Risk Factors for Infection Following Total Wrist Arthroplasty and Arthrodesis: An Analysis of 6641 Patients

Total Wrist Arthroplasty Versus Wrist Fusion in Rheumatoid Arthritis

Total wrist fusion (TWF) and total wrist arthroplasty (TWA) are viable treatment options for the rheumatic wrist. TWF fuses through the carpus to stabilize the wrist in 10° to 15° of extension and neutral coronal alignment. Although TWF can be performed with many implants, dorsal fusion plates are best supported. TWA has the advantage of preserving wrist motion but has historically had unacceptable complication rates. The current fourth and fifth generation implants represent significant improvements and have acceptable long-term survivorship and complication rates. Both TWF and TWA can improve quality of life and hand function in patients with rheumatoid arthritis.

The impacts of anxiety and depression on outcomes in orthopaedic trauma surgery: a narrative review

Introduction

The impact of anxiety and depression on outcomes in orthopaedic trauma surgery is a topic of growing research interest.

Patients and methods

Orthopaedic trauma patients often experience high rates of psychiatric disorders, with anxiety and depression being the most prevalent. Mental health disorders have been shown to increase the risk of negative surgical outcomes and morbidity. This narrative review seeks to summarize the current literature surrounding the impacts of anxiety and depression on orthopaedic trauma surgery outcomes.

Discussion

There is a bidirectional relationship between chronic pain and mental health disorders, involving overlapping brain regions and neurotransmitter pathways. Anxiety and depression have been identified as predictors of negative surgical outcomes in orthopaedic trauma patients. Screening tools like the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Screener-7 (GAD-7), and Medical Outcomes Study 36-item Short Form (SF-36) can assess mental health status and help tailor interventions. Psychological distress, chronic pain, and traumatic limb amputation are factors that contribute to adverse mental health outcomes in orthopaedic trauma patients. Opioid use for pain management is common in orthopaedic surgery, but it can worsen symptoms of depression and lead to dependency. Non-opioid pain management strategies may improve postoperative outcomes by reducing the impact of opioid-exacerbated depression.

Conclusion

Mental health interventions, both preoperative and postoperative, are crucial in optimizing surgical outcomes and improving patient quality of life. Multidisciplinary approaches that address both physical and mental health are recommended for orthopaedic trauma patients. Further research is needed to develop effective interventions for improving mental health outcomes in this patient population.

Total Wrist Arthrodesis: An Update on Indications, Technique and Outcomes

Painful end-stage wrist osteoarthritis (OA) unresponsive to conservative treatment is frequently managed with total wrist arthrodesis (TWA), which might render pain alleviation and ameliorate function, pain, and grip strength. Usual indications for TWA include inflammatory arthritis, idiopathic degenerative OA and posttraumatic OA, Kienböck's illness, brachial plexus palsy, cerebral paralysis, infraclavicular brachial plexus blocks and other spastic and contracture base illnesses, scapholunate advanced collapse, scaphoid nonunion advanced collapse, and failure of other surgical techniques such as after failed total wrist arthroplasty, four-corner fusion, proximal row carpectomy and severe ligament injuries (this procedure is carried out when all other treatment alternatives have failed to control the individual's symptoms). TWA is commonly carried out with a dorsal plate fixed from the distal radius to the third metacarpal. However, other surgical procedures have been reported, including intramedullary fixation and new implants that do not cross the third carpometacarpal joint or some procedures without utilizing hardware for example using a vascularized fibular grafting In individuals with rheumatoid arthritis. TWA has been shown to give persistent and painless stability for 20 years or more. The rate of adverse events for TWA ranges from 0.1% to 6.1%, though some authors have published that it can be as high as 27%. The most common adverse events are tendon ruptures, peri-implant fractures of the third metacarpal, the need for hardware removal, and constant pain at the third carpometacarpal joint. In idiopathic degenerative OA, the reoperation rate following TWA has been reported as high as 63%. While TWA can render foreseeable pain alleviation and ameliorate function, orthopedic surgeons should remember that this surgical technique is not without its risks and that the accessibility of many surgical procedures requires orthopedic surgeons to scrupulously contemplate the risks and benefits of each alternative for the individual in front of them.

