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Learn the Wrist replacement :Motec wrist joint prosthesis system (Swemac) surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Wrist replacement :Motec wrist joint prosthesis system (Swemac) surgical procedure.
Total wrist replacement is a motion preserving alternative to wrist fusion for patients with advanced arthritis of the wrist. Once the conservative options such as splints, analgesics and steroid injections are ineffectual surgical options should be considered.
Wrist replacement is an options for motivated patients with good bone stock and good quality soft tissues. Despite the significant advantages offered by motion preservation, wrist replacement has the distinct disadvantage of implant failure over time, not present with fusion. The current generation of implants also with improved jigs and carefully designed approaches have resulted in a slow but steady improvement in outcomes and an increase in the adoption of wrist replacement for well defined cases.
Total wrist replacement is an option for both osteoarthritis and rheumatoid arthritis patients with destruction of the cartilage in the radiocarpal joint. It can also be used in patients with secondary osteoarthritis such as SLAC and SNAC wrist as well as advanced Keinbock’s disease.
The MOTEC wrist replacement is a ball and socket type modular joint with Metacarpal Head made from CoCrMo alloy and the Radius Cup made from carbon fibre reinforced polyetheretherketone (PEEK OPTIMATM Wear Performance Polymer), though there is also a CoCrMo alloy option. The head component fits into the capitate and third metacarpal and the socket sits on the radius. Fixation is using a threaded implant which is made up of a coated Titanium alloy to promote osseointegration.
The alternative wrist replacement implant currently available is the the ReMotion Total Wrist System which needs less resection of the distal radius and carpal bones of the wrist. It has three components, radial, carpal ball and carpal plate. The carpal plate is fixed to carpal bones using screws.
The main differences between the two implants are the shape of the ball and socket and the fact that Remotion implants are fixed with screws.
A proximal row carpectomy is performed as part of the Motec technique which needs to be borne in mind if subsequently a fusion is required for salvage following implant failure. There is however a salvage fusion system designed to that assist with this situation, and the loss of bone stock.
OrthOracle readers will also find the following associated instructional techniques of interest:
Four Corner carpal Fusion using Medartis plate and scaphoid excision
Radioscapholunate fusion using Medartis plate with distal Scaphoid excision
Wrist Arthritis: Proximal Row Carpectomy
Wrist Arthritis: Posterior and Anterior interosseous nerve neurectomies
Wrist fusion: Radiolunate limited fusion with Acutrak headless screw
Wrist fusion for Volkmann’s ischaemic contracture (Using Synthes fusion plate)
Acknowledgements:
Miss Gemma Smith, Mr Mike Craigen & Mr Waleed Tawfeek at the Department of Hand Surgery& Mr Sarvnaz Sepehripour at the Department of Plastic Surgery, Queen Elizabeth Hospital, Birmingham, UK.
Author: Rajive Jose FRCS
Institution: The Queen Elisabeth Hospital, Birmingham, UK.
Clinicians should seek clarification on whether any implant demonstrated is licensed for use in their own country.
In the USA contact: fda.gov
In the UK contact: gov.uk
In the EU contact: ema.europa.eu
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