Department of Orthopaedic and Hand Surgery, Faculty of Medicine and Health, Örebro University, Sweden.
Karlskoga Hospital, Sweden.
Hand (N Y). 2024 Jul;19(5):742-750. doi: 10.1177/15589447231151427. Epub 2023 Feb 8.
Distal component loosening is a common mode of failure in total wrist arthroplasty (TWA). A radial hemi-wrist arthroplasty (RHWA) has the potential to avoid problems related to the distal component in TWA. The aim of this study is to investigate clinical outcomes following surgical treatment with a new RHWA design.
In this pilot study of 20 consecutive RHWAs, patients were assessed preoperatively and postoperatively for range of motion, grip strength, Visual Analog Scale (VAS) pain scores, and functional scoring using Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder, and Hand (DASH), and Canadian Occupational Performance Measure. Radiographs were analyzed at 12 months and 5 years (mean, 5.1 years) postoperatively.
A total of 46 secondary surgeries were undertaken in 16 wrists, including 7 revisions. Another 6 patients are waiting for revision to radiocarpal arthrodesis. In non-revised patients, the DASH and PRWE scores improved, and wrist range of motion remained largely unchanged except for wrist flexion, which decreased. The VAS pain score during activity was reduced, and hand grip strength remained largely unchanged.
The new implant resulted in improved functional scoring and improved VAS pain scores in non-revised patients, but many cases needed secondary surgery due to persistent pain. The high revision rate is a major concern, and further use of the implant in its current form cannot be recommended.
在全腕关节置换术（TWA）中，远端部件松动是一种常见的失效模式。桡骨半腕关节置换术（RHWA）有可能避免与 TWA 远端部件相关的问题。本研究旨在探讨一种新型 RHWA 设计的手术治疗的临床结果。
在这项对 20 例连续 RHWA 的初步研究中，对患者进行术前和术后的运动范围、握力、视觉模拟量表（VAS）疼痛评分以及使用患者评定腕关节评估（PRWE）、手臂、肩部和手残疾（DASH）和加拿大职业表现衡量的功能评分进行评估。在术后 12 个月和 5 年（平均 5.1 年）时对 X 线片进行分析。
16 只手腕中有 46 只进行了二次手术，其中包括 7 次翻修。另外 6 名患者等待桡腕关节融合术的翻修。在未接受翻修的患者中，DASH 和 PRWE 评分有所改善，腕关节活动范围基本保持不变，除了腕关节屈曲度略有下降。活动时的 VAS 疼痛评分降低，手握力基本保持不变。
新型植入物使未接受翻修的患者的功能评分和 VAS 疼痛评分得到改善，但由于持续疼痛，许多病例需要进行二次手术。高翻修率是一个主要问题，不能推荐目前形式的植入物进一步使用。
