Long-term functional outcomes after bilateral total wrist arthrodesis

Eric R. Wagner, Bassem T. Elhassan, Sanjeev Kakar

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Purpose To report on the long-term outcomes of bilateral total wrist arthrodeses. Methods We conducted a review of all living patients who underwent bilateral wrist arthrodeses from 1980 to 2010 within a single institution. Outcome measures included pain, Disabilities of the Arm, Shoulder, and Hand questionnaire, Patient-Rated Wrist Evaluation, Michigan Hand Questionnaire, satisfaction scores, complications, and revision surgeries. Results Thirteen patients (26 wrists) were treated with an average follow-up of 14 years (range, 3-28 y). Average time for contralateral wrist arthrodesis was 16 months after initial wrist arthrodesis. Eleven wrists had undergone prior surgery. Eleven patients had a primary diagnosis of inflammatory arthritis. Wrists were fused from 5° flexion to 30° extension, with all but one patient's wrist fused within 10° of the contralateral wrist. There was a significant improvement in postoperative grip strength and pain levels. Postoperative Disabilities of the Arm, Shoulder, and Hand, Patient-Rated Wrist Evaluation, and Michigan Hand Questionnaire scores were 21, 29, and 73, respectively. Increasing age, preoperative steroid usage, and concomitant shoulder or elbow disorders were associated with worse outcomes. Twelve patients (93%) were satisfied and would repeat the surgery and 9 returned to full-time work. The major functional limitation was turning a doorknob or tight jar lid. Seven patients underwent additional surgery including 5 revision arthrodeses and 2 plate removals. Revision surgeries were more common in patients with prior surgeries or preoperative steroid usage, women, smokers, those with ipsilateral elbow dysfunction, and those with fixation with a dorsal locking plate. Conclusions Bilateral total wrist arthrodesis improved pain while enabling patients with severe carpal arthrosis to maintain a satisfactory level of extremity function and quality of life. In general, patients adapted and were satisfied with functional capabilities. This is a viable salvage option for patients with severe bilateral disease. Type of study/level of evidence Therapeutic III.

Original languageEnglish (US)
Pages (from-to)224-228.e1
JournalJournal of Hand Surgery
Volume40
Issue number2
DOIs
StatePublished - Feb 1 2015

Fingerprint

Arthrodesis
Wrist
Hand
Reoperation
Elbow
Pain
Arm
Steroids
Joint Diseases
Hand Strength
Arthritis
Extremities

Keywords

  • arthrodesis
  • Bilateral wrist
  • function fusion

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Long-term functional outcomes after bilateral total wrist arthrodesis. / Wagner, Eric R.; Elhassan, Bassem T.; Kakar, Sanjeev.

In: Journal of Hand Surgery, Vol. 40, No. 2, 01.02.2015, p. 224-228.e1.

Research output: Contribution to journalArticle

Wagner, Eric R. ; Elhassan, Bassem T. ; Kakar, Sanjeev. / Long-term functional outcomes after bilateral total wrist arthrodesis. In: Journal of Hand Surgery. 2015 ; Vol. 40, No. 2. pp. 224-228.e1.
@article{3c50137fc3d7455591632f8c5a56ac61,
title = "Long-term functional outcomes after bilateral total wrist arthrodesis",
abstract = "Purpose To report on the long-term outcomes of bilateral total wrist arthrodeses. Methods We conducted a review of all living patients who underwent bilateral wrist arthrodeses from 1980 to 2010 within a single institution. Outcome measures included pain, Disabilities of the Arm, Shoulder, and Hand questionnaire, Patient-Rated Wrist Evaluation, Michigan Hand Questionnaire, satisfaction scores, complications, and revision surgeries. Results Thirteen patients (26 wrists) were treated with an average follow-up of 14 years (range, 3-28 y). Average time for contralateral wrist arthrodesis was 16 months after initial wrist arthrodesis. Eleven wrists had undergone prior surgery. Eleven patients had a primary diagnosis of inflammatory arthritis. Wrists were fused from 5° flexion to 30° extension, with all but one patient's wrist fused within 10° of the contralateral wrist. There was a significant improvement in postoperative grip strength and pain levels. Postoperative Disabilities of the Arm, Shoulder, and Hand, Patient-Rated Wrist Evaluation, and Michigan Hand Questionnaire scores were 21, 29, and 73, respectively. Increasing age, preoperative steroid usage, and concomitant shoulder or elbow disorders were associated with worse outcomes. Twelve patients (93{\%}) were satisfied and would repeat the surgery and 9 returned to full-time work. The major functional limitation was turning a doorknob or tight jar lid. Seven patients underwent additional surgery including 5 revision arthrodeses and 2 plate removals. Revision surgeries were more common in patients with prior surgeries or preoperative steroid usage, women, smokers, those with ipsilateral elbow dysfunction, and those with fixation with a dorsal locking plate. Conclusions Bilateral total wrist arthrodesis improved pain while enabling patients with severe carpal arthrosis to maintain a satisfactory level of extremity function and quality of life. In general, patients adapted and were satisfied with functional capabilities. This is a viable salvage option for patients with severe bilateral disease. Type of study/level of evidence Therapeutic III.",
keywords = "arthrodesis, Bilateral wrist, function fusion",
author = "Wagner, {Eric R.} and Elhassan, {Bassem T.} and Sanjeev Kakar",
year = "2015",
month = "2",
day = "1",
doi = "10.1016/j.jhsa.2014.10.032",
language = "English (US)",
volume = "40",
pages = "224--228.e1",
journal = "Journal of Hand Surgery",
issn = "0266-7681",
publisher = "W.B. Saunders Ltd",
number = "2",

}

TY - JOUR

T1 - Long-term functional outcomes after bilateral total wrist arthrodesis

AU - Wagner, Eric R.

