid bone stock.
- Overall results were rated as excellent (20 wrists), good (10 wrists), fair (2 wrists), and poor (6 wrists).
- Ten revisions were required, primarily due to technical errors or inappropriate patient selection.
Conclusions:
- Cementless total wrist arthroplasty is a viable option for restoring wrist function, achieving good to excellent outcomes.
- Meticulous surgical technique, including precise component placement and appropriate patient selection, is paramount to minimize revision rates and maximize functional recovery.