Indications
Wrist arthritis
Low demand
Preserve wrist range of motion
Design
4th generation Universal 2 / Remotion implants
- ball and socket design
- distal radius implant: uncemented porous coated distal radius
- carpal implant: uncemented + screw fixation
- UHMWPE interface
Options
Universal 2 Total Wrist Implant system surgical technique PDF
Styker Remotion Total Wrist Arthroplasty technique PDF
Motec Wrist Joint Prosthesis System
Technique
Vumedi Total Wrist Arthroplasty video
Dorsal approach
- incision in line with 3rd meta-carpal / Lister's tubercle
- divide extensor retinaculum over 5/6 compartment and reflect radially
- mobilize extensor tendons
- elevate wrist capsule as a distally based flap for later repair
Carpal cutting guide
- resect through scaphoid / capitate / hamate
- broach into capitate
- screw radial side in line with second metacarpal
- screw ulna side in line with fourth metacarpal
Distal radius
- insert cutting guide
- resect distal radius to subchondral bone
- broach distal radius for stem
- uncemented radial prosthesis
- excise lunate and apply carpal cutting block to capitate
- cut 1 mm hamate / capitate head / midscaphoid
- screw fixation of carpal plate
- trial polyethylene component
Outcomes
- 425 primary total wrist arthroplasty followed for mean 2 years
- 90% inflammatory arthritis
- intra-operative fractures 2%
- postoperative fractures 2%
- 88% 10 year survival
Herzberg et al J Wrist Surg 2012
- 215 Remotion total wrist arthroplasty with 4 year follow up
- revision rate: rheumatoid arthritis 4%, non rheumatoid arthritis 8%
- 60 degrees of flexion / extension
Complications
Intra-operative fractures 2%
Periprosthetic fractures 2%
Wound issues / infection 3% - higher in rheumatoid arthritis
Extensor tendon adhesions
Wrist stiffness 20%
Instability
Loosening 10 - 15%
Gaspar et al J Hand Surg Am 2016
- 100 wrist arthroplasty with 3 year follow up
- complication rate 51%
- revision rate 39%
- wrist contracture requiring surgery most common complication 20%
- component failure 15%
- deep infections 3%
- 425 primary total wrist arthroplasty followed for mean 2 years
- intra-operative fractures 2%
- postoperative fractures 2%
Periprosthetic fracture total wrist arthroplasty case report
Failed total wrist arthroplasty
Options
Revision total wrist arthroplasty
Wrist arthrodesis with allograft
Technique
Salvage TWA with femoral head allograft and wrist fusion PDF
Results
Adams et al J Hand Surg Am 2016
- 20 failed total wrist arthroplasty
- revised to wrist arthrodesis with dorsal plate and femoral head allograft
- union in 19/20