AU - Elhassan, Bassem T.

AU - Kakar, Sanjeev

PY - 2015/2/1

Y1 - 2015/2/1

N2 - Purpose To report on the long-term outcomes of bilateral total wrist arthrodeses. Methods We conducted a review of all living patients who underwent bilateral wrist arthrodeses from 1980 to 2010 within a single institution. Outcome measures included pain, Disabilities of the Arm, Shoulder, and Hand questionnaire, Patient-Rated Wrist Evaluation, Michigan Hand Questionnaire, satisfaction scores, complications, and revision surgeries. Results Thirteen patients (26 wrists) were treated with an average follow-up of 14 years (range, 3-28 y). Average time for contralateral wrist arthrodesis was 16 months after initial wrist arthrodesis. Eleven wrists had undergone prior surgery. Eleven patients had a primary diagnosis of inflammatory arthritis. Wrists were fused from 5° flexion to 30° extension, with all but one patient's wrist fused within 10° of the contralateral wrist. There was a significant improvement in postoperative grip strength and pain levels. Postoperative Disabilities of the Arm, Shoulder, and Hand, Patient-Rated Wrist Evaluation, and Michigan Hand Questionnaire scores were 21, 29, and 73, respectively. Increasing age, preoperative steroid usage, and concomitant shoulder or elbow disorders were associated with worse outcomes. Twelve patients (93%) were satisfied and would repeat the surgery and 9 returned to full-time work. The major functional limitation was turning a doorknob or tight jar lid. Seven patients underwent additional surgery including 5 revision arthrodeses and 2 plate removals. Revision surgeries were more common in patients with prior surgeries or preoperative steroid usage, women, smokers, those with ipsilateral elbow dysfunction, and those with fixation with a dorsal locking plate. Conclusions Bilateral total wrist arthrodesis improved pain while enabling patients with severe carpal arthrosis to maintain a satisfactory level of extremity function and quality of life. In general, patients adapted and were satisfied with functional capabilities. This is a viable salvage option for patients with severe bilateral disease. Type of study/level of evidence Therapeutic III.

AB - Purpose To report on the long-term outcomes of bilateral total wrist arthrodeses. Methods We conducted a review of all living patients who underwent bilateral wrist arthrodeses from 1980 to 2010 within a single institution. Outcome measures included pain, Disabilities of the Arm, Shoulder, and Hand questionnaire, Patient-Rated Wrist Evaluation, Michigan Hand Questionnaire, satisfaction scores, complications, and revision surgeries. Results Thirteen patients (26 wrists) were treated with an average follow-up of 14 years (range, 3-28 y). Average time for contralateral wrist arthrodesis was 16 months after initial wrist arthrodesis. Eleven wrists had undergone prior surgery. Eleven patients had a primary diagnosis of inflammatory arthritis. Wrists were fused from 5° flexion to 30° extension, with all but one patient's wrist fused within 10° of the contralateral wrist. There was a significant improvement in postoperative grip strength and pain levels. Postoperative Disabilities of the Arm, Shoulder, and Hand, Patient-Rated Wrist Evaluation, and Michigan Hand Questionnaire scores were 21, 29, and 73, respectively. Increasing age, preoperative steroid usage, and concomitant shoulder or elbow disorders were associated with worse outcomes. Twelve patients (93%) were satisfied and would repeat the surgery and 9 returned to full-time work. The major functional limitation was turning a doorknob or tight jar lid. Seven patients underwent additional surgery including 5 revision arthrodeses and 2 plate removals. Revision surgeries were more common in patients with prior surgeries or preoperative steroid usage, women, smokers, those with ipsilateral elbow dysfunction, and those with fixation with a dorsal locking plate. Conclusions Bilateral total wrist arthrodesis improved pain while enabling patients with severe carpal arthrosis to maintain a satisfactory level of extremity function and quality of life. In general, patients adapted and were satisfied with functional capabilities. This is a viable salvage option for patients with severe bilateral disease. Type of study/level of evidence Therapeutic III.

KW - arthrodesis

KW - Bilateral wrist

KW - function fusion

UR - http://www.scopus.com/inward/record.url?scp=84921608776&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84921608776&partnerID=8YFLogxK

U2 - 10.1016/j.jhsa.2014.10.032

DO - 10.1016/j.jhsa.2014.10.032

M3 - Article

C2 - 25510154

AN - SCOPUS:84921608776

VL - 40

SP - 224-228.e1

JO - Journal of Hand Surgery

JF - Journal of Hand Surgery

SN - 0266-7681

IS - 2

ER -