Scientific article
Radiolunate and Radioscapholunate Arthrodeses as Treatments for Rheumatoid and Psoriatic Arthritis: Long-Term Follow-Up

https://doi.org/10.1016/j.jhsa.2011.10.012Get rights and content

Purpose

We evaluated long-term results for radiolunate and radioscapholunate arthrodeses for patients with rheumatoid or psoriatic arthritis to determine the durability and efficacy of the procedures. The results are described and compared with those in the literature.

Methods

We carried out arthrodesis of the radiolunate joint (33 wrists) and the radioscapholunate joint (13 wrists) to achieve pain reduction and ulnar translation of the carpus in patients with rheumatoid (42 wrists) or psoriatic arthritis (4 wrists). At follow-up, 11 patients (13 wrists) had died, 2 patients (4 wrists) were lost to follow-up, and in 6 wrists an additional midcarpal arthrodesis had been performed. We evaluated the remaining 23 wrists (19 radiolunate and 4 radioscapholunate, and 1 psoriatic arthritic wrist) after a mean of 11 years.

Results

Clinical outcome was good, with a mean visual analog score of 2 out of 10 for pain, mean grip strength of 13 kg, and mean range of flexion-extension of 60°. Outcomes as measured by questionnaires were good. Radiographs demonstrated deterioration of all intracarpal joints as noted by an increased Larsen score and evidence of carpal translation. We noted no significant change in carpal height.

Conclusions

Despite radiographic progression, radiolunate and radioscapholunate arthrodeses yield good clinical results at long-term follow-up.

Type of study/level of evidence

Therapeutic IV.

Section snippets

Materials and Methods

In a retrospective consecutive case study, we included 46 wrists in 38 patients (27 female and 11 male). Patients underwent either RL (33 wrists) or RSL arthrodesis (13 wrists) between 1989 and 1994. Our local ethics committee approved the study. A total of 42 wrists in patients with RA and 4 wrists in patients with psoriatic arthritis were entered in this study. Indication for operation was progressive radiocarpal destruction, resulting in pain, and carpal instability. Contraindication for

Results

Preoperatively, the average modified Larsen score of the RL and RSL joint was 2.7 (SD, 1.3) and 2.2 (SD, 1.2), respectively, so all wrists had early- to medium-stage disease at the time of operation. At follow-up, all RL arthrodeses demonstrated radiographic evidence of solid fusion. Of the RSL arthrodeses, 3 failed to unite at the radioscaphoid interval, but this finding did not correlate with a poor outcome (Fig. 1). Six wrists necessitated a midcarpal arthrodesis owing to pain, although they

Discussion

Table 7 lists the results of the published articles of case series and cohort studies of the RL arthrodesis. Twelve studies reported the outcome of 395 RL arthrodeses.15, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29 The indication for operation was similar for all studies: rheumatoid wrist disease with carpal instability. The preoperative Larsen score varied substantially between studies. An increase in the Larsen score was found at latest follow-up in all studies. Average follow-up was 4.4

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