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

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.

Amandys® implant: Novel pyrocarbon arthroplasty for the wrist

“…Despite limited follow-up, the results of our series show that Amandys 1 arthroplasty is a valid alternative to the more conventional invasive procedures such as total wrist arthrodesis and arthroplasty using a total or partial prosthesis. The preservation of wrist mobility is actually the most important functional priority for patients along with pain relief [5,40]. These objectives are attained in our series.…”

Stage III Advanced Wrist Collapse Treatment Options: A Cadaveric Study

“…3,9,16 Despite clinical studies reporting adequate outcomes regarding postoperative range of motion and grip strength, 10 Kirschenbaum et al 8 reported a nonunion incidence rate of 33%. However, their results were likely attributed to the precarious nature of the osteosynthesis material (pins).…”

“…Scans were collected of each specimen in neutral, flexion, extension, radial, and ulnar deviation before and after each surgical procedure was performed ( [1] scaphoidectomy and lunate-capitate arthrodesis, [2] addition of triquetrum-hamate arthrodesis, and [3] triquetrum excision). CT scans were reconstructed in both coronal and sagittal planes.…”

“…Although treatment options for these pathologies have been described in the literature, restoration of physiological wrist motion poses a significant challenge in young and highly active patients. 3 Traditionally, a scaphoidectomy and a midcarpal joint arthrodesis are performed to restore carpal alignment and maintain adequate range of motion. However, there is currently no consensus regarding the type of arthrodesis that should be performed.…”

“…Partial arthrodesis of the lunate-capitate is another common procedure, initially proposed to preserve wrist mobility with a stable midcarpal fusion. 3 Although early reports demonstrated inferior results when compared with four-corner arthrodesis, 8,9 recent studies using advanced fixation techniques have reported good to excellent results for union rate, grip strength, and wrist mobility. [10][11][12] Lunate-capitate arthrodesis is generally performed with scaphoidectomy and can be performed with or without triquetrum excision.…”