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Distal Radius Hemiarthroplasty Combined with Proximal Row Carpectomy for Arthritis of the Wrist
Scott Gelman, BA; Sidney Jacoby, MD; Randall W. Culp, MD
Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA

Introduction: Wrist arthritis is a chronic disorder characterized by severe pain, decreased range of motion and grip strength, as well as a diminished quality of life. Surgical options include limited arthroscopic debridement, salvage procedures such as partial wrist arthrodesis or proximal row carpectomy (PRC), total wrist arthrodesis and finally, total wrist arthroplasty. Each of these procedures has benefits and drawbacks. A newly described treatment for wrist arthritis is distal radius hemiarthroplasty combined with PRC. To our knowledge, all previous publications on wrist hemiarthroplasty with radius resurfacing combined with PRC have been limited to case reports.

Methods: A retrospective chart review was completed for twenty-nine patients with a diagnosis of wrist arthritis who underwent wrist hemiarthroplasty combined with PRC. Only those patients with pre and post-operative range of motion (wrist flexion and extension) and grip strength were included. Twenty-seven patients qualified for evaluation. All available medical records and imaging studies were reviewed. Patient-Rated Wrist Evaluation (PRWE) and QuickDASH questionnaires were administered over the phone after an average follow up of 67.0 weeks (range 27-113 wks). Fifteen women and twelve men were evