Surgical Treatment of Wrist Arthritis in Young Patients

Campbell, Collier; Neustein, Thomas M.; Daly, Charles A.; Wagner, Eric R.

doi:10.2106/jbjs.rvw.19.00078

Cited by 11 publications

(9 citation statements)

References 66 publications

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“…3 , 4 Etiologies include posttraumatic, degenerative (eg, osteoarthritis), infectious (eg, septic arthritis), congenital (eg, Madelung deformity), inflammatory (eg, rheumatoid arthritis [RA]), and unknown (eg, Kienböck's disease). 5 , 6 , 7 After failure of nonsurgical management, surgical treatment may be pursued to treat pain and decreased motion. 8 Perhaps the most important factor in preoperative decision-making is determining which joints to spare.…”

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confidence: 99%

“… 8 Perhaps the most important factor in preoperative decision-making is determining which joints to spare. 7 , 9 , 10 , 11 In many common forms of arthritis, the radiolunate (RL) articulation is spared, allowing for options such as proximal row carpectomy or 4-corner arthrodesis. 12 , 13 , 14 , 15 , 16 However, when the RL joint is involved, patients are left with limited options, which include but are not limited to RL or radioscapholunate (RSL) arthrodesis, total wrist arthrodesis (TWA), total wrist arthroplasty, or partial wrist denervation.…”

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confidence: 99%

“… 12 , 13 , 14 , 15 , 16 However, when the RL joint is involved, patients are left with limited options, which include but are not limited to RL or radioscapholunate (RSL) arthrodesis, total wrist arthrodesis (TWA), total wrist arthroplasty, or partial wrist denervation. 7 , 8 , 9 , 10 , 11 , 17 , 18 , 19 , 20 …”

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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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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 review by the Wagner group noted that clinical satisfaction following 4CA may be predicated on bony union. 19 Thus, activities such as smoking which increases the risk of nonunion must be considered. 21 Additionally, job or lifestyle activities which require a greater range of motion may indicate a preference for the motion preservation of PRC.…”

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Age Considerations in Four-Corner Arthrodesis and Proximal Row Carpectomy: A Review

Heifner,

Karadimas,

DeVito

et al. 2023

J Wrist Surg

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Purpose Although indications for four-corner arthrodesis (4CA) and proximal row carpectomy (PRC) are not completely aligned, the surgeon is often tasked with deciding between these options which vary in the surgical technique and complication profile. Patient age is often discussed as a determining factor for treatment; however, outcome data for these procedures are rarely stratified by patient age. Our objective was to perform a systematic review on the age-specific outcomes for 4CA and PRC. Methods A PubMed database search for 4CA and PRC was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The inclusion criteria required individual case reporting of patient age, surgical intervention, and appropriate outcome measures. The data were stratified by procedure and by patients older and younger than 45 years. Results Within the 4CA group, the relative risk for a disabilities of the arm, shoulder, and hand (DASH) score above 30 was 1.94 (95% confidence interval, 1.1–3.67) in patients over 45 years compared with patients under 45 years. Within the PRC group, grip strength as a percentage of the contralateral side was higher in the over 45 age group (mean 75%) compared to the under 45 age group (mean 61%) but did not reach the level of significance. Conclusion Despite satisfactory results for 4CA in aggregate, the distribution of scores indicates the need for setting expectations when treating younger adult patients with 4CA. The current results demonstrate increased disability based on DASH score following 4CA in patients under 45 years compared with patients over 45 years. Although outcomes were comparable between younger and older adults following PRC, recovery of grip strength may occur less frequently in younger adults. Level of evidence IV systematic review.

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“…When osteotomy is not an amenable treatment for cases of posttraumatic arthritis, severe malunion, or nonunion, salvage options include partial or total wrist arthrodesis or arthroplasty 13,[17][18][19][20][21][22][23] . Total wrist arthroplasty (TWA) is traditionally indicated for pancarpal arthritis as a motion-sparing alternative to arthrodesis in low demand patients [24][25][26][27][28][29] . However, it can be considered for patients with severe distal radius malunions that are not amenable to treatment with corrective osteotomy.…”

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Total Wrist Arthroplasty as a Motion-Sparing Option for Distal Radius Malunion in a Patient of Advanced Age

Cooke,

Schaeffer,

Gabig

et al. 2023

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Case: A 62-year-old woman presented with wrist pain secondary to a distal radius fracture malunion 4 months after a fall onto an outstretched hand. She was not an ideal candidate for osteotomy and bone graft because of the degree of displacement and osteoporosis, so after nonoperative treatment was unsuccessful, she was offered total wrist arthroplasty (TWA) or arthrodesis and opted for TWA. Conclusion: At 14-month follow-up, the patient reported significant improvement in her pain and function. The current generation of TWA implants may allow use in the management of symptomatic distal radius malunions in older, low-demand patients.

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Surgical Treatment of Wrist Arthritis in Young Patients

Cited by 11 publications

References 66 publications

A Systematic Review of Radiolunate and Radioscapholunate Arthrodesis

A Systematic Review of Radiolunate and Radioscapholunate Arthrodesis

Age Considerations in Four-Corner Arthrodesis and Proximal Row Carpectomy: A Review

Total Wrist Arthroplasty as a Motion-Sparing Option for Distal Radius Malunion in a Patient of Advanced Age

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