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Knie C, van Schoonhoven J. Long-term results after total wrist fusion. Arch Orthop Trauma Surg 2023; 143:6469-6475. [PMID: 37344687 DOI: 10.1007/s00402-023-04938-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/25/2023] [Indexed: 06/23/2023]
Abstract
Sixty-eight patients with seventy-one total wrist fusions were retrospectively reviewed with a mean follow-up of 11.7 years. The main purpose of this study was to determine long-term functional results and define possible reasons for remaining pain. Except one asymptomatic non-union, all wrist fusions united. The long-term functional result averaged 30 points using the DASH score and appears to be more favorable compared to midterm results in another publication from this department. Only 15 patients were completely free of pain. Most patients complained about remaining pain during strong activities with a mean VAS of 4/10 that could not further been defined on clinical or radiological examinations. Patients with more than two previous operations had a significant worse outcome concerning the modified Mayo wrist score [≤ 1 operation mean 61 points vs. ≥ 2 operations mean 56 points (Mann-Whitney U test: p = 0.009)] and PRWE-G [≤ 1 operation mean 27 points vs. ≥ 2 operations mean 37 points (t test: p = 0.047)] and furthermore a downward trend for worse DASH [≤ 1 operation mean 265 points vs. ≥ 2 operations mean 35 points (t test: p = 0.086)] results. Despite the loss of wrist motion and remaining pain, patients were highly satisfied with the long-term result and 93% would undergo the operation again.
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Affiliation(s)
- C Knie
- Clinic for Hand Surgery, Rhön-Klinikum, Von-Guttenberg-Straße11, 97616, Bad Neustadt a.d. Saale, Germany.
| | - J van Schoonhoven
- Clinic for Hand Surgery, Rhön-Klinikum, Von-Guttenberg-Straße11, 97616, Bad Neustadt a.d. Saale, Germany
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Gupta A, Scheker L. Wrist and Distal Radioulnar Joint Arthroplasty: Maximizing Results in Difficult Conditions. Hand Clin 2023; 39:331-339. [PMID: 37453761 DOI: 10.1016/j.hcl.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Traditional management of wrist arthritis consists of proximal row carpectomy, partial carpal fusions, or, in the event of pancarpal arthritis, total wrist fusion. Although proximal row carpectomy and partial wrist fusions preserve some motion at the wrist while relieving pain symptoms, the quality of results obtained from these procedures is not predictable or optimal in many instances. Management of hip, knee, ankle, and shoulder joints has evolved from arthrodesis to arthroplasty. The wrist joint is following the same pattern of evolution with the advent of reliable designs.
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Affiliation(s)
- Amit Gupta
- Department of Orthopedic Surgery, University of Louisville, Louisville, KY, USA; Louisille Arm & Hand, Louisville, KY, USA.
| | - Luis Scheker
- Plastic and Reconstructive Surgery, University of Louisville School of Medicine, Glenview, KY, USA
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Total arthrodesis for non-rheumatoid wrists: Outcomes at 5 and 20years of follow-up. Orthop Traumatol Surg Res 2022; 109:103522. [PMID: 36539032 DOI: 10.1016/j.otsr.2022.103522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/16/2022] [Accepted: 07/18/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Total wrist arthrodesis (TWA) aims to obtain a painless wrist with a strong grip. Its main disadvantage is compromised mobility and for many authors it remains a rescue intervention. However, after one or more palliative interventions, TWA confers poorer results. The objective of our study was to evaluate the medium-term results of TWA, and their long-term stability. HYPOTHESIS Our hypothesis was that the results are reliable and persistent for pain and strength, without repercussions to other joints. MATERIAL AND METHODS This was a single-center consecutive series of TWA performed with a dedicated plate, excluding rheumatoid wrists, evaluated at 5.4 and 21.1years of follow-up. RESULTS Thirty wrists were assessed at the first review and 17 reassessed at the last follow-up. At the mean follow-up of 5.4years, 93% of patients considered themselves "very satisfied" or "satisfied" with the TWA surgery. No infectious complications occurred. At the mean follow-up of 21.1years, all were "very satisfied" or "satisfied" and 88% of them considered their result stable or improved compared to the first revision. The average VAS had gone from 8.4/10 preoperatively to 1.8/10 at the first evaluation and to 0.3/10 at the last follow-up. Except for a patient with both wrists operated on for whom comparison was not possible, the strength of the operated side was on average 89.7% of that of the contralateral side (from 45% to 150%). The mean Quick DASH score was 30.3 (4.5 to 61.4) and the mean PRWE score was 32.5 (1 to 77). DISCUSSION TWA using a plate provides excellent results for both pain control and strength restoration. The clinical results remain stable over time, and arthrodesis at more than 20years of follow-up does not seem to have any impact on the other joints of the upper limb. After wrist surgery, the main complaint of patients is the limited range of motion, but the main cause of dissatisfaction is persistent pain. Arthrodesis can be performed first-line in case of questionable indication of partial arthrodesis on a stiff wrist because the results of TWA are better in the absence of a surgical history. LEVEL OF EVIDENCE IV; retrospective study.
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Smith MB, Stirling PHC, McEachan JE. Long-term functional outcomes after total wrist arthrodesis. HAND SURGERY & REHABILITATION 2022; 41:595-598. [PMID: 35850180 DOI: 10.1016/j.hansur.2022.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/29/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
Current literature surrounding functional outcomes after total wrist arthrodesis is limited by short follow-up or limited use of validated patient reported outcome measures (PROMs). The primary aim of this study was to describe long-term functional outcomes following wrist arthrodesis. Secondary aims were to describe the incidence of complications and patient satisfaction. This was a retrospective single-center study. Patients with a minimum of 10-year follow-up completed a questionnaire including the Patient-Rated Wrist Evaluation (PRWE), the Quick version of the Disabilities of the Arm, Shoulder and Hand (Quick-DASH) score, the EQ-5D-5L score, and a question assessing satisfaction. Presence of a complication was also assessed. During the study period 66 patients underwent total arthrodesis. At a median follow-up of 15 years, complete patient reported outcomes were available for 34 patients. Thirty-two patients were lost to follow-up. Mean age at surgery was 49 and 16 patients were female. Mean PRWE and Quick-DASH scores were 44.8 (SD 27.7; range 0-96) and 41.9 (SD 23.6; range 2.3-97.7) respectively. Twenty-eight patients were satisfied. Nine patients reported complications. There were six cases of hardware removal and two cases of prominent metalwork. One patient underwent revision surgery for non-union. Presence of a complication did not affect the Quick-DASH or PRWE scores. Median EQ-5D-5L score was 0.7. This long-term follow-up suggests high levels of patient satisfaction and health related quality of life, despite significant functional disability. The complication rates are not insignificant, although the presence of a complication did not affect functional outcomes.
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Affiliation(s)
- M B Smith
- University of Edinburgh, School of Medicine, Chancellor's Building, Edinburgh, EH16 4TJ, UK
| | - P H C Stirling
- Fife Hand Clinic, Queen Margaret Hospital, Whitefield Road, Dunfermline, KY12 0SU, UK.
| | - J E McEachan
- Fife Hand Clinic, Queen Margaret Hospital, Whitefield Road, Dunfermline, KY12 0SU, UK
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Zijlker HJA, Fakkert RK, Beumer A, IJsselstein CB, Wessels M, Ritt MJPF. Comparative outcomes of total wrist arthrodesis for salvage of failed total wrist arthroplasty and primary wrist arthrodesis. J Hand Surg Eur Vol 2022; 47:302-307. [PMID: 34796775 PMCID: PMC8892058 DOI: 10.1177/17531934211057389] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A retrospective study compared outcomes of total wrist arthrodesis as a salvage for total wrist arthroplasty versus primary total wrist arthrodesis. Seventy-one wrists were reviewed after a minimum follow-up of 12 months. Thirty-two wrists with failed total wrist arthroplasty were converted to a wrist arthrodesis and 39 wrists received a primary wrist arthrodesis. Seven converted wrist arthrodeses and five primary arthrodeses failed to fuse. Mean patient-rated wrist and hand evaluation scores and work-related questionnaire for upper extremity disorders scores were 43 and 39 for converted total wrist arthrodesis and 38 and 33 for the primary total wrist arthrodesis. Overall, there were 25 complications in 15 patients in the converted wrist arthrodesis group and 21 complications in 16 patients after a primary wrist arthrodesis. The results between the two groups were slightly in favour of patients with a primary wrist arthrodesis. Therefore, we conclude that the timing, primary or conversion, of total wrist arthrodesis could influence patient outcomes.Level of evidence: III.
