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- Fischer, Per, 1981-, et al.
(författare)
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Revision Arthroplasty of the Wrist in Patients With Rheumatoid Arthritis, Mean Follow-Up 6.6 Years
- 2018
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Ingår i: Journal of Hand Surgery-American Volume. - : Elsevier. - 0363-5023 .- 1531-6564. ; 43:5, s. 489.e1-489.e7
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Management of failed total wrist arthroplasty (TWA) can be challenging; surgical treatment options include salvage arthrodesis, revision arthroplasty, and resection arthroplasty. There are few studies regarding salvage arthrodesis, and revision arthroplasty has been infrequently investigated. The aim of the study was to report the outcome after revision arthroplasty of the wrist.METHODS: A retrospective cohort of 16 revision TWAs was evaluated between 2003 and 2016. Data were collected before surgery and 1 and 5 years after surgery. The indication for revision arthroplasty was failed TWA. The primary end point was implant survival. Secondary outcome measures included visual analog scale (VAS) pain scores, range of motion, handgrip strength, and functional scoring with the Canadian Occupational Performance Measure (COPM), Patient-Rated Wrist Evaluation (PRWE), and Disabilities of the Arm, Shoulder, and Hand (DASH).RESULTS: Mean follow-up was 6.6 years. Synthetic bone graft was used in 9 cases, allograft corticocancellous bone graft in 1 case, and cement in 6 cases. Of the 16 revision TWAs, 4 were re-revised, 1 because of infection, and 3 cases underwent total wrist arthrodesis. In the non-re-revised cases, range of motion and grip strength was preserved compared with preoperative results. The VAS pain score in activity improved, but not significantly, at 1 (median, 1; range, 0-4.5) and 5 years after surgery (median, 0) compared with before surgery (median, 5). The COPM performance and satisfaction as well as PRWE scores improved significantly at 1 year (median COPM performance, 4.8; COPM satisfaction, 5.6; and PRWE, 24) and improved, but not significantly, at the 5-year follow (median COPM performance, 4.8; COPM satisfaction, 5.0; and PRWE, 37) in the non-re-revised cases.CONCLUSIONS: Revision arthroplasty of the wrist is a valid motion-preserving option to wrist arthrodesis in the management of failed TWA. However, the outcome is uncertain and as many as 25% require additional surgery.TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
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| 3. |
- Sagerfors, Marcus, MD, PhD, 1977-, et al.
(författare)
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Patient-Perceived Outcome After Total Wrist Arthroplasty : A Single-Center Study of 223 Cases
- 2016
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Ingår i: Hand. - : Sage Publications. - 1558-9447 .- 1558-9455. ; 11:1_suppl, s. 2S-2S
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Total wrist arthroplasty (TWA) is an established surgical treatment for wrist arthritis. The aim of the investigation is to report patient-perceived outcome measures after TWA operated at a single referral center in Sweden.Methods: In a cohort study with prospective collection of data, we evaluated 193 consecutive patients with a TWA (223 wrists) preoperatively, 1 and 5 years postoperatively. The wrists were implanted between 2002 and 2014. Outcome measures studied were range of motion (ROM), visual analogue scale (VAS) pain scores, hand grip strength, and patient-related outcome measures. Secondary outcome measures included implant survivorship, which was estimated using the Kaplan-Meier method, and radiographic loosening 5 years postoperatively.Results: VAS pain scores and patient-related outcome measures improved significantly for all TWAs. Improved hand grip strength was noted for all TWAs except Universal 2. ROM improved somewhat, especially for the Biax and Maestro TWAs. Cumulative implant survival after 5 years was 99% for Remotion, 95% for Maestro, and 84% for Biax. Radiographic loosening was present in 26% of the Biax cases, 18% of the Remotion cases, and 2% of the Maestro cases.Conclusions: All TWA designs in this study offer a high level of patient satisfaction. The design of the implant may affect patient-perceived outcome 5 years postoperatively. Good mid to long-term results can be achieved in patients undergoing TWA.
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| 4. |
- Sagerfors, Marcus, 1977-, et al.
(författare)
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Patient related functional outcome after total wrist arthroplasty : a single center study of 206 cases
- 2015
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Ingår i: Hand Surgery. - Singapore : World Scientific Publishing. - 0218-8104. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To prospectively evaluate patient related outcome measures after total wrist arthroplasty (TWA) using four different total wrist implants operated at a single referral center in Sweden.Methods: 206 primary TWAs were assessed preoperatively and after one year postoperatively with respect to the following eight outcome measures: Range of motion (flexion/extension, radial/ulnar deviation, pronation/supination), hand grip strength, Canadian Occupational Performance Measure (COPM), performance and satisfaction, Visual Analog Scale (VAS) pain scores at rest and in activity.Results: The Maestro TWA had a significantly greater improvement of radial/ulnar deviation than the Biax and Remotion TWAs. COPM performance and satisfaction improved more for the Maestro and Universal 2 prostheses than the Biax and Remotion.Conclusions All four TWAs offer reduced VAS-scores and improved COPM-scores with preserved hand grip strength and somewhat improved range of motion. The Maestro TWA performed favorably compared to the Remotion TWA. Implant design may affect patient related outcome.
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| 5. |
- Sagerfors, Marcus, 1977-, et al.
(författare)
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Total Wrist Arthroplasty : A Single-Center Study of 219 Cases With 5-Year Follow-up
- 2015
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Ingår i: Journal of Hand Surgery-American Volume. - : Saunders Elsevier. - 0363-5023 .- 1531-6564. ; 40:12, s. 2380-2387
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To assess implant survival and radiographic loosening after total wrist arthroplasty (TWA) operated at a single tertiary referral center in Sweden.Methods: In a prospective cohort study, we evaluated 189 consecutive patients with a TWA(219 wrists). The wrists were implanted between 2002 and 2013. The primary end point was revision for any reason. The mean follow-up period was 7 years (range, 2-13 years). In addition, radiological examination was done for evidence of prosthetic loosening 5 years postoperatively. Implant survival was estimated using the Kaplan-Meier method. Secondary outcome measures included range of motion, visual analog scale pain scores, hand grip strength, and patient-related outcome measures.Results: Cumulative implant survival after 8 years was 81% for Biax, 94% for Remotion, and 95% for Maestro implants. Radiographic loosening was present in 26% of wrists with the Biax design, 18% of those with Remotion, and 2% of those with Maestro. Visual analog scale pain scores and patient-related outcome scores improved significantly for all TWAs. Improved hand grip strength was noted for all TWAs except for the Universal 2. Range of motion improved somewhat, especially for the Biax and Maestro TWAs.Conclusions: Good midterm to long-term results were achieved in patients undergoing TWA. Radiographic loosening did not necessarily correlate with implant survival rates, but rather to severe arthritic destruction of the wrist preoperatively. All TWA implants studied offered a high level of patient satisfaction.
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