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J Wrist Surg 2023; 12(04): 295-300
DOI: 10.1055/s-0042-1759687
Scientific Article

Outcome of Preoperative Asymptomatic or Minimally Symptomatic DRUJ Arthritis after Total Wrist Arthrodesis: A Single-Institution Case Series

Lauren E. Dittman
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Alexander Y. Shin
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Peter C. Rhee
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
2   Clinical Investigation Facility, Travis Air Force Base, California
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Abstract

Background Concomitant severe radiocarpal (RC) arthritis with asymptomatic or minimally symptomatic distal radioulnar joint (DRUJ) arthritis can be debilitating for patients. Surgical management of these combined arthritides can pose a dilemma for surgeons and patients. The purpose of this study was to evaluate patients with concomitant RC and DRUJ arthritides who underwent only total wrist arthrodesis (TWA) to determine the need for subsequent surgical management of preoperative asymptomatic/minimally symptomatic DRUJ arthritis.

Materials and Methods All patients who underwent TWA between 2008 and 2018 at a single institution were evaluated. Those patients who underwent TWA for degenerative, inflammatory, or posttraumatic arthritis with concomitant asymptomatic or minimally symptomatic DRUJ arthritis preoperatively were included. A retrospective review was performed for demographic variables, TWA indications, pre- versus post-TWA DRUJ symptoms, and severity of DRUJ arthritis on radiographs. Primary outcome measure was survivorship from subsequent DRUJ surgery for development of symptomatic arthritis after initial TWA.

Results One hundred and eighty-three patients underwent TWA during the study period, of which 39 wrists met inclusion criteria. Indications for TWA included posttraumatic arthritis (n = 22), avascular necrosis of the lunate (n = 10), and inflammatory arthritis (n = 7). The mean clinical follow-up was 5.7 years (range: 1.5–12.7 years). Four patients (10%) who underwent TWA ultimately required a subsequent procedure to address DRUJ arthritis at a mean time of 20 months (range: 3–60 months) after initial TWA. The initial indication for TWA in these patients included symptomatic posttraumatic arthritis (n = 3) and lunate avascular necrosis (n = 1).

Conclusion In patients with symptomatic RC and asymptomatic or minimally symptomatic DRUJ arthritides undergoing TWA alone, 10% in this series required subsequent surgical management for progressive DRUJ arthritis.

Clinical Relevance Surgical management of concomitant symptomatic RC and asymptomatic/minimally symptomatic DRUJ arthritides with TWA alone is a reasonable initial approach. Patients should be counseled preoperatively that subsequent surgical management of progressive DRUJ arthritis may be necessary in ∼10% of patients.

Keywords

distal radioulnar joint - total wrist arthrodesis - arthritis


Publikationsverlauf

Eingereicht: 01. Juni 2022

Angenommen: 02. November 2022

Artikel online veröffentlicht:
08. Dezember 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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