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Affiliation(s)
- Hero J. A. Zijlker
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ruben K. Fakkert
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Annechien Beumer
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands,Coronel Institute of Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
| | - Cees B. IJsselstein
- Department of Plastic, Reconstructive and Hand Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Mascha Wessels
- Department of Radiology, Reade, Amsterdam, The Netherlands
| | - Marco J. P. F. Ritt
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands,Marco J. P. F. Ritt, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, location VUmc, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
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Chojnowski K, Opiełka M, Piotrowicz M, Sobocki BK, Napora J, Dąbrowski F, Piotrowski M, Mazurek T. Recent Advances in Assessment and Treatment in Kienböck's Disease. J Clin Med 2022; 11:jcm11030664. [PMID: 35160115 PMCID: PMC8836398 DOI: 10.3390/jcm11030664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/09/2022] [Accepted: 01/21/2022] [Indexed: 12/17/2022] Open
Abstract
Kienböck’s disease is a rare disease described as progressive avascular osteonecrosis of the lunate. The typical manifestations include a unilateral reduction in wrist motion with accompanying pain and swelling. Besides recent advances in treatment options, the etiology and pathophysiology of the disease remain poorly understood. Common risk factors include anatomical features including ulnar variance, differences in blood supply, increased intraosseous pressure along with direct trauma, and environmental influence. The staging of Kienböck’s disease depends mainly on radiographic characteristics assessed according to the modified Lichtman scale. The selection of treatment options is often challenging, as radiographic features may not correspond directly to initial clinical symptoms and differ among age groups. At the earliest stages of Kienböck disease, the nonoperative, unloading management is generally preferred. Patients with negative ulnar variance are usually treated with radial shortening osteotomy. For patients with positive or neutral ulnar variance, a capitate shortening osteotomy is a recommended option. One of the most recent surgical techniques used in Stage III Kienböck cases is vascularized bone grafting. One of the most promising procedures is a vascularized, pedicled, scaphoid graft combined with partial radioscaphoid arthrodesis. This technique provides excellent pain management and prevents carpal collapse. In stage IV, salvage procedures including total wrist fusion or total wrist arthroplasty are often required.
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Radioscapholunate Arthrodesis and Distal Radioulnar Joint Arthroplasty for Rheumatoid Wrist Arthritis. Tech Orthop 2021. [DOI: 10.1097/bto.0000000000000566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Campbell CC, Neustein TM, Daly CA, Wagner ER. Surgical Treatment of Wrist Arthritis in Young Patients. JBJS Rev 2021; 8:e0078. [PMID: 32149931 DOI: 10.2106/jbjs.rvw.19.00078] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Surgical treatment of wrist arthritis in the younger patient population remains a challenging issue, and various surgical options need to be carefully considered for each patient. Proximal row carpectomy and 4-corner arthrodesis have proven to be reliable options for reducing pain and restoring adequate function in most young high-demand patients if the lunate facet is spared. Selective neurectomy has proven to be a promising stand-alone or complementary procedure for the treatment of pain that is associated with wrist arthritis in patients of all ages, with spared motion and the opportunity to perform additional procedures if pain continues. Alternative procedures, including capitolunate arthrodesis, total wrist arthrodesis, radial styloidectomy, total wrist arthroplasty, and wrist hemiarthroplasty, have considerable strengths and weaknesses and need to be studied further in younger patients.
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Outcomes of Revision Total Wrist Arthroplasty. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202103000-00008. [PMID: 33730000 PMCID: PMC7969306 DOI: 10.5435/jaaosglobal-d-21-00035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/13/2021] [Indexed: 11/22/2022]
Abstract
In this study, we analyzed the outcomes of revision total wrist arthroplasty done over a 40-year period. During this period, 76 consecutive revision total wrist arthroplasties were done in 69 patients with a mean age of 56 and a follow-up of 10.3 years. Patients commonly experienced pain relief, with 58 (91%) experiencing no or mild pain postoperatively. There was no statistically significant change in flexion or extension, but a statistically significant decrease in ulnar deviation and a corresponding increase in radial deviation. However, a high rate of complications and repeat revision surgery were observed. The primary indications for a repeat revision surgery were distal loosening (n = 11), proximal loosening (n = 1), deformity and pain (n = 8), periprosthetic infection (n = 3), dislocation (n = 2), subluxation (n = 1), intraoperative fracture (n = 1), and suspected metal allergy (n = 1). Complications were distal loosening (n = 15), proximal loosening (n = 3), dislocation (n = 7), intraoperative fracture (n = 7), postoperative fracture (n = 2), and component fracture (n = 3). When advising the patient, clear information must be given about the high rate of complications connected with revision arthroplasty and the risk of further revision, eventually leading to total wrist fusion.
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Marie C, Aribert M, Bouyer M, Forli A, Corcella D. Clinical, functional, and radiological results of the Amandys® interposition arthroplasty in 13 cases of wrist osteoarthritis. HAND SURGERY & REHABILITATION 2021; 40:420-426. [PMID: 33689925 DOI: 10.1016/j.hansur.2021.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 12/21/2022]
Abstract
Amandys® pyrocarbon interposition arthroplasty is intended for widespread arthritis of the wrist. The aim of this study was to assess the clinical, functional, and radiological results of this arthroplasty with a minimum follow-up of 12 months. This retrospective single-center study brought together all osteoarthritis indications that can benefit from an Amandys® arthroplasty. Twenty-one implants were used between January 2011 and October 2018. There were seven cases of distal radius malunion, eight SLAC wrists, two SNAC wrists, two cases of Kienböck's disease at Lichtman's stage 4, and two aftermaths of inflammatory arthritis. Twenty-four percent of patients had previously undergone another type of surgery for this wrist arthritis. Six implants were removed, five early for dislocation and one after 6 years for chronic pain. Thirteen patients were reviewed with an average follow-up of 40.7 months (21-90). The average pain level on a visual analog scale was 3.1/10 (0-7). The mean range motion was 36° flexion (10-60) and 33° extension (15-50). The mean grip strength at the last follow-up was 14.8 kg (2-30) (43% of contralateral). The average QuickDASH and PRWE functional scores were 37.9/100 (0-80) and 29.6/100 (0-83.5), respectively. Amandys® interposition arthroplasty is an interesting alternative to total wrist fusion or total wrist prosthesis for widespread arthritis of the wrist. For the implant to be stable, the capsulo-ligamentous systems must be intact.
