Learning Outcomes of Fourth-Generation Total Wrist Arthroplasty Using the Motec Implant: Does Dual-Consultant Operating Improve Outcomes?

INTRODUCTION: Total wrist arthroplasty (TWA) has evolved as a motion-preserving alternative to arthrodesis, offering improved pain relief, functional outcomes, and patient satisfaction. The fourth-generation Motec wrist prosthesis, a cementless, ball-and-socket, metal-on-metal implant, has demonstrated encouraging mid- to long-term results. However, TWA remains a technically demanding, low-volume procedure with a steep learning curve. Dual-consultant operating has been proposed as a method to optimize learning outcomes and reduce complications, but evidence remains limited. METHODS: A retrospective service evaluation was conducted on all Motec TWA procedures performed between September 2021 and November 2024 by six fellowship-trained hand surgeons at Kent and Canterbury Hospital. Nineteen patients met the inclusion criteria and were divided into dual-consultant (n = 14) and single-consultant (n = 5) groups. Complications were classified according to the Clavien-Dindo system, and surgeon expertise was categorized per the Tang and Giddins classification. Statistical analysis was performed using Fisher's exact test. RESULTS: Nineteen patients were evaluated, including 14 operated by dual consultants and 5 by a single consultant. In the dual-consultant group, 7 patients (50%) had no complications, 4 (28.6%) had Grade I, and 3 (21.4%) had Grade II complications. In the single-consultant group, 2 patients (40%) had no complications, 2 (40%) had Grade I, and 1 (20%) had a Grade IV complication.  Conclusion: Dual-consultant operating did not confer a statistically significant reduction in complications; however, an absence of severe complications in dual cases suggests potential benefits in safety and mentorship. Given the small sample size and high baseline expertise of surgeons, larger, prospective, multicenter studies are warranted to define the role of dual-consultant surgery in TWA.