Abstract：
OBJECTIVE: To analyze the short-term outcome of two types of total wrist arthroplasty (TWA) in terms of wrist function, migration, and periprosthetic bone behaviour.
METHODS: A total of 40 patients suffering from non-rheumatoid wrist arthritis were enrolled in a randomized controlled trial comparing the ReMotion and Motec TWAs. Patient-rated and functional outcomes, radiological changes, blood metal ion levels, migration measured by model-based radiostereometric analysis (RSA), bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA), complications, loosening, and revision rates at two years were compared.
RESULTS: Patient-Rated Wrist and Hand Evaluation (PRWHE) scores, abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire scores, and pain improved similarly and significantly in both groups. Wrist motion improved significantly in the Motec group only, and forearm rotation in the ReMotion group only. Cobalt (Co) and chromium (Cr) blood ion levels were significantly higher in the metal-on-metal (MoM) Motec group than in the metal-on-polyethylene (MoP) ReMotion group. Mean total translation was 0.65 mm (95% confidence interval (CI) 0.26 to 1.12) and 0.27 mm (95% CI 0.14 to 0.47) for the ReMotion carpal and radial components, and 0.32 mm (95% CI 0.22 to 0.45) and 0.26 mm (95% CI 0.20 to 0.34) for the Motec metacarpal and radial components, respectively. Apart from dorsal and volar tilts, which were significantly higher for the radial ReMotion than for the Motec component, no significant differences in absolute migration occurred. BMD around the radial components never returned to baseline. Almost one-third of patients required reoperation due to complications. Two ReMotion implants were revised to Motec TWAs due to carpal component loosening, and three Motec MoM articulations were revised to metal-on-polyether ether ketone due to painful synovitis.
CONCLUSIONS: Both implants provided matched function and were stable at short-term follow-up, but with a high complication rate. This procedure should be restricted to specialist centres undertaking prospective analysis until its role is clarified.Cite this article: Bone Joint J 2022;104-B(10):1132-1141.
METHODS: A total of 40 patients suffering from non-rheumatoid wrist arthritis were enrolled in a randomized controlled trial comparing the ReMotion and Motec TWAs. Patient-rated and functional outcomes, radiological changes, blood metal ion levels, migration measured by model-based radiostereometric analysis (RSA), bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA), complications, loosening, and revision rates at two years were compared.
RESULTS: Patient-Rated Wrist and Hand Evaluation (PRWHE) scores, abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire scores, and pain improved similarly and significantly in both groups. Wrist motion improved significantly in the Motec group only, and forearm rotation in the ReMotion group only. Cobalt (Co) and chromium (Cr) blood ion levels were significantly higher in the metal-on-metal (MoM) Motec group than in the metal-on-polyethylene (MoP) ReMotion group. Mean total translation was 0.65 mm (95% confidence interval (CI) 0.26 to 1.12) and 0.27 mm (95% CI 0.14 to 0.47) for the ReMotion carpal and radial components, and 0.32 mm (95% CI 0.22 to 0.45) and 0.26 mm (95% CI 0.20 to 0.34) for the Motec metacarpal and radial components, respectively. Apart from dorsal and volar tilts, which were significantly higher for the radial ReMotion than for the Motec component, no significant differences in absolute migration occurred. BMD around the radial components never returned to baseline. Almost one-third of patients required reoperation due to complications. Two ReMotion implants were revised to Motec TWAs due to carpal component loosening, and three Motec MoM articulations were revised to metal-on-polyether ether ketone due to painful synovitis.
CONCLUSIONS: Both implants provided matched function and were stable at short-term follow-up, but with a high complication rate. This procedure should be restricted to specialist centres undertaking prospective analysis until its role is clarified.Cite this article: Bone Joint J 2022;104-B(10):1132-1141.
摘要：
目的：从腕关节功能方面分析两种类型的全腕关节置换术（TWA）的短期结果，迁移,和假体周围的骨骼行为。
方法：在一项比较ReMotion和MotecTWAs的随机对照试验中，共纳入40例非类风湿腕关节关节炎患者。患者评级和功能结果，放射学变化，血液金属离子水平，通过基于模型的放射立体测量分析(RSA)测量的迁移，通过双能X射线吸收法（DXA）测量骨密度（BMD），并发症,松开,并比较了两年的修订率。
结果：患者额定腕部和手部评估（PRWHE）评分，手臂残疾的缩写版本，肩和手问卷得分，两组的疼痛改善相似且显著。仅Motec组的手腕运动明显改善，和“ReMotion”组中的前臂旋转。金属对金属（MoM）Motec组的钴（Co）和铬（Cr）血液离子水平明显高于金属对聚乙烯（MoP）ReMotion组。ReMotion腕骨和radial部的平均总平移为0.65mm（95％置信区间（CI）0.26至1.12）和0.27mm（95％CI0.14至0.47），Motec掌骨和桡骨分量分别为0.32mm(95%CI0.22至0.45)和0.26mm(95%CI0.20至0.34)，分别。除了背侧和掌侧倾斜，径向ReMotion明显高于Motec组件，绝对迁移没有显着差异。径向组件周围的BMD从未恢复到基线。由于并发症，几乎三分之一的患者需要再次手术。由于腕骨组件松动，两个ReMotion植入物被修改为MotecTWAs，由于疼痛性滑膜炎，三个MotecMoM关节被修改为金属对聚醚醚酮。
结论：两种植入物都提供了匹配的功能，并且在短期随访中保持稳定，但并发症发生率很高。在明确其作用之前，此程序应仅限于进行前瞻性分析的专家中心。引用本文：骨关节J2022；104-B（10）：1132-1141。
方法：在一项比较ReMotion和MotecTWAs的随机对照试验中，共纳入40例非类风湿腕关节关节炎患者。患者评级和功能结果，放射学变化，血液金属离子水平，通过基于模型的放射立体测量分析(RSA)测量的迁移，通过双能X射线吸收法（DXA）测量骨密度（BMD），并发症,松开,并比较了两年的修订率。
结果：患者额定腕部和手部评估（PRWHE）评分，手臂残疾的缩写版本，肩和手问卷得分，两组的疼痛改善相似且显著。仅Motec组的手腕运动明显改善，和“ReMotion”组中的前臂旋转。金属对金属（MoM）Motec组的钴（Co）和铬（Cr）血液离子水平明显高于金属对聚乙烯（MoP）ReMotion组。ReMotion腕骨和radial部的平均总平移为0.65mm（95％置信区间（CI）0.26至1.12）和0.27mm（95％CI0.14至0.47），Motec掌骨和桡骨分量分别为0.32mm(95%CI0.22至0.45)和0.26mm(95%CI0.20至0.34)，分别。除了背侧和掌侧倾斜，径向ReMotion明显高于Motec组件，绝对迁移没有显着差异。径向组件周围的BMD从未恢复到基线。由于并发症，几乎三分之一的患者需要再次手术。由于腕骨组件松动，两个ReMotion植入物被修改为MotecTWAs，由于疼痛性滑膜炎，三个MotecMoM关节被修改为金属对聚醚醚酮。
结论：两种植入物都提供了匹配的功能，并且在短期随访中保持稳定，但并发症发生率很高。在明确其作用之前，此程序应仅限于进行前瞻性分析的专家中心。引用本文：骨关节J2022；104-B（10）：1132-1141。
