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Newly Designed Distal Fixation for Biaxial Total Wrist Arthroplasty

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ABSTRACT

Total wrist arthroplasty with the ellipsoidal designed biaxial implant has shown success in maintaining motion, relieving pain, and providing stability in arthritic wrist reconstruction; however, 20% of distal components have loosened in 5-year follow up studies. This has prompted modifications in surgical technique (Van Leeuwen) and stem elongation (Beckenbaugh), both of which have resulted in decreased distal component loosening.

Prosthetic wrist implants using distal screw fixation combined with carpal bone fusion was developed by Menon and resulted in minimal loosening in a similarly designed total wrist arthroplasty. Many features of the biaxial wrist implant offer advantages in stability, alignment, and favorable wear characteristics. In view of this, an alternative distal, modular, screw-fixed component has been developed for the biaxial wrist system, which maintains the favorable characteristics of the biaxial wrist design, but offers alternatives for improved distal component fixation when needed. This paper discusses the rationale for these changes and describes the new implant and insertion technique.