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Proximal row carpectomy in total arthrodesis of the rheumatoid wrist.
Orthop Traumatol Surg Res. 2015 Dec; 101(8):919-22.OT

Abstract

BACKGROUND

Advanced proximal carpal row damage is common in rheumatoid arthritis (RA). Proximal row carpectomy (PRC) simplifies total wrist arthrodesis, obviating the need for an iliac bone graft. In theory, PRC also improves the chances of healing, as fusion of a single joint space is needed for the procedure to be successful. Potential effects of the loss of carpal height related to PRC are unknown.

HYPOTHESIS

We hypothesised that PRC performed concomitantly with total wrist arthrodesis in patients with RA produces good clinical and radiological outcomes, without inducing loss of strength or digital deformities.

MATERIAL AND METHODS

In 38 total arthrodeses of rheumatoid wrists, a clinical evaluation was performed, including a visual analogue scale (VAS) pain score, the Patient-Rated Wrist Evaluation (PRWE), grip strength, digital deformities, and patient satisfaction. A standard radiographic workup was obtained to assess healing and carpal height indices.

RESULTS

After a mean follow-up of 50 months, the mean VAS pain score was 0.4 (range: 0-7), the mean PRWE score was 21 (range: 0-80.5), and grip strength as a percentage of the contralateral limb was 76%. The healing rate was 92% (35/38 wrists), and 34 (90%) patients reported being satisfied or very satisfied. No effects of carpal height loss on clinical or radiographic parameters was detected.

DISCUSSION

Total wrist arthrodesis combined with PRC provides reliable and reproducible benefits. This study found no evidence of adverse effects related to the loss of carpal height.

LEVEL OF EVIDENCE

IV, retrospective study.

Authors+Show Affiliations

Service de chirurgie orthopédique et traumatologique, hôpital Pierre-Paul-Riquet, CHRU de Toulouse, rue Jean-Dausset, 31000 Toulouse, France.Service de chirurgie orthopédique et traumatologique, hôpital Pierre-Paul-Riquet, CHRU de Toulouse, rue Jean-Dausset, 31000 Toulouse, France. Electronic address: hubert.lenoir@laposte.net.Service de chirurgie de la main et du membre supérieur, hôpital Lapeyronie, CHRU de Montpellier, 34295 Montpellier, France.Laboratoire d'épidémiologie, CHRU de Toulouse, 31073 Toulouse, France.Service de chirurgie de la main et du membre supérieur, hôpital Lapeyronie, CHRU de Montpellier, 34295 Montpellier, France.Service de chirurgie de la main et du membre supérieur, hôpital Lapeyronie, CHRU de Montpellier, 34295 Montpellier, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26611715

Citation

Pham, T T., et al. "Proximal Row Carpectomy in Total Arthrodesis of the Rheumatoid Wrist." Orthopaedics & Traumatology, Surgery & Research : OTSR, vol. 101, no. 8, 2015, pp. 919-22.
Pham TT, Lenoir H, Coulet B, et al. Proximal row carpectomy in total arthrodesis of the rheumatoid wrist. Orthop Traumatol Surg Res. 2015;101(8):919-22.
Pham, T. T., Lenoir, H., Coulet, B., Wargny, M., Lazerges, C., & Chammas, M. (2015). Proximal row carpectomy in total arthrodesis of the rheumatoid wrist. Orthopaedics & Traumatology, Surgery & Research : OTSR, 101(8), 919-22. https://doi.org/10.1016/j.otsr.2015.09.032
Pham TT, et al. Proximal Row Carpectomy in Total Arthrodesis of the Rheumatoid Wrist. Orthop Traumatol Surg Res. 2015;101(8):919-22. PubMed PMID: 26611715.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Proximal row carpectomy in total arthrodesis of the rheumatoid wrist. AU - Pham,T T, AU - Lenoir,H, AU - Coulet,B, AU - Wargny,M, AU - Lazerges,C, AU - Chammas,M, Y1 - 2015/11/25/ PY - 2015/01/07/received PY - 2015/07/09/revised PY - 2015/09/10/accepted PY - 2015/11/28/entrez PY - 2015/11/28/pubmed PY - 2016/7/20/medline KW - Arthrodesis KW - Proximal row carpectomy KW - Rheumatoid arthritis KW - Synovectomy KW - Wrist SP - 919 EP - 22 JF - Orthopaedics & traumatology, surgery & research : OTSR JO - Orthop Traumatol Surg Res VL - 101 IS - 8 N2 - BACKGROUND: Advanced proximal carpal row damage is common in rheumatoid arthritis (RA). Proximal row carpectomy (PRC) simplifies total wrist arthrodesis, obviating the need for an iliac bone graft. In theory, PRC also improves the chances of healing, as fusion of a single joint space is needed for the procedure to be successful. Potential effects of the loss of carpal height related to PRC are unknown. HYPOTHESIS: We hypothesised that PRC performed concomitantly with total wrist arthrodesis in patients with RA produces good clinical and radiological outcomes, without inducing loss of strength or digital deformities. MATERIAL AND METHODS: In 38 total arthrodeses of rheumatoid wrists, a clinical evaluation was performed, including a visual analogue scale (VAS) pain score, the Patient-Rated Wrist Evaluation (PRWE), grip strength, digital deformities, and patient satisfaction. A standard radiographic workup was obtained to assess healing and carpal height indices. RESULTS: After a mean follow-up of 50 months, the mean VAS pain score was 0.4 (range: 0-7), the mean PRWE score was 21 (range: 0-80.5), and grip strength as a percentage of the contralateral limb was 76%. The healing rate was 92% (35/38 wrists), and 34 (90%) patients reported being satisfied or very satisfied. No effects of carpal height loss on clinical or radiographic parameters was detected. DISCUSSION: Total wrist arthrodesis combined with PRC provides reliable and reproducible benefits. This study found no evidence of adverse effects related to the loss of carpal height. LEVEL OF EVIDENCE: IV, retrospective study. SN - 1877-0568 UR - https://www.unboundmedicine.com/medline/citation/26611715/Proximal_row_carpectomy_in_total_arthrodesis_of_the_rheumatoid_wrist_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1877-0568(15)00278-9 DB - PRIME DP - Unbound Medicine ER -