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Affiliation(s)
- C Marie
- SOS Main Grenoble, Unité de Chirurgie Réparatrice, de la Main et des Brûlés, Hôpital A - Michallon, CHU de Grenoble, Avenue du Marquis de Grésivaudan, BP 217, 38043 Grenoble cedex 09, France.
| | - M Aribert
- SOS Main Grenoble, Unité de Chirurgie Réparatrice, de la Main et des Brûlés, Hôpital A - Michallon, CHU de Grenoble, Avenue du Marquis de Grésivaudan, BP 217, 38043 Grenoble cedex 09, France.
| | - M Bouyer
- SOS Main Grenoble, Unité de Chirurgie Réparatrice, de la Main et des Brûlés, Hôpital A - Michallon, CHU de Grenoble, Avenue du Marquis de Grésivaudan, BP 217, 38043 Grenoble cedex 09, France.
| | - A Forli
- SOS Main Grenoble, Unité de Chirurgie Réparatrice, de la Main et des Brûlés, Hôpital A - Michallon, CHU de Grenoble, Avenue du Marquis de Grésivaudan, BP 217, 38043 Grenoble cedex 09, France.
| | - D Corcella
- SOS Main Grenoble, Unité de Chirurgie Réparatrice, de la Main et des Brûlés, Hôpital A - Michallon, CHU de Grenoble, Avenue du Marquis de Grésivaudan, BP 217, 38043 Grenoble cedex 09, France.
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11
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Ruskin JB, Shah HA, Congiusta DV, Ahmed IH, Vosbikian MM. Union of Radiocarpal Fusion With and Without Proximal Row Carpectomy: A Systematic Review. J Hand Surg Am 2021; 46:200-208. [PMID: 33663695 DOI: 10.1016/j.jhsa.2020.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 07/23/2020] [Accepted: 09/30/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Wrist fusion provides a solution to the painful, arthritic wrist, and can be concomitantly performed with or without a proximal row carpectomy (PRC). The benefits of combining a PRC with fusion include a large amount of local bone graft for fusion and a lower number of joints needed to fuse. We hypothesized that wrist fusion combined with PRC will have a higher fusion rate than wrist fusion performed without PRC. METHODS A systematic review was performed to identify all papers involving wrist arthrodesis using the following databases: PubMed, Ovid, Scopus, Web of Science, and COCHRANE. A literature search was performed using the phrases "wrist" OR "radiocarpal" and "fusion" OR "arthrodesis". Inclusion criteria included complete radiocarpal fusion performed for rheumatoid, posttraumatic, or primary arthritis; union rates available; English-language study. Studies were excluded if case reports; diagnoses other than the ones listed previously; inability to abstract the data. Data collected included wrist fusions with PRC or without PRC, union rate, patient age, underlying diagnosis, and method of fixation. RESULTS A total of 50 studies were included in the analysis. There were 41 studies with no PRC, 8 studies with PRC, and 1 study with and without PRC. There were 347 patients with a PRC and 339 patients had a successfully fused wrist (97.7%). There were 1,355 patients who had a wrist fusion with no PRC, and1,303 patients had successful wrist fusion (96.2%). The difference in fusion rate between the 2 groups, 97.7% versus 96.2%, was not statistically significant. CONCLUSIONS There is no statistically significant difference with regards to union rate in wrist fusion with a PRC versus wrist fusion without a PRC. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Jeremy B Ruskin
- Department of Orthopedic Surgery, Rutgers-New Jersey Medical School, Newark, NJ.
| | - Harsh A Shah
- Department of Orthopedic Surgery, University of Miami, Miami, FL
| | | | - Irfan H Ahmed
- Department of Orthopedic Surgery, Rutgers-New Jersey Medical School, Newark, NJ
| | - Michael M Vosbikian
- Department of Orthopedic Surgery, Rutgers-New Jersey Medical School, Newark, NJ
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Zhu XM, Perera E, Gohal C, Dennis B, Khan M, Alolabi B. A systematic review of outcomes of wrist arthrodesis and wrist arthroplasty in patients with rheumatoid arthritis. J Hand Surg Eur Vol 2021; 46:297-303. [PMID: 32938290 PMCID: PMC7897788 DOI: 10.1177/1753193420953683] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 08/01/2020] [Accepted: 08/08/2020] [Indexed: 02/03/2023]
Abstract
Surgical management of end-stage rheumatoid wrists is a contentious topic. The standard surgical treatment has traditionally been wrist arthrodesis. Wrist arthroplasty, however, offers an alternative that preserves some wrist motion. A systematic review of MEDLINE, EMBASE and CENTRAL databases was conducted. Data from 23 studies representing 343 cases of wrist arthrodesis and 618 cases of wrist arthroplasty were included. Complication rates were 17% for arthrodesis and 19% for arthroplasty, and both procedures were effective at alleviating pain and improving grip strength. Functional assessment by Disabilities of the Arm, Shoulder, and Hand and Patient-Related Wrist Evaluation of arthroplasty patients revealed clinically meaningful functional improvement compared with preoperative measurements. In contrast to previously published findings both procedures demonstrated comparable complication rates. While this can be speculated to be from advancements in prosthetics, robust long-term follow-up data on wrist arthroplasty are not available yet.
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Affiliation(s)
- Xi Ming Zhu
- St. George’s University Hospitals NHS Foundation Trust, University of London, London, UK
| | - Edward Perera
- St. George’s University Hospitals NHS Foundation Trust, University of London, London, UK
| | - Chetan Gohal
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Brittany Dennis
- St. George’s University Hospitals NHS Foundation Trust, University of London, London, UK
| | - Moin Khan
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Bashar Alolabi
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
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13
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Hazewinkel MHJ, Lans J, Lunn KN, Garg R, Eberlin KR, Chen NC. Complications and Factors Associated with Reoperation following Total Wrist Fusion. J Wrist Surg 2020; 9:498-508. [PMID: 33282536 PMCID: PMC7708030 DOI: 10.1055/s-0040-1714683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/15/2020] [Indexed: 10/23/2022]
Abstract
Background Total wrist fusion can be elected to relieve pain in patients with osteoarthritis and rheumatoid arthritis. This study aimed to investigate the overall complications and the factors associated with reoperation and soft tissue complication after total wrist fusion. Methods We retrospectively identified adult patients who underwent total wrist fusion using Current Procedural Terminology (CPT) codes, International Classification of Diseases, Ninth and Tenth Revision (ICD-9 and ICD-10) and verified these by medical chart review. We included patients ( n = 215) who were treated at a single institutional system from January 1, 2002 to January 1, 2019. The mean age was 53.3 ± 15.0 years and the median follow-up was 6.1 years (interquartile range [IQR] =1.7-9.0). The most common indications for wrist fusion included inflammatory arthritis ( n = 66, 31%), degenerative arthritis ( n = 59, 27%), and posttraumatic arthritis ( n = 47, 22%). All wrist fusions were performed using a dorsal fusion plate or dorsal spanning plate, either with a local autograft ( n = 167, 78%), iliac crest autograft ( n = 2, 1.0%), allograft ( n = 7, 3.3%), a combination of both ( n = 16, 7.4%), or without a graft ( n = 23, 11%). We performed a multivariable logistic regression to evaluate factors associated with reoperation. In addition, we performed a similar analysis to identify the factors associated with soft tissue complication after total wrist fusion. Results Forty-one (19%) patients underwent reoperation at a median of 6.9 months (IQR = 3.9-18). The indications included symptomatic implants ( n = 12, 27%), implant failures ( n = 8, 20%), infections ( n = 7, 17%), and nonunions ( n = 6, 15%). In multivariable analysis, total wrist fusion of the dominant hand (odds ratio [OR]: 2.2, 95% confidence interval [CI]: 1.1-4.7, p = 0.033) was associated with a higher reoperation rate. Soft tissue complications occurred in 20 patients (9.3%) consisting of hematomas ( n = 8, 3.7%), observed blistering ( n = 5, 2.3%), and observed wound dehiscence ( n = 4, 1.9%). In multivariable analysis, smoking (OR: 2.5, CI: 0.95-6.4, p = 0.010) was independently associated with soft tissue complication after total wrist fusion. Seventy-two (33%) patients had a postoperative complication including symptomatic hardware ( n = 16, 7.4%), implant failure ( n = 11, 5.1%), infection ( n = 11, 5.1%), nonunion ( n = 8, 3.7%), and carpal tunnel syndrome ( n = 4, 1.9%). Conclusion Roughly one-third (33%) of the patients undergoing total wrist fusion experience a postoperative complication and 19% of the patients underwent a reoperation. Total wrist fusion of the dominant hand results in higher reoperation rates. The risk of a soft tissue complication after total wrist fusion is increased in smokers.
