Radio-lunate arthrodesis in rheumatoid arthritis: outcome and techniques

Trieb, Klemens; Machácek, P; Hofstaetter, Stefan G.; Panotopoulos, Joannis; Wanivenhaus, A.

doi:10.1007/s00402-013-1729-2

Cited by 8 publications

(9 citation statements)

References 19 publications

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“…1 , Table 1 , Table 2 ). 6 , 21 , 22 , 24 , 25 , 26 , 27 , 28 , 29 , 31 , 32 , 33 , 47 A total of 274 patients were included across all studies; 180 were treated with RSL arthrodesis and 94 with RL arthrodesis. Patients undergoing RSL compared with RL arthrodesis were younger (age 45 vs 50 years; P = .34), and there were fewer females (49% vs 87%; P = .016) and a shorter overall follow-up (60 vs 91 months; P = .022), respectively ( Table 3 ).…”

Section: Resultsmentioning

confidence: 99%

“…Thirteen studies were included for final review ( Table 2 ). 6 , 21 , 22 , 24 , 25 , 26 , 27 , 28 , 29 , 31 , 32 , 33 , 47 Eight studies focused on RSL arthrodesis, 6 , 21 , 22 , 24 , 25 , 27 , 28 , 38 3 were on RL arthrodesis, 26 , 31 , 33 and 2 included both. 29 , 32 Two studies included patient data with slight procedural variations: Ha et al 47 included patients with iliac crest bone graft, distal scaphoidectomy, and/or triquetrectomy, whereas Mühldorfer-Fodor et al 22 included patients with and without distal scaphoidectomy.…”

Section: Methodsmentioning

confidence: 99%

“…Studies that reported nonunion rates are detailed in Table 5. In the RSL group, rates of nonunion ranged from 0% within multiple studies to 75% by Raven et al 6,24,27,29,47 Among RL arthrodeses, Raven et al 29 and Trieb et al 31 both reported 0% nonunion whereas Stanley and Boot 33 had the maximum of 6%. The weighted rates of nonunion for RSL and RL were 15% and 2%, respectively.…”

Section: Nonunion and Reoperationmentioning

confidence: 97%

“…The RL or RSL arthrodesis maintains midcarpal motion by fusing only arthritic radiocarpal joints. 6 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 Compared with TWA, RSL and RL usually achieve the minimum range of motion (ROM) necessary to complete ADLs, defined as 5° to 10° of flexion, 30° to 35° of extension, 10° of radial deviation, and 15° of ulnar deviation. 22 , 34 , 35 , 36 In 1955, Watson-Jones described RSL arthrodesis for radiocarpal degeneration from posttraumatic arthritis, RA, and Kienböck's disease.…”

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confidence: 99%

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A Systematic Review of Radiolunate and Radioscapholunate Arthrodesis

Fakunle

DeMaio

Spencer

et al. 2021

Journal of Hand Surgery Global Online

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The aims of this systematic review were to examine the use of radiolunate (RL) or radioscapholunate (RSL) arthrodesis as surgical management for patients with advanced radiocarpal arthritis that failed conservative management and to assess postoperative outcomes. Methods: We reviewed articles from PubMed, EMBASE, and Web of Science from inception through December 2019. We identified complete manuscripts written in English reporting on RL or RSL arthrodesis for treatment of wrist pathology that included the primary outcomes (pain or grip strength) and at least 2 secondary outcomes (range of motion, patient-reported outcomes, or nonunion). Data pooling was used to calculate weighted averages. Results: We identified 2,252 articles and selected 13 for inclusion. Across all studies, RSL arthrodesis was performed for 180 patients (49% female; 45 years old) and RL for 94 (87% female; 50 years old). Both procedures exhibited improvements in pain score and grip strength. Both cohorts demonstrated postoperative changes in flexion-extension arc, flexion, extension, ulnar deviation, supination, and pronation after data pooling. The nonunion rate for RSL was 15% versus 2% for RL, whereas the rate of progression to total wrist arthrodesis for RSL and RL was 4% and 0%, respectively. Conclusions: Both RL and RSL arthrodesis can be successfully used to manage debilitating radiocarpal arthritis by affording patients with pain reduction. Each has its own benefits, in which RSL arthrodesis provides a total arc of motion within the functional demands of most activities of daily living, and RL arthrodesis has low rates of nonunion and progression to total wrist arthrodesis. Further research is needed to compare the 2 surgeries directly and prospectively in comparable patient groups. Type of study/level of evidence: Therapeutic III.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Nonunion and Reoperationmentioning

