Comparison of Clinical Results After Pisiformectomy in Patients With Rheumatic Versus Posttraumatic Osteoarthritis

Abstract

Pisotriquetral osteoarthritis is important to consider in the differential diagnosis of chronic ulnar-sided wrist pain. It can develop following traumatic injury to the pisiform or in rheumatic diseases, such as rheumatoid arthritis or psoriatic arthritis. It has been shown that pisiformectomy can relieve symptoms in cases that have not responded to nonoperative treatment, and the excision does not compromise the function or strength of the wrist. Most studies focus on posttraumatic causes of pisotriquetral osteoarthritis. In the current study, rheumatic causes are also considered and the outcomes are compared. This retrospective study included 35 patients who underwent pisiformectomy for pisotriquetral osteoarthritis. All patients underwent a thorough diagnostic evaluation to exclude other etiologies for ulnar-sided wrist pain. Radiological examinations including posteroanterior and lateral views of the wrist and a tangential view of the pisotriquetral joint were analyzed. All patients had excellent or very good results after pisiformectomy, with a significant reduction in pain. No significant difference was found in the outcomes for patients with rheumatic vs posttraumatic osteoarthritis. Patients with rheumatic causes of pisotriquetral osteoarthritis can be successfully treated with pisiformectomy. With respect to idiopathic causes, these patients need a longer postoperative period to gain full pain relief. It is important to consider the possibility of pisotriquetral osteoarthritis after excluding other diagnoses in patients with rheumatic osteoarthritis.

Long-Term Results of Pisiformectomy in a Cohort of 57 Patients

“…12 Our patients were broadly similar demographically to patients who underwent pisiformectomy in other studies, as 68% were female with an average age of 52 years. In other studies, the average age of participants was in their late 40s 5,10,[12][13][14] and between 56 12 and 88% female. 7,8,10,16 In keeping with other studies, all our patients presented with pain.…”

“…This compares favorably with other cohorts ranging from 9 8,10 to 30 patients. 5,7,11,13,14,16,19 Carroll and Coyle described outcomes of 76 pisiformectomies but did not report any patient-reported outcomes. 12 Our patients were broadly similar demographically to patients who underwent pisiformectomy in other studies, as 68% were female with an average age of 52 years.…”

“…of these observational studies consist of small cohorts of up to 30 patients 5,7,8,11,[13][14][15][16] and generally use patient-reported outcome measures. This study reviews the patient-reported outcomes of patients treated with pisiformectomy by one of three surgeons, and furthermore focuses on the complications and the need for and time to revision procedure.…”

Observer Variability in Evaluating Pisotriquetral Osteoarthritis using Pisotriquetral View

“…As a specific radiographic classification system is absent, general features including sclerosis, joint space width (JSW) narrowing and osteophyte formation can be used to assess the level of pisotriquetral OA. 5 Radiographic evaluation of the pisotriquetral joint, however, seems to be prone for misinterpretation. 2…”

Joint Space Narrowing in Patients With Pisotriquetral Osteoarthritis

“…11 In radiological evaluation of the wrist, lateral, anteroposterior, and semisupinated oblique views are often used to grade PT OA. By lack of a specific classification, 6 general radiologic OA parameters are used, but can be easily misinterpreted due to overlapping projection of carpal bones. 5 One OA parameter that is often used in orthopedics is the minimum joint space width (JSW), as a measure of joint space narrowing.…”