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Affiliation(s)
- M. H. J. Hazewinkel
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jonathan Lans
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kiera N. Lunn
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rohit Garg
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kyle R. Eberlin
- Department of Plastic Surgery, Hand Surgery, and Peripheral Nerve Surgery, General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Neal C. Chen
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, General Hospital, Harvard Medical School, Boston, Massachusetts
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Cost-Effectiveness Analysis of Motion-Preserving Operations for Wrist Arthritis. Plast Reconstr Surg 2020; 146:588e-598e. [PMID: 33141535 DOI: 10.1097/prs.0000000000007260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The authors conducted a cost-effectiveness analysis to answer the question: Which motion-preserving surgical strategy, (1) four-corner fusion, (2) proximal row carpectomy, or (3) total wrist arthroplasty, used for the treatment of wrist osteoarthritis, is the most cost-effective? METHODS A simulation model was created to model a hypothetical cohort of wrist osteoarthritis patients (mean age, 45 years) presenting with painful wrist and having failed conservative management. Three initial surgical treatment strategies-(1) four-corner fusion, (2) proximal row carpectomy, or (3) total wrist arthroplasty-were compared from a hospital perspective. Outcomes included clinical outcomes and cost-effectiveness outcomes (quality-adjusted life-years and cost) over a lifetime. RESULTS The highest complication rates were seen in the four-corner fusion cohort: 27.1 percent compared to 20.9 percent for total wrist arthroplasty and 17.4 percent for proximal row carpectomy. Secondary surgery was common for all procedures: 87 percent for four-corner fusion, 57 percent for proximal row carpectomy, and 46 percent for total wrist arthroplasty. Proximal row carpectomy generated the highest quality-adjusted life-years (30.5) over the lifetime time horizon, compared to 30.3 quality-adjusted life-years for total wrist arthroplasty and 30.2 quality-adjusted life-years for four-corner fusion. Proximal row carpectomy was the least costly; the mean expected lifetime cost for patients starting with proximal row carpectomy was $6003, compared to $11,033 for total wrist arthroplasty and $13,632 for four-corner fusion. CONCLUSIONS The authors' analysis suggests that proximal row carpectomy was the most cost-effective strategy, regardless of patient and parameter level uncertainties. These are important findings for policy makers and clinicians working within a universal health care system.
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Reigstad O, Holm-Glad T, Korslund J, Grimsgaard C, Thorkildsen R, Røkkum M. High re-operation and complication rates 11 years after arthrodesis of the wrist for non-inflammatory arthritis. Bone Joint J 2019; 101-B:852-859. [PMID: 31256671 DOI: 10.1302/0301-620x.101b7.bjj-2018-0943.r4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Plate and screw fixation has been the standard treatment for painful conditions of the wrist in non-rheumatoid patients in recent decades. We investigated the complications, re-operations, and final outcome in a consecutive series of patients who underwent wrist arthrodesis for non-inflammatory arthritis. PATIENTS AND METHODS A total of 76 patients, including 53 men and 23 women, with a mean age of 50 years (21 to 79) underwent wrist arthrodesis. Complications and re-operations were recorded. At a mean follow-up of 11 years (2 to 18), 63 patients completed questionnaires, and 57 attended for clinical and radiological assessment. RESULTS Of the 76 patients, 46 (60.5%) had complications, resulting in 65 re-operations, mainly related to the plate and screws. In the 63 patients who completed the questionnaires, the mean Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) score was 36 (0 to 91), the mean Patient-Rated Wrist and Hand Evaluation (PRWHE) score was 40 (0 to 96), and 14 patients (22%) reported no wrist pain. Grip strength, pinch strength, and pronation and supination were significantly reduced compared with the contralateral forearm. The outcome was worse in patients who had previously undergone surgery to the wrist, and those with complications. A total of 13 are awaiting further re-operations, giving a total re-operation rate of 63% (40/63). CONCLUSION We observed complications and re-operations throughout the follow-up period and therefore consider wrist arthrodesis to be more complicated than previously assumed. Many of the patients never got used to or accepted their stiff wrists and reported a substantial reduction in function and residual pain. Motion-sparing surgery should be offered prior to wrist arthrodesis. Cite this article: Bone Joint J 2019;101-B:852-859.
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Affiliation(s)
- O Reigstad
- Hand and Microsurgery Department, Division of Orthopaedic Surgery, Oslo University Hospital, OUS-Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - T Holm-Glad
- Hand and Microsurgery Department, Division of Orthopaedic Surgery, Oslo University Hospital, OUS-Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - J Korslund
- Hand and Microsurgery Department, Division of Orthopaedic Surgery, Oslo University Hospital, OUS-Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - C Grimsgaard
- Hand and Microsurgery Department, Division of Orthopaedic Surgery, Oslo University Hospital, OUS-Rikshospitalet, Oslo, Norway
| | - R Thorkildsen
- Hand and Microsurgery Department, Division of Orthopaedic Surgery, Oslo University Hospital, OUS-Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - M Røkkum
- Hand and Microsurgery Department, Division of Orthopaedic Surgery, Oslo University Hospital, OUS-Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Berber O, Garagnani L, Gidwani S. Systematic Review of Total Wrist Arthroplasty and Arthrodesis in Wrist Arthritis. J Wrist Surg 2018; 7:424-440. [PMID: 30349758 PMCID: PMC6196084 DOI: 10.1055/s-0038-1646956] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 03/20/2018] [Indexed: 12/19/2022]
Abstract
Background End-stage wrist arthritis has traditionally been treated with a total wrist fusion. There is a recent trend toward motion preserving surgery in the form of total wrist replacement. Questions Is there a functional benefit to performing a total wrist replacement instead of a total wrist fusion in patients with end-stage wrist arthritis? Is there any difference in secondary outcome measures including pain, grip strength, and range of motion? Does the risk of adverse events and treatment failure differ between the two techniques? Methods A systematic literature search was performed to identify studies reporting either total wrist arthrodesis or arthroplasty for end-stage wrist arthritis. Studies were systematically screened and assessed for risk of bias and quality. Data were extracted and reviewed. Results A total of 43 studies were included in the review: 17 on arthrodesis, 24 on arthroplasty, and 2 matched cohort studies. This represented 669 index arthrodesis operations in 603 patients, and 1,371 index arthroplasty operations in 1,295 patients. A significant improvement in functional outcome was seen with both interventions. Similar improvements were seen in pain scores, and modest improvements were seen in grip strength. Range of motion following arthroplasty improved to a functional level in two studies. Complication rates were higher after arthroplasty (range: 0.2-9.5%) than those after arthrodesis (range: 0.1-6.1%; p = 0.06). Fourth-generation implants (range 0.1-2.9%) performed better than earlier designs (range: 0.2-8.1%; p = 0.002). Implant revision rates ranged from 3.5 to 52.6%. Fourth-generation prostheses survival rates were 78% at 15 years (Universal 2), 86% at 10 years (Motec), 90% at 9 years (Re-Motion), and 95% at 8 years (Maestro). Conclusion The newer fourth-generation wrist implants appear to be performing better than earlier designs. Both wrist arthrodesis and wrist arthroplasty improve function, pain, and grip strength. The risk of complication following wrist replacements is higher than that after total wrist arthrodesis.