confidence: 97%

mentioning

confidence: 99%

See 2 more Smart Citations

A Systematic Review of Radiolunate and Radioscapholunate Arthrodesis

Fakunle

DeMaio

Spencer

et al. 2021

Journal of Hand Surgery Global Online

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“…Arthrodesen werden beim "Rheumapatienten" häufig an den unteren Sprunggelenken der oberen Halswirbelsäule durchgeführt. Sie weisen hinsichtlich Schmerzen, Funktion und Patientenzufriedenheit sehr gute Ergebnisse auf [16][17][18].…”

Section: Rekonstruktive/gelenkersetzende Operationenunclassified

Medizinisches Vorgehen in der Orthopädischen Rheumatologie

Henniger

Rehart

2018

Akt Rheumatol

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ZusammenfassungDie orthopädische Rheumatologie befasst sich mit der Diagnostik und der konservativen sowie der operativen Behandlung von rheumatischen Erkrankungen am muskulo-skelettalen System. Um eine dauerhafte Remission der entzündlichen Aktivität einer rheumatischen Erkrankung zu erreichen, ist ein multidisziplinäres Therapiekonzept notwendig. Begleitend zur medikamentösen Therapie und angepasst an die Schwere der Erkrankung, bzw. die entzündliche Aktivität und den Grad der Destruktion von Gelenken, umfasst dieses verschiedene konservative und operative Maßnahmen. Die enge interdisziplinäre Kooperation mit internistischen Rheumatologen, Radiologen, Nuklearmedizinern, Anästhesisten und nicht zuletzt Ergo- und Physiotherapeuten sowie Orthopädietechnikern ist dabei unabdingbar. In der Therapie von rheumatischen Erkrankungen erfolgt in der Regel neben einer medikamentösen Basistherapie eine konservative Therapie an den Strukturen des muskulo-skelettalen Systems. Je nach Gelenk und Zustand umfasst diese alle lokalen Maßnahmen der physikalischen Therapie, Physiotherapie, Ergotherapie, Schienenversorgung, Einlagen- und Schuhversorgung, bzw. zuletzt Gelenkinfiltrationen. Erst, wenn mit diesen konservativen Maßnahmen keine ausreichende Wirkung erzielt wird, kommen operative Maßnahmen zum Einsatz. Ausnahmen hiervon sind absolute oder dringliche OP-Indikationen wie Nervenausfälle, ausgeprägte Achsabweichungen von Gelenken, ein rasches Fortschreiten der Destruktionen oder Sehnenrupturen. Je nach Gelenk und radiologischem Destruktionsgrad werden bei der operativen Therapie präventive/gelenkerhaltende von rekonstruktiven/gelenkersetzenden Verfahren unterschieden. Aufgrund des multilokulären Befalls sowohl artikulärer als auch ligamentärer Strukturen, v. a. aber der besonderen Medikation und deren potentiellen Nebenwirkungen gilt es, im operativen Bereich die Besonderheiten dieser Patientengruppe zu berücksichtigen.

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Rheumaorthopädische Therapieoptionen

Trieb¹

2017

Rheumatologie Aus Der Praxis

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Radio-lunate arthrodesis in rheumatoid arthritis: outcome and techniques

Abstract: Due to high patient satisfaction and functional outcome, radio-lunate wrist arthrodesis can be recommended independent of fixation method.

Cited by 8 publications

References 19 publications

A Systematic Review of Radiolunate and Radioscapholunate Arthrodesis

A Systematic Review of Radiolunate and Radioscapholunate Arthrodesis

Medizinisches Vorgehen in der Orthopädischen Rheumatologie

Rheumaorthopädische Therapieoptionen

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