FUNCTIONAL EVALUATION AFTER BILATERAL ARTHRODESIS OF THE WRIST FOR INFLAMMATORY JOINT DISEASE

Abstract

Purpose: Arthodesis is the conventional treatment for the rheumatoid wrist. In the event of severe bilateral disease, bilateral arthrodesis can be discussed as an alternative to unilateral arthrodesis an contralateral prosthesis. We wanted to know the functional outcomes after bilateral arthrodesis.

Material and methods: This retrospective analysis involved seven patients (one man and six women), mean age 46 years (28–69) who underwent total bilateral arthrodesis of the wrist for inflammatory joint disease (six rheumatoid, one chronic juvenile arthritis). Mean follow-up was five years. The patients were reviewed clinically and radiographically. We noted goniometric measurements of the upper limbs, the Jebsen hand function test (for activities of daily life), force (wrist and grip), and the Buck-Gramcko-Lohmann evaluation.

Results: On average, the position achieved after arthrodesis was 2° flexion (−5° to +10°) with 6° ulnar inclination (−5° to +20°). Radiological fusion was achieved in all cases. At last follow-up, we noted that three patients had resumed their occupational activities, one had been reclassified as handicapped, and one as disabled. One patient was a housewife and one other woman was retired. The Jebsen hand test showed that our patients could perform 32 of the 49 daily activities (65%). Daily activity was noted excellent in three patients, good in two and fair in two. The Buck-Gramcko-Lohmann score was fair 6.8/10 (2–10) corresponding to good outcome. All patients were satisfied with the outcome.

Discussion: Daily life activities could be performed readily after bilateral arthrodesis of the wrist. Perineal hygiene was possible for five of our patients. The only problems concerned activities requiring force and fine movements, because of the apprehension and the lack of fine dexterity. Poor results could be attributed to metacarpophalangeal deformations and decreased grip force. We observed an 80% reduction in force compared with a representative population of non-operated patients with rheumatoid disease. Bilateral arthrodesis is a valid alternative to bilateral arthroplasty or combined arthrodesis prosthesis implantation. It does not expose the patients to the risk of mechanical arthroplasty.