Abstract
Background: In order to evaluate the effectiveness of interventions for osteoarthritis of the wrist in adults we performed a systematic review and meta-analysis. Methods: The MEDLINE and EMBASE via OVID, CINAHL and SPORTDiscus via EBSCO databases were searched from inception to 25th April 2018.All randomised controlled clinical trials (RCTs) and any prospective studies of adults with wrist osteoarthritis investigating any intervention with a comparator were included. Data were extracted and checked for accuracy and completeness by pairs of reviewers. Primary outcomes were pain and function. Comparative treatment effects were analysed by random effects at all time points. Results: Three RCTs were identified for inclusion after screening and all had a high risk of bias. Two compared proximal row carpectomy (PRC) with four corner fusion (4CF) for post-traumatic osteoarthritis, while the other compared leather with commercial wrist splints in patients with chronic wrist pain, of which a small group had wrist osteoarthritis. Conclusion: There is no prospective study comparing operative to non-operative treatment for wrist osteoarthritis, while there is a paucity of prospective studies assessing the effectiveness of both non-operative and operative interventions. Further research is necessary in order to better define which patients benefit from which specific interventions. Registration: The review protocol was registered with PROSPERO under the registration number CRD42018094799.
Highlights
Osteoarthritis of the wrist is a diverse and poorly understood clinical condition, likely relating to the complexity of the anatomy and biomechanics of the human wrist joint[1]
Further complexity is added by the variety of terms used to describe ulnocarpal osteoarthritis, such as ulnocarpal abutment and ulnocarpal impaction syndrome, while tears and/or degeneration of the triangular fibrocartilage complex (TFCC) are intimately involved in ulnocarpal osteoarthritis and distal radioulnar joint synovitis[7]
Osteoarthritis of the wrist may occur after trauma, such as scaphoid non-union advanced collapse (SNAC), while the pattern of osteoarthritis seen in scapholunate advanced collapse (SLAC) may be post-traumatic or degenerative[8]
Summary
Osteoarthritis of the wrist is a diverse and poorly understood clinical condition, likely relating to the complexity of the anatomy and biomechanics of the human wrist joint[1]. The prevalence of radiographic wrist osteoarthritis varies widely in the literature[3,4,5], while there is a lack of epidemiological research relating pain to structural change in this condition. In order to evaluate the effectiveness of interventions for osteoarthritis of the wrist in adults we performed a systematic review and meta-analysis. April 2018.All randomised controlled clinical trials (RCTs) and any prospective studies of adults with wrist osteoarthritis investigating any intervention with a comparator were included. Two compared proximal row carpectomy (PRC) with four corner fusion (4CF) for post-traumatic osteoarthritis, while the other compared leather with commercial wrist splints in patients with chronic wrist pain, of which a small group had wrist osteoarthritis. Conclusion: There is no prospective study comparing operative to non-operative treatment for wrist osteoarthritis, while there is a paucity of prospective studies assessing the effectiveness of both non-operative and operative interventions. Registration: The review protocol was registered with PROSPERO under the registration number CRD42018094799
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