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Affiliation(s)
- Onur Berber
- Hand and Wrist Unit, Department of Orthopaedics, Guy's and St Thomas' Hospitals, London, United Kingdom
- University of Brighton, Brighton, United Kingdom
| | - Lorenzo Garagnani
- Hand and Wrist Unit, Department of Orthopaedics, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Sam Gidwani
- Hand and Wrist Unit, Department of Orthopaedics, Guy's and St Thomas' Hospitals, London, United Kingdom
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Abstract
Scapholunate ligament (SLL) injuries are a common cause of wrist pain and instability. Treatment of SLL injuries requires intricate understanding of wrist anatomy and biomechanics. Mindful physical exam and appropriate diagnostic studies can orient the surgeon to the defined stage of injury. Review of the literature on each treatment by stage can prepare the upper extremity surgeon to provide the best evidence-based care. The optimal management of SLL injuries should result in a stable, painless wrist.
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Affiliation(s)
- Geoffrey Konopka
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA,
| | - Harvey Chim
- Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine, Gainesville, FL, USA,
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18
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Rancy SK, Ek ET, Paul S, Hotchkiss RN, Wolfe SW. Nonspanning Total Wrist Arthrodesis with a Low-Profile Locking Plate. J Wrist Surg 2018; 7:127-132. [PMID: 29576918 PMCID: PMC5864497 DOI: 10.1055/s-0037-1606257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
Purpose This study aims to compare the outcomes and complications of our technique for nonspanning total wrist arthrodesis using a locking plate with the standard carpometacarpal spanning technique. Methods A retrospective review of charts was performed to identify patients who underwent total wrist arthrodesis by the senior author (S.W.W.). We compared the outcomes of 15 cases of nonspanning wrist fusion with a 2.4/2.7 mm locking T plate to 11 cases of spanning wrist fusion with a 2.7/3.5 mm locking compression plate. Minimum follow-up was 3 months. Indications for fusion included rheumatoid arthritis, posttraumatic arthritis, Kienböck's disease, primary osteoarthritis, juvenile inflammatory arthropathy, psoriasis, brachial plexopathy, failed hemi or total wrist arthroplasty, failed four-corner fusion, and failed proximal row carpectomy. The primary outcome was fusion. Secondary outcomes included time to union, patient-rated wrist evaluation score, numerical rating scale pain score, grip strength, and complications. Results All the wrists got fused. There were no significant differences in objective and subjective outcomes between cohorts. There were three complications (27%) in the spanning group, including tendon rupture and peri-implant fracture at the third metacarpal. This was compared with three complications (20%) in the nonspanning group, consisting of hardware removal. Discussion We achieved similar fusion rates employing both spanning and nonspanning total wrist arthrodesis techniques, without necessitating carpometacarpal arthrodesis in the latter. Complications associated with our method were comparably less severe than those reported in the literature. We advocate nonspanning arthrodesis as an alternative method for total wrist fusion with a high union rate and minimal risk of complications at the carpometacarpal joint. Level of Evidence Therapeutic level IV.
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Affiliation(s)
- Schneider K. Rancy
- Division of Hand and Upper Extremity Surgery, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Eugene T. Ek
- Department of Surgery, Melbourne Orthopaedic Group, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
| | - Sophia Paul
- Division of Hand and Upper Extremity Surgery, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Robert N. Hotchkiss
- Division of Hand and Upper Extremity Surgery, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
- Weill Medical College of Cornell University, New York, New York
| | - Scott W. Wolfe
- Division of Hand and Upper Extremity Surgery, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
- Weill Medical College of Cornell University, New York, New York
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19
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Verdecchia N, Johnson J, Baratz M, Orebaugh S. Neurologic complications in common wrist and hand surgical procedures. Orthop Rev (Pavia) 2018; 10:7355. [PMID: 29770175 PMCID: PMC5937362 DOI: 10.4081/or.2018.7355] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 01/07/2018] [Indexed: 12/21/2022] Open
Abstract
Nerve dysfunction after upper extremity orthopedic surgery is a recognized complication, and may result from a variety of different causes. Hand and wrist surgery require incisions and retraction that necessarily border on small peripheral nerves, which may be difficult to identify and protect with absolute certainty. This article reviews the rates and ranges of reported nerve dysfunction with respect to common surgical interventions for the distal upper extremity, including wrist arthroplasty, wrist arthrodesis, wrist arthroscopy, distal radius open reduction and internal fixation, carpal tunnel release, and thumb carpometacarpal surgery. A relatively large range of neurologic complications is reported, however many of the studies cited involve relatively small numbers of patients, and only rarely are neurologic complications included as primary outcome measures. Knowledge of these neurologic outcomes should help the surgeon to better counsel patients with regard to perioperative risk, as well as provide insight into workup and management of any adverse neurologic outcomes that may arise.
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Affiliation(s)
| | - Julie Johnson
- Department or Orthopedic Surgery, University of Pittsburgh Medical Center, PA, USA
| | - Mark Baratz
- Department or Orthopedic Surgery, University of Pittsburgh Medical Center, PA, USA
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20
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Abstract
Total wrist arthrodesis remains an important technique in the surgical armamentarium of upper extremity surgeons. The procedure has evolved over time but continues to provide reliable pain relief at the expense of wrist motion. It is indicated for management of a wide variety of upper extremity conditions, including rheumatoid arthritis, posttraumatic osteoarthritis, cerebral palsy, and brachial plexus injuries, and as a salvage technique after failed implant arthroplasty. Recent studies demonstrate high levels of patient satisfaction and good functional outcomes after bilateral wrist fusion. Compared with total wrist arthroplasty, total wrist arthrodesis provides more reliable pain relief with lower rates of complications, but further studies are needed to compare functional outcomes and cost-effectiveness.
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21
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Hinds RM, Melamed E, O’Connell A, Cherry F, Seu M, Capo JT. Assessment of Wrist Function After Simulated Total Wrist Arthrodesis: A Comparison of 6 Wrist Positions. Hand (N Y) 2016; 11:464-468. [PMID: 28149215 PMCID: PMC5256647 DOI: 10.1177/1558944715626930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: There is poor consensus in the literature regarding associated functional limitation and the preferred wrist position for total wrist arthrodesis. The purpose of the current investigation was twofold: (1) to assess the functional limitations of wrist arthrodesis and (2) to determine the optimal position for wrist arthrodesis using a simulated wrist fusion model. Methods: Twenty healthy volunteers underwent simulated wrist arthrodesis in 6 different positions using custom-molded wrist splints: 15° extension with 0° radio-ulnar deviation, 15° extension with 10° ulnar deviation, 15° extension with 10° radial deviation, 0° extension with 0° radio-ulnar deviation, 0° extension with 10° ulnar deviation, and 0° extension with 10° radial deviation. Each volunteer was independently assessed for wrist function using the Jebsen-Taylor hand function test, grip strength, and satisfaction in the simulated wrist fusion positions. Comparisons between all simulated fusion wrists and the baseline unsplinted wrist as well as among the 6 simulated fusion positions were performed. Results: Turning over a card (5.1 vs 4.3 seconds), picking up small objects (7.1 vs 5.8 seconds), and simulated feeding (8.3 vs 7.1 seconds) as well as total Jebsen-Taylor test duration (41.8 vs 37.9 seconds) was significantly longer in simulated fusion wrists. Both grip strength (55.9 vs 80.7 kg) and satisfaction scores (6.4 vs 9.6) were lower in simulated fusion wrists. Wrists in 0° extension also demonstrated significantly shorter durations in stacking checkers than wrists in 15° extension. Conclusion: Our findings suggest that wrist arthrodesis may only compromise select wrist functions. Among the tested wrist fusion positions, wrists fused in neutral may demonstrate better function than wrist fused in slight extension. However, grip strength and satisfaction seem to be unaffected by wrist fusion position.
