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

Abstract

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.

Complications and Factors Associated with Reoperation following Total Wrist Fusion

“…They state that arthrodesis of the third CMC joint should be performed in patients with good soft tissue and normal-sized hands. 16 On the contrary, Nagy et al reported that 20 (43%) patients developed nonunion among 47 patients who underwent arthrodesis of the third CMC joint with plate removal. Eleven (23%) of these were painful and required Tenosynovitis, n (%) 10 (4.7)…”

“…They reported that the most frequent complication was pain over the plate/breakage (42%) followed by nonunion (4%). 16 Rauhaniemi et al included 115 patients with rheumatoid arthritis who underwent a TWF.…”

“…25 Reigstad et al also found that prior wrist surgery was associated with reduced wrist function and higher pain scores. 16 It is not clear why prior surgery is associated with reoperation. This could represent a more difficult pathology, a poor capacity for healing or alternatively, this could reflect that some patients prefer operative intervention to address persistent symptoms.…”

“…30 Some of the findings of this study have been described previously. 16,17 However, this study provides new information on the results of total wrist fusion. First, our study describes the largest cohort of patients undergoing TWF to date.…”

“…Second, all indications for TWF were included in our cohort compared with previous studies that described either patients with noninflammatory arthritis or patients with rheumatoid arthritis. 16,17 Finally, in this study, surgeries were performed by 15 different surgeons that result in a high degree of generalizability. Other studies report that the surgeries were performed by one or two surgeons.…”