La artroplastia de muñeca como solución a la artrosis postraumática o fracaso de artrodesis parcial: Una serie de casos

Introducción Diferentemente de la artrodesis, la artroplastia total de muñeca permite mantener um rango de movimiento funcional en pacientes operados por artrosis de diferentes causas. La evolución de los implantes pemitió llegar a una mayor tasa de éxito, con disminución de las complicaciones como el aflojamiento de componentes. Este estudio tiene como objetivo demostrar los resultados funcionales y las tasas de complicaciones en una serie de casos operados con el implante Motec (Swemac Orthopaedics AB, Linköping, Suecia) por un único cirujano.

Materiales y Métodos Se trata de un estudio retrospectivo con 14 pacientes intervenidos de artroplastia total de muñeca con el sistema Motec entre 2017 y 2022 y evaluados pre y posoperatoriamente por la Escala de Muñeca de la Clínica Mayo (Mayo Wrist Score, en inglés) y la Escala Visual Analógica (EVA). Se realizó revisión de historias clínicas en junio de 2022 y análisis estadístico con prueba t pareada considerando significativos valores de p < 0,05.

Resultados Fueron operados 13 hombres y 1 mujer, con una edad media de 64,8 (desviación estándar [DE] = 7,5) años, y el tiempo medio de seguimiento fue de 25,1 (DE = 10,9) meses. La puntuación en la Escala de Mayo presentó media preoperatoria de 23,2 (DE = 8,9) y posoperatoria de 82,8 (DE = 7), mientras la EVA preoperatoria tuvo una media de 7,6 (DE = 1,1), y la posoperatoria fue de 1 (DE = 1,2). Las diferencias en los resultados pre y posoperatorios de la Escala de Mayo y la EVA fueron estadísticamente significativas (p < 0,001).

Conclusión Como se demuestra en esta serie, las mejoras funcionales y en el dolor fueron importantes, no hubo complicaciones mayores en el período de tiempo evaluado, y la prótesis fue capaz de reemplazar las artrodesis parciales que fallaron. Los pacientes deben ser seguidos durante más tiempo, pero con la certeza de que, en caso de fracaso, aún se puede realizar una artrodesis total de muñeca.

The effects of preoperative alcohol, tobacco, and psychological stress on postoperative complications: a prospective observational study

Background

Postoperative complications occur frequently, despite progress in anesthetic pharmacology and surgical techniques. Although habits, such as alcohol and tobacco use, and mental health have been studied individually as modifying factors, few studies have examined the relationship between multiple lifestyle choices and postoperative complications in patients undergoing surgery. Hence, this study aimed to investigate the associations between unhealthy lifestyle choices and postoperative complications.

Methods

We included 730 patients who underwent surgery in our department between March 2015 and April 2016. Participants completed preoperative questionnaires, including the Alcohol Use Disorders Identification Test, Fagerström Test for Nicotine Dependence, and tests for psychological stress (6-item Kessler Psychological Distress Scale; Hospital Anxiety and Depression Scale). Multivariable logistic analysis was used to analyze the association of preoperative drug dependence and psychological stress with postoperative complications.

Results

Of the 721 cases analyzed, 461 (64%) were women. The median age of patients was 62 years (interquartile range: 48–71). At the time of surgical decision-making, 429 out of 710 respondents (60%) had a drinking habit, and 144 out of 693 respondents (21%) had a smoking habit during the preceding year. Seventy-nine patients had developed complications. Multivariable analysis revealed that old age (p = 0.020), psychological stress (p = 0.041), and longer anesthesia time (p < 0.001) were significantly associated with postoperative complications. Drinking or smoking variables were not associated with postoperative complications.

Conclusions

Preoperative psychological stress, as evaluated with the 6-item Kessler Psychological Distress Scale, is associated with the risk of postoperative complications.