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Affiliation(s)
| | - Eitan Melamed
- New York University Hospital for Joint Diseases, NY, USA,Eitan Melamed, Division of Hand Surgery, New York University Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA.
| | | | | | - Monica Seu
- New York University Hospital for Joint Diseases, NY, USA
| | - John T. Capo
- New York University Hospital for Joint Diseases, NY, USA
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22
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Ayers R, Pickford M. Rheumatoid arthritis of the hand and wrist. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Wagner ER, Elhassan BT, Kakar S. Long-term functional outcomes after bilateral total wrist arthrodesis. J Hand Surg Am 2015; 40:224-228.e1. [PMID: 25510154 DOI: 10.1016/j.jhsa.2014.10.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 10/22/2014] [Accepted: 10/22/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To report on the long-term outcomes of bilateral total wrist arthrodeses. METHODS We conducted a review of all living patients who underwent bilateral wrist arthrodeses from 1980 to 2010 within a single institution. Outcome measures included pain, Disabilities of the Arm, Shoulder, and Hand questionnaire, Patient-Rated Wrist Evaluation, Michigan Hand Questionnaire, satisfaction scores, complications, and revision surgeries. RESULTS Thirteen patients (26 wrists) were treated with an average follow-up of 14 years (range, 3-28 y). Average time for contralateral wrist arthrodesis was 16 months after initial wrist arthrodesis. Eleven wrists had undergone prior surgery. Eleven patients had a primary diagnosis of inflammatory arthritis. Wrists were fused from 5° flexion to 30° extension, with all but one patient's wrist fused within 10° of the contralateral wrist. There was a significant improvement in postoperative grip strength and pain levels. Postoperative Disabilities of the Arm, Shoulder, and Hand, Patient-Rated Wrist Evaluation, and Michigan Hand Questionnaire scores were 21, 29, and 73, respectively. Increasing age, preoperative steroid usage, and concomitant shoulder or elbow disorders were associated with worse outcomes. Twelve patients (93%) were satisfied and would repeat the surgery and 9 returned to full-time work. The major functional limitation was turning a doorknob or tight jar lid. Seven patients underwent additional surgery including 5 revision arthrodeses and 2 plate removals. Revision surgeries were more common in patients with prior surgeries or preoperative steroid usage, women, smokers, those with ipsilateral elbow dysfunction, and those with fixation with a dorsal locking plate. CONCLUSIONS Bilateral total wrist arthrodesis improved pain while enabling patients with severe carpal arthrosis to maintain a satisfactory level of extremity function and quality of life. In general, patients adapted and were satisfied with functional capabilities. This is a viable salvage option for patients with severe bilateral disease. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Affiliation(s)
- Eric R Wagner
- Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN
| | - Bassem T Elhassan
- Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN.
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24
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Wrist essentials: the diagnosis and management of scapholunate ligament injuries. Plast Reconstr Surg 2014; 134:312e-322e. [PMID: 25068352 DOI: 10.1097/prs.0000000000000423] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand the pathophysiology of a scapholunate injury. 2. Understand how to diagnose scapholunate injuries 3. Formulate and carry out a surgical plan for patients with a scapholunate injury. SUMMARY Scapholunate ligament instability is the most common form of carpal instability. Untreated scapholunate injuries can lead to a predictable pattern of wrist arthritis. Early forms of scapholunate ligament instability can be missed, and clinical detection relies on an educated observer. This article covers the basic anatomy and biomechanics of the wrist, and reviews in detail scapholunate ligament injury. This article also reviews and discusses the current relevant topics and issues surrounding scapholunate ligament injury.
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Dréano T, Bouillis J, Ropars M. [Evaluation of a technical modification to Mannerfelt's total wrist fusion technique in a series of 19 rheumatoid wrists]. ACTA ACUST UNITED AC 2014; 33:344-9. [PMID: 25260765 DOI: 10.1016/j.main.2014.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 06/06/2014] [Accepted: 06/28/2014] [Indexed: 11/27/2022]
Abstract
We studied a technical modification of Mannerfelt's total wrist fusion technique in a series of 19 wrists. A fully intramedullary technique without dorsal carpal fixation was used to protect the extensor tendons. Two intramedullary Rush pins without dorsal staples were used during the arthrodesis procedure. Nineteen rheumatoid arthritis wrists (2 bilateral cases) were reviewed with a mean follow-up of 4.9 years (range 2-10 years). Clinical outcomes were assessed using the VAS pain scale, DASH-score and wrist strength measurements. Wrist fusion was assessed on AP and lateral X-rays of the wrist. The position of the carpal Rush pin entry points and distal hook orientation were also assessed. Pain was 8.9 preoperatively and 1.1 at the last follow-up with 95% patients satisfied. Mean DASH-score was 46.9 points. The pinch strength was 79% and the grip strength was 68% of the contralateral wrist. Carpal height, carpal anterior subluxation and ulnar deviation were stable at the last follow-up. All of the wrists were in straight position and no extensor tendon ruptures were noted. Fusion was complete in all cases within 6 to 12 weeks, except in one case. The technical modification proposed in the current study -intraosseous fixation only- appears to be a good alternative to Mannerfelt's original technique. Every case treated with this modified technique had good functional results and none required pin removal.
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Affiliation(s)
- T Dréano
- Service de chirurgie orthopédique, unité de chirurgie du membre supérieur, centre hospitalier universitaire de Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - J Bouillis
- Service de chirurgie orthopédique, unité de chirurgie du membre supérieur, centre hospitalier universitaire de Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - M Ropars
- Service de chirurgie orthopédique, unité de chirurgie du membre supérieur, centre hospitalier universitaire de Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
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Trieb K. Arthrodesis of the wrist in rheumatoid arthritis. World J Orthop 2014; 5:512-515. [PMID: 25232527 PMCID: PMC4133457 DOI: 10.5312/wjo.v5.i4.512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 03/29/2014] [Accepted: 06/27/2014] [Indexed: 02/06/2023] Open
Abstract
In rheumatoid arthritis the small joints of the feet and hands are the first targets of the autoimmune process. In about one half of the patient the wrist is involved in the first stages of the disease (two years) increasing up to nearly 90 percent after a decade often including both sides. Osteoarthritis of the wrist is one of the most common conditions encountered by hand surgeons. One aim of all treatment options is to achieve the best possible hand function without pain. If conservative treatment fails, operative treatment is necessary. Choice of surgical treatment depends on the soft tissue and bone situation. Techniques can be differentiated by joint preservation or joint replacement. The first include radio-synoviorthesis, synovectomy and tendon repair, the latter resection-arthroplasty, total joint arthroplasty and arthrodesis. In this paper arthrodesis of the wrist as one treatment option is reviewed.
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27
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Lautenbach M, Millrose M, Langner I, Eisenschenk A. Results of Mannerfelt wrist arthrodesis for rheumatoid arthritis in relation to the position of the fused wrist. INTERNATIONAL ORTHOPAEDICS 2013; 37:2409-13. [PMID: 23955819 DOI: 10.1007/s00264-013-2063-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 07/30/2013] [Indexed: 12/14/2022]
Abstract
PURPOSE The wrist is involved early in rheumatoid arthritis and is often severely affected. A stable wrist is crucial to good hand function, which often necessitates a fusion. One of the most commonly used techniques in rheumatoid patients is the Mannerfelt arthrodesis. In this retrospective study the outcome and the patient's subjective satisfaction are presented and compared to other techniques. Also the influence of the position of the wrist following a fusion procedure is analysed. METHODS Thirty-four wrists were retrospectively analysed using radiological measurements, functional scores such as the Disabilities of the Arm, Shoulder and Hand (DASH) and a pain assessment. The objective function of the hand with the fused wrist was assessed. RESULTS In 92.6% of wrists the patients rated their satisfaction as good or excellent. The mean DASH score post-operatively was 63.3. Of the wrists, 17 were fixed in a median flexed position of 13° and 17 wrists in a median extended position of 8°. There was no statistically significant correlation between the position of the wrist and the satisfaction or objective function. The rate of fusion was 94.1%. CONCLUSIONS The Mannerfelt arthrodesis achieves good results and provides a high rate of satisfaction and pain relief in our study. It has major advantages compared to other wrist fusion techniques in the rheumatoid patient. We could not show clear statistical evidence for better results in either a flexed or an extended position, but the ratings of the patients indicated better subjective results with a slightly extended position of the arthrodesis.
