Safer hands study

Learning outcomes of fourth generation total wrist arthroplasty using the Motec implant: Does dual consultant operating improve outcomes?

This study investigated whether having two consultant surgeons operating together, rather than just one, improves the safety of a complex wrist joint replacement surgery.

Total wrist replacement using the Motec implant is a technically demanding, low-volume procedure, and like all complex surgery, there is a learning curve. Scrubbing into these cases as a surgical trainee, Siddhartha became increasingly aware of just how rare this operation is, and how limited the published literature was on optimising safety during the adoption phase. That curiosity became the starting point for this project. Researchers looked at 19 patients who received the "Motec" wrist implant to see if the dual-surgeon approach reduced surgical complications.

Why is this important?

Severe wrist arthritis or trauma can cause extreme pain and significantly reduce a person's ability to use their hands, deeply impacting their daily life. Historically, the main treatment was fusing the wrist bones together to stop the pain, but this completely prevents the wrist from bending. Total wrist replacement using the modern Motec implant relieves pain while allowing patients to keep moving their wrist. However, because this surgery is rare and highly complex, it takes time for surgeons to perfect it, which can increase the risk of complications for early patients.

How was the study carried out?

With guidance and active support from Mr Smith, Siddhartha began exploring whether dual-consultant operating could reduce complications. The study included 19 patients who underwent total wrist replacement at Kent and Canterbury Hospital between September 2021 and November 2024. Researchers compared two groups: 14 patients whose surgery was performed by two consultant surgeons working together, and 5 patients who were operated on by a single consultant. Post-surgery complications were measured and graded by severity to see which group fared better.

What did the study find?

The surgery was generally well tolerated, providing an excellent alternative to wrist fusion. In the dual-surgeon group, half the patients had zero complications, and the rest experienced only minor or moderate issues that were easily managed. In the single-surgeon group, 40% had no complications, but one patient experienced a severe complication (a fractured implant) that required a second surgery. Because the study only looked at 19 people, the mathematical difference in complications between the two groups was small and could have been due to chance.

What did this mean for participants?

For the patients involved, the modern wrist implant allowed them to maintain wrist flexibility while relieving debilitating arthritis pain, helping them regain independence. Practically, those who had two surgeons operating on them avoided severe surgical complications, meaning a smoother recovery without the physical toll and stress of needing an unexpected second major operation.

What does this mean overall?

Overall, the results suggest that having two expert surgeons work together on a complex, low-volume wrist replacement may prevent severe complications and improve patient safety. However, the key limitation is the very small number of patients studied, which prevents drawing definitive, statistically significant conclusions. It does show that shared surgical expertise is a promising way to protect patients while surgeons adopt new technologies.

What happens next?

To confirm these benefits, larger studies involving more patients across multiple different hospitals are needed. Tracking patients over a longer time will help confirm if dual-surgeon operations should become the standard of care for this specific procedure.

We are immensely grateful to the Hand Firm at EKHUFT for their guidance throughout, Mr C James, Mr M Williamson, Mr J Stanton, and Ms Mailing, and to the EKHUFT Research & Innovation team, particularly Dr Jane Povey, for their support in getting this work to publication.