Wrist Arthrodesis in Severe Wrist Arthritis in Rheumatoid Arthritis Patients: A Retrospective Study

Abstract

Objective: Osteoarthritis of wrist is an uncommon disorder but in rheumatoid arthritis (RA), wrist and metacarpophlangeal joint are involved in early stages. RA of wrist leads to severe pain and loss of function in a large number of patients. Conservative treatment is required in early stages, but in severe cases arthroplasty or total wrist arthrodesis is the treatment of choice. Problems in wrist arthroplasty include implant breakage, cystic erosion in the surrounding bone, and marked synovitis, which requires revision in most of cases. Total wrist arthrodesis is treatment of choice in severe wrist arthritis patient, who want to have good grip and wish to do heavy labour.
 Material and Methods: A retrospective review of 15 patients of RA with severe wrist arthritis, managed by wrist arthrodesis using 3.5 mm reconstruction plate and iliac crest bone graft was done. Patients were evaluated for pain relief, functional improvement and radiographic analysis. Patient function measures included: Visual analog score (VAS), the Mayo wrist score, and Disabilities of Arm, Shoulder, and Hand (DASH) score.
 Result: All 15 cases united well with marked improvement in wrist strength and diminished pain allowing improved function and heavy labor. Mayo wrist scores increased on an average of 37.5 Points (preoperative) 10 to 65 (postoperative). The average DASH score has decreased significantly up to 47 Points.
 Conclusion: Wrist Arthrodesis provides pain relief and functional hand in sever wrist arthritis in RA cases.