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Affiliation(s)
- Martin Lautenbach
- Department of Upper Extremity, Hand and Microsurgery, Immanuel Hospital, Königstrasse 63, 14109, Berlin, Germany
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28
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Novel approach for posttraumatic panarthritis of the wrist using a pyrocarbon interposition arthroplasty (Amandys®): Preliminary series of 11 patients. ACTA ACUST UNITED AC 2012; 31:188-94. [DOI: 10.1016/j.main.2012.07.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 06/28/2012] [Accepted: 07/01/2012] [Indexed: 11/19/2022]
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29
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El-Kazzi W, Robert C, Mouraux D, Feipel V, Burny F, Schuind F. Arthrodesis of the wrist with bone autograft and Hoffmann external fixation. J Hand Surg Eur Vol 2012; 37:149-54. [PMID: 22279099 DOI: 10.1177/1753193411416565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report a series of 29 cases of wrist arthrodesis using a radiometacarpal half-frame or triangular Hoffmann configuration, bone autograft, and relocation of a retinacular rectangular flap under the extensor tendons to prevent adhesions. No splint or plaster cast has been used. Early active motion of the fingers was encouraged. The average duration of follow-up was 4 years. Bone healing was obtained in 27 patients after 104 days on average. All patients regained full finger movements and rotation of the forearm. Nine patients were reassessed on average 7.2 years after the arthrodesis: the VAS for pain at rest was 2.4/10, the DASH score 33/100, the grip strength 75% of the contralateral side on average.
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Affiliation(s)
- W El-Kazzi
- Erasme University Hospital, Université libre de Bruxelles, route de Lennik 808, Brussels, Belgium
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30
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Rudolf KD, Kus S, Chung KC, Johnston M, LeBlanc M, Cieza A. Development of the International Classification of Functioning, Disability and Health core sets for hand conditions--results of the World Health Organization International Consensus process. Disabil Rehabil 2011; 34:681-93. [PMID: 21978202 DOI: 10.3109/09638288.2011.613514] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE A formal decision-making and consensus process was applied to develop the first version of the International Classification on Functioning, Disability and Health (ICF) Core Sets for Hand Conditions. METHOD To convene an international panel to develop the ICF Core Sets for Hand Conditions (HC), preparatory studies were conducted, which included an expert survey, a systematic literature review, a qualitative study and an empirical data collection process involving persons with hand conditions. A consensus conference was convened in Switzerland in May 2009 that was attended by 23 healthcare professionals, who treat hand conditions, representing 22 countries. RESULTS The preparatory studies identified a set of 743 ICF categories at the second, third or fourth hierarchical level. Altogether, 117 chapter-, second-, or third-level categories were included in the comprehensive ICF Core Set for HC. The brief ICF Core Set for HC included a total of 23 chapter- and second-level categories. CONCLUSIONS A formal consensus process integrating evidence and expert opinion based on the ICF led to the formal adoption of the ICF Core Sets for Hand Conditions. The next phase of this ICF project is to conduct a formal validation process to establish its applicability in clinical settings.
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Affiliation(s)
- Klaus-Dieter Rudolf
- Department of Hand Surgery, Plastic- and Microsurgery, Burns Unit, BG Trauma Hospital Hamburg, Germany
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Abstract
The clinical picture of rheumatoid arthritis (RA) is best viewed as a combination of systemic symptoms associated with the inflammatory process and articular symptoms related both to potentially reversible synovitis and structural damage brought on by inflammation. In simple terms, the treatment of inflammation is medical, and structural lesions often require surgical solutions. The prime indications for surgery in patients with RA are essentially determined by the patient and consist of a desire to obtain pain relief and/or functional improvement. Pain is difficult to quantify. Essential concepts regarding surgical intervention are that surgery is elective in all but a few rare situations and always requires local therapy. Any evaluation of surgical intervention must be based on its total effect on the patient. Although there have been immense advances in the surgical options for patients with rheumatoid arthritis over the last several decades, the role of specific procedures in the total picture has many areas of uncertainty and controversy.
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Affiliation(s)
- Ronald J Anderson
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Vekris MD, Pakos EE, Soucacos PN, Gavriilidis I, Beris AE. Wrist arthrodesis for brachial plexus palsy using an external fixator and a cannulated screw (Ioannina technique). J Orthop Surg (Hong Kong) 2010; 18:87-91. [PMID: 20427843 DOI: 10.1177/230949901001800120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To present a new technique for wrist arthrodesis and review its treatment outcomes in 33 patients with brachial plexus palsy. METHODS 26 men and 7 women (mean age, 26 years) with global brachial plexus palsy underwent wrist arthrodesis using an external fixator and a cannulated screw. All surgeries were performed under local anaesthesia by a single senior surgeon. An external fixator was applied to the radius and the metacarpal of the index finger. The articular surfaces of the radius, scaphoid, lunate, and capitate were debrided, and a cannulated screw inserted from the base of the radial styloid to the carpo-metacarpal joint of the ring finger. Cancellous allografts mixed with demineralised bone matrix were added to the decorticated wrist bones. The external fixator was removed at week 8 and the wrist protected with a short-arm splint until solid wrist fusion. RESULTS All patients achieved wrist fusion after a mean of 14 (range, 12-16) weeks. Two patients had delayed fusion and slight wrist instability, because the shorter screw was embedded in the cancellous bone and not self-tapped to the cortex. Fusion was achieved after replacement with a longer screw. No patient developed a superficial or deep wound infection; 2 developed pin track infections. All patients were satisfied with the outcome and able to perform simple daily activities after one year. CONCLUSION Our new technique for wrist arthrodesis is less invasive. Blood loss, the risk of postoperative infection, and adhesions at the extensors are decreased.
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Affiliation(s)
- Marios D Vekris
- Department of Orthopaedic Surgery, University Hospital of Ioannina, University of Ioannina, School of Medicine, Ioannina, Greece.
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Pardini AG, Pádua Gonçalves RF, Freitas AD, Chaves AB. WRIST ARTHRODESIS WITH MINIMAL FIXATION PRESERVING THE CARPOMETACARPAL JOINTS. Rev Bras Ortop 2010; 45:67-71. [PMID: 27022522 PMCID: PMC4799146 DOI: 10.1016/s2255-4971(15)30219-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Wrist arthrodesis is a surgical procedure that should always be considered in cases of pathological conditions in which anatomical and functional structures are altered. In general, the results are very satisfactory, particularly for pain relief, and in the majority of cases, there is considerable functional improvement. Various techniques have been described, with different methods of internal fixation, most of which include the carpometacarpal joints in the fusion. The objective of this study was to evaluate the results from wrist arthrodesis using a technique that is simpler, more biological, less expensive, and does not involve the carpometacarpal joints. Methods: Fifteen patients with wrist arthrodesis were evaluated (six with sequelae from trauma, four with rheumatoid arthritis, three with Kienbock grade IV, one with Preiser and one with panarthrosis). The technique consisted of using an iliac bone plate and internal fixation with Kirschner wires, avoiding the carpometacarpal joints. Results: The evaluation was based on consolidation time (93% in seven weeks); movements of the fingers and pronosupination; pinch and grasp strength; functional evaluation through the DASH, pain and patient satisfaction questionnaires. In general, the results were similar to those of other, more aggressive techniques, and the non-inclusion of the carpometacarpal joints did not affect the final result. Conclusion: Wrist arthrodesis with fixation using Kirschner wires and an iliac bone plate, preserving the carpometacarpal joints, gives good or excellent results that are not inferior to those of other techniques that have been described. However, it presents major advantages over other methods: it is less aggressive and cheaper, and does not have the inconvenience and complications associated with the use of plates and screws.
