The arthritic wrist. II - The degenerative wrist: Indications for different surgical treatments

Service de Chirurgie Orthopédique 1 et 2, Unité de Chirurgie de la Main, Hôpital Trousseau, CHRU de Tours, 37044 Tours cedex, France.
Orthopaedics & Traumatology Surgery & Research (Impact Factor: 1.17). 06/2011; 97(4 Suppl):S37-41. DOI: 10.1016/j.otsr.2011.03.007
Source: PubMed

ABSTRACT For the patient (and the surgeon) the ideal wrist is one that has good mobility, however very often the optimal surgical treatment is one that provides effective pain relief. The patient must be informed of the potential complications and limitations of each procedure. The patient's psychological profile and functional requirements will determine how well he/she adapts to the changes. Also, each surgeon has beliefs and personal experiences that influence the treatment decision and final result. Proximal row carpectomy (PRC) and the Watson procedure are two reference operations for osteoarthritis secondary to scapholunate instability and scaphoid non-union (SLAC and SNAC). Beyond the early complications and drawbacks specific to each, they provide good results that are maintained over time. PRC, which can be performed up to Stage II, is mainly indicated in patients with moderate functional demands, while the Watson procedure is more often done on a patient who performs manual labour, as long as the radiolunate joint space is maintained. Complete denervation is effective in three out of four cases and preserves the remaining mobility. Because of its low morbidity, the procedure can be suggested in patients with a mobile wrist and low functional demands or in older patients, independent of their wrist mobility. Total wrist fusion is not only a rescue procedure. For a young patient who performs heavy manual labour with extensive osteoarthritis and progressive forms of Kienböck's disease, this procedure provides the greatest chance of returning to work and not being socially outcast. The role of osteochondral autografts, implants and wrist prostheses in the treatment arsenal need to be better defined.

Download full-text


Available from: Dominique Le Nen, Jun 22, 2015
  • [Show abstract] [Hide abstract]
    ABSTRACT: The pathophysiology of Kienböck's disease is not well understood: factors that were previously considered as potentially being responsible for the disease are now only seen as predisposing factors that contribute to discovering pre-existing disease. The natural history of the disease is also not well known. The arthroscopic classification proposed by Bain and Begg is now an essential supplement to the well-known Lichtman radiographic classification system. Various treatment options exist and some are better suited to each stage of the disease. This review will explore the advantages and disadvantages of these treatment options and match them with the best indications.
    Chirurgie de la Main 12/2014; 34(1). DOI:10.1016/j.main.2014.10.149 · 0.25 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Painful wrist osteoarthritis can result in major functional impairment. Most cases are related to posttraumatic sequel, metabolic arthropathies, or inflammatory joint disease, although wrist osteoarthritis occurs as an idiopathic condition in a small minority of cases. Surgery is indicated only when conservative treatment fails. The main objective is to ensure pain relief while restoring strength. Motion-preserving procedures are usually preferred, although residual wrist mobility is not crucial to good function. The vast array of available surgical techniques includes excisional arthroplasty, limited and total fusion, total wrist denervation, partial and total arthroplasty, and rib-cartilage graft implantation. Surgical decisions rest on the cause and extent of the degenerative wrist lesions, degree of residual mobility, and patient's wishes and functional demand. Proximal row carpectomy and four-corner fusion with scaphoid bone excision are the most widely used surgical procedures for stage II wrist osteoarthritis secondary to scapho-lunate advanced collapse (SLAC) or scaphoid non-union advanced collapse (SNAC) wrist. Proximal row carpectomy is not indicated in patients with stage III disease. Total wrist denervation is a satisfactory treatment option in patients of any age who have good range of motion and low functional demands; furthermore, the low morbidity associated with this procedure makes it a good option for elderly patients regardless of their range of motion. Total wrist fusion can be used not only as a revision procedure, but also as the primary surgical treatment in heavy manual labourers with wrist stiffness or generalised wrist-joint involvement. The role for pyrocarbon implants, rib-cartilage graft implantation, and total wrist arthroplasty remains to be determined, given the short follow-ups in available studies.
    Orthopaedics & Traumatology Surgery & Research 01/2015; 101(1). DOI:10.1016/j.otsr.2014.06.025 · 1.17 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Wrist arthrodesis offers high success rates in patients with rheumatoid arthritis; however, loss of residual mobility may cause unnecessary disability. This makes wrist denervation an appealing alternative. However, there is a distinct lack of patient-reported outcome measure studies comparing these two procedures. The aim of this study was to report any change in function, pain and satisfaction following wrist arthrodesis compared to denervation in a single surgeon series of rheumatoid patients.
    Archives of Orthopaedic and Trauma Surgery 06/2014; 134(7). DOI:10.1007/s00402-014-2018-4 · 1.31 Impact Factor