Long-term functional outcomes after bilateral total wrist arthrodesis

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.