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Affiliation(s)
- Arlindo Gomes Pardini
- Full Professor of Orthopedics and Traumatology. Head of the Hand Surgery Service at the Orthopedics Hospital of Belo Horizonte
| | | | | | - Antonio Barbosa Chaves
- Hand Surgeon at the Orthopedics Hospital of Belo Horizonte
- Correspondence: Rua Prof. Otávio Coelho de Magalhães, 111, 30210-300 Belo Horizonte, MG –Correspondence: Rua Prof. Otávio Coelho de Magalhães, 111Belo HorizonteMG30210-300
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Cavaliere CM, Chung KC. Total wrist arthroplasty and total wrist arthrodesis in rheumatoid arthritis: a decision analysis from the hand surgeons' perspective. J Hand Surg Am 2008; 33:1744-55, 1755.e1-2. [PMID: 19084173 PMCID: PMC4410850 DOI: 10.1016/j.jhsa.2008.06.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Revised: 06/19/2008] [Accepted: 06/24/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE Treatment of severely destroyed rheumatoid wrists with total wrist arthroplasty or total wrist arthrodesis relies on patient and surgeon preferences rather than rigorous prospective outcomes data. The purpose of this study is to develop a decision analytic model of arthroplasty and arthrodesis in rheumatoid arthritis (RA) using utility values obtained from a random sample of hand surgeons. METHODS A utility survey using a time trade-off design was administered to 175 members of the American Society for Surgery of the Hand. Based on the results of the survey, the utility values that surgeons assign to health states associated with arthroplasty and arthrodesis and their complications were calculated. By combining utility values with complication rates in the published literature, we developed a decision tree to calculate the expected quality-adjusted life years (QALYs) for each procedure compared to living with a painful RA wrist. RESULTS Based on surgeon preferences, living for 30 years with a painful, poorly functioning RA wrist (utility = 0.54) is associated with 16.2 QALYs. Treatment with arthroplasty (utility = 0.85) is associated with 25.5 QALYs, a gain of 9.3 QALYs over nonsurgical management. Arthrodesis (utility = 0.82) is associated with 24.6 QALYs, a gain of 8.4 QALYs over nonsurgical management. Arthroplasty is associated with a small incremental increase in QALYs (0.9) compared to arthrodesis. CONCLUSIONS Based on utility scores, hand surgeons feel that living with a painful, poorly functioning RA wrist for 30 years is worth approximately half as many years with a painless, well-functioning wrist. The outcomes for arthroplasty and arthrodesis are valued more than nonsurgical management. On the basis of its higher expected gain in QALYs, arthroplasty should be the preferred treatment. The minimal increase in utility for arthroplasty over arthrodesis suggests however, that surgeons do not view arthroplasty as superior to arthrodesis. TYPE OF STUDY/LEVEL OF EVIDENCE Economic and decision analysis IV.
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Affiliation(s)
- Christi M. Cavaliere
- Clinical Lecturer, Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System and VA Ann Arbor Health System; Ann Arbor, MI. Robert Wood Johnson Clinical Scholar, University of Michigan; Ann Arbor, MI
| | - Kevin C. Chung
- Professor of Surgery, Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System; Ann Arbor, MI
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Herzberg G. Management of bilateral advanced rheumatoid wrist destruction. J Hand Surg Am 2008; 33:1192-5. [PMID: 18762118 DOI: 10.1016/j.jhsa.2008.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Accepted: 06/06/2008] [Indexed: 02/02/2023]
Affiliation(s)
- Guillaume Herzberg
- Hand and Upper Extremity Orthopaedic Unit, Edouard Herriot Hospital, Lyon, France.
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A Systematic Review of Total Wrist Arthroplasty Compared with Total Wrist Arthrodesis for Rheumatoid Arthritis. Plast Reconstr Surg 2008; 122:813-825. [PMID: 18766045 DOI: 10.1097/prs.0b013e318180ece3] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Wrist involvement is common in rheumatoid arthritis and affects up to 50% of patients within the first 2 years after the onset of the disease, including bilateral involvement. It is a progressive disease that destroys the articular cartilage and surrounding soft tissues, thus leading to severe deformities. Radiological changes are characteristic and include narrowing of the joint line, cysts, and periarticular osteoporosis. Clinical changes are characterized by different scoring systems, indicating different therapeutic options. Surgical orthopedic treatment options include joint-preserving techniques to prevent further damage (radiosynoviorthesis, synovectomy, or axial correction with tendon transfers in earlier stages) and joint replacing techniques to restore function (arthrodesis, resection arthroplasty or total joint arthroplasty in later stages). This article reviews pathologic changes in the rheumatoid hand and their surgical treatment alternatives.
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Affiliation(s)
- Klemens Trieb
- Department of Orthopaedics, Klinikum Kreuzschwestern Wels, Wels, Austria.
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Toma CD, Machacek P, Bitzan P, Assadian O, Trieb K, Wanivenhaus A. Fusion of the wrist in rheumatoid arthritis. ACTA ACUST UNITED AC 2007; 89:1620-6. [PMID: 18057363 DOI: 10.1302/0301-620x.89b12.18880] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We retrospectively compared wrist arthrodesis using the Mannerfelt technique in 19 or an AO-plate in 23 patients with long-standing rheumatoid arthritis. The mean follow-up was for 76 months. Compared with the Mannerfelt fusion group, patients in the AO-plate group reported greater satisfaction with their wrist function (74% vs 37%, p = 0.015). Complications were reported in six wrists in the AO-plate group and two wrists in the Mannerfelt fusion group (p = 0.258). At final follow-up, 95% of patients (41) reported either no pain or only mild pain. There was improvement in flexion of the finger joints in both groups but no significant improvement in the extension lag in either group. Both methods relieve pain and improve function. Overall, the activities of daily living scores and the patients’ subjective assessment of outcome tended to be higher in the AO-plate group than in the Mannerfelt fusion group, although the difference was not statistically significant. Similarly, although more postoperative complications occurred in the AO-plate group, the difference between the two groups was not statistically significant.
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Affiliation(s)
| | - P. Machacek
- Orthopädisches Spital Wien Speising, Speisinger Strasse, 109, 1130 Vienna, Austria
| | | | - O. Assadian
- Clinical Institute for Hygiene and Medical Microbiology, Medical University of Vienna, General Hospital Vienna, Waehringer Guertel 18-20, Vienna A-1090, Austria
| | - K. Trieb
- Department of Orthopaedic Surgery, Klinikum Kreuzschwestern Wels, Grieskirchnerstrasse, 42, A-4200 Wels, Austria
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Abstract
The wrists are affected in the long-term in 90% of people with rheumatism and are often (42%) the first manifestation of a destructive disease. The functionality of the wrist and the whole hand is of great importance because in many cases loss of function of the wrists leads to severe limitations. Local and operative treatment of the wrist in rheumatoid arthritis (RA) is one of the main duties in rheuma-orthopaedics. For operative treatment there is a finely tuned differential therapeutic spectrum available. The diagnostic indications take the local and total pattern of affection, the current systemic therapy as well as patient wishes and patient compliance into consideration. In the early stages according to LDE (Larsen, Dale, Eek), soft tissues operations such as articulo-tenosynovectomy (ATS) are most commonly carried out. In further advanced stages osseus stabilisation must often be performed. At this point a smooth transition from partial arthrodesis to complete fixation is possible. After initial euphoria, arthroplasty of the wrist is being increasingly less used for operative treatment due to the unconvincing long-term results and high complication rate. With reference to the good long-term results of all operative procedures, in particular early ATS with respect to pain, function and protection of tendons, after failure of medicinal treatment and persistence of inflammatory activity in the wrist, patients should be transferred to an experienced rheuma-orthopaedic surgeon.
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Affiliation(s)
- H Dinges
- Orthopädische Klinik mit Schwerpunkt Rheumaorthopädie, Westpfalz-Klinikum GmbH Kaiserslauter/Kusel, Im Flur 1, 66869, Kusel, Germany.
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