The treatment of arthritis of the wrist

Logan, James S.; Warwick, David

doi:10.1302/0301-620x.97b10.35717

Cited by 18 publications

(13 citation statements)

References 51 publications

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“…Introduction: Arthrodesis has been the salvage procedure for painful pan-arthrosis of the wrist for 2 more than a hundred years. In cases with intact articular surfaces limited arthrodesis or fusions can 3 be performed 1,2 . For total wrist arthrodesis, fusion can be achieved by various methods of fixation, 4…”

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confidence: 99%

High re-operation and complication rates 11 years after arthrodesis of the wrist for non-inflammatory arthritis

Reigstad

Holm-Glad

Korslund

et al. 2019

The Bone & Joint Journal

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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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confidence: 99%

High re-operation and complication rates 11 years after arthrodesis of the wrist for non-inflammatory arthritis

Reigstad

Holm-Glad

Korslund

et al. 2019

The Bone & Joint Journal

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“…Logan and Warwick 19 provide an overview of the treatment options available for patients with arthritis of the wrist and an algorithm for the selection of an appropriate surgical strategy for the treatment of arthritis of the wrist. Modern arthroplasties of the wrist are still not sufficiently robust to meet the demands of many patients, nor do they restore normal kinematics of the wrist.…”

Section: Discussionmentioning

confidence: 99%

Single- and Bicolumn Limited Intercarpal Fusion: A Solution for the SLAC or SNAC Wrist

Solgård

Gvozdenovic

2023

J Wrist Surg

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Background Single- or bicolumn limited intercarpal fusion, also called one- or two-column fusion, has been introduced as an alternative to four-corner fusion. The rationale behind this is obtaining less need for bone grafting and consequently improving the chances of the union. Method From August 2014 to October 2020, 45 consecutive patients (15 women), with a mean age of 58.4 years (range: 35–79), have been treated for scapholunate advanced collapse or scaphoid nonunion advanced collapse wrist. In 33 cases, the surgery was performed as two-column fusion, and in 12 cases as one-column fusion. The union was determined by a computed tomography (CT) scan or X-ray follow-up studies. The pain assessments (visual analog score: 0–100), range of motion (ROM), grip strength, and Quick Disabilities of the Arm, Shoulder, and Hand score were prospectively included. Results Of 45 patients, 43 were available for the follow-up, at a mean of 35 months (range: 12–68). All patients but two achieved union at a mean of 9.5 weeks (range: 5–25 weeks). Pain diminished from 60.3 (mean) preoperatively to 16.7 (mean) postoperatively (p = 0.0001). Grip strength slightly increased from 28.2 KgF (mean) to 29 KgF (mean) (not significantly, p = 0.86). Quick Disability of the Arm, Shoulder, and Hand score improved from 39.5 (median) before the surgery to 11 (median) after the surgery (p = 0.0004). The postoperative ROM of 62/37 degrees (mean) were recorded for total dorsovolar/radioulnar flexions, respectively. Three patients were converted to total wrist fusion and one to total wrist arthroplasty. One had a rearthrodesis to two-column fusion, which united. Conclusion One- and two-column fusion showed significant improvement in pain and function, with minimal impairment of the grip strength on the short- to mid-term follow-up. A union rate of 95% and an acceptable complication rate were achieved, without fusing all carpals. Level of evidence: Prospective, cohort study, level III.

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“…Wrist arthroscopy for OA includes the debridement of osteophytes, synovectomy, distal radial styloidectomy, as well as proximal row carpectomy (PRC) or arthroscopically assisted partial fusion for advanced disease [ 15 , 16 , 17 ]. At the level of the distal radioulnar joint (DRUJ), the removal of loose bodies and capsulorrhaphy is an option in the early stages, while arthroscopic resection of the ulnar head (Wafer procedure) or the arthroscopic Sauve–Kapandji procedure are options for advanced disease [ 15 , 16 ]. The thumb carpometacarpal joint osteoarthritis can be addressed arthroscopically with thermal stabilization of the joint capsule, or arthroscopic (hemi-)trapeziectomy [ 18 ].…”

Section: Arthroscopymentioning

confidence: 99%

The Surgical Treatment of Osteoarthritis

Brumat

Kunšič

Novak

et al. 2022

Life

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Osteoarthritis is a degenerative condition affecting the whole joint with the underlying bone, representing a major source of pain, disability, and socioeconomic cost worldwide. Age is considered the strongest risk factor, albeit abnormal biomechanics, morphology, congenital abnormality, deformity, malalignment, limb-length discrepancy, lifestyle, and injury may further increase the risk of the development and progression of osteoarthritis as well. Pain and loss of function are the main clinical features that lead to treatment. Although early manifestations of osteoarthritis are amenable to lifestyle modification, adequate pain management, and physical therapy, disease advancement frequently requires surgical treatment. The symptomatic progression of osteoarthritis with radiographical confirmation can be addressed either with arthroscopic interventions, (joint) preservation techniques, or bone fusion procedures, whereas (joint) replacement is preferentially reserved for severe and end-stage disease. The surgical treatment aims at alleviating pain and disability while restoring native biomechanics. Miscellaneous surgical techniques for addressing osteoarthritis exist. Advanced computer-integrated surgical concepts allow for patient personalization and optimization of surgical treatment. The scope of this article is to present an overview of the fundamentals of conventional surgical treatment options for osteoarthritis of the human skeleton, with emphasis on arthroscopy, preservation, arthrodesis, and replacement. Contemporary computer-assisted orthopaedic surgery concepts are further elucidated.

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The treatment of arthritis of the wrist

Cited by 18 publications

References 51 publications

High re-operation and complication rates 11 years after arthrodesis of the wrist for non-inflammatory arthritis

High re-operation and complication rates 11 years after arthrodesis of the wrist for non-inflammatory arthritis

Single- and Bicolumn Limited Intercarpal Fusion: A Solution for the SLAC or SNAC Wrist

The Surgical Treatment of Osteoarthritis

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