The effects of partial wrist denervation in wrist osteoarthritis: patient-reported outcomes and objective function

Abstract

This prospective longitudinal study aimed to analyse the effect of partial wrist denervation on patient-reported outcomes, quality of life and objective function in symptomatic wrist osteoarthritis during the first year after surgery. Sixty consecutive patients underwent an anterior and posterior interosseous neurectomy during 2018–2020. Disabilities of the Arm, Shoulder and Hand, Patient-Rated Wrist Evaluation, EuroQol-5D-3L, pain at rest and on load, and objective function were assessed preoperatively and 3, 6 and 12 months postoperatively. Generalized estimating equations were used to analyse the effect on the outcome variables. Disabilities of the Arm, Shoulder and Hand, Patient-Rated Wrist Evaluation and pain scores improved significantly postoperatively with no decline over time, but no patient reported outcome measure reached the minimal clinically important difference. Quality of life, strength and range of motion did not improve. We found no complications. Seventeen patients needed further surgery during the study period. More studies are needed to evaluate whether denervation is truly effective or not. Level of evidence: II

Research in hand surgery: types of study design

“…In an uncontrolled trial, analytical (rather than descriptive) statistics would be applied to test a pre-defined hypothesis. The following example of an uncontrolled experimental study (Sw€ ard et al, 2022) examined the effects of partial wrist denervation in wrist osteoarthritis through patient-reported outcomes and objective function. The authors themselves highlight key limitations of this study design, namely the lack of control group or blinding leading to high risk of bias and confounding variables (mitigated somewhat by use of statistical methods).…”

Wrist & Hand

“…Loss to follow-up, a lack of a firm endpoint, and temporary relief of symptoms are all issues with accurately reporting the outcome in these patients. Authors from Stockholm (Sweden) have reported their prospective longitudinal series of patients undergoing partial wrist denervation of the anterior interosseous nerve (AIN) and posterior interosseous nerve (PIN) over a two-year period to 2020 5. Via a dorsal approach, a PIN neurectomy was performed before an incision through the intraosseous membrane allowed a neurectomy of the terminal branches of the AIN.Operations were performed by experienced but not expert surgeons under either regional orlocal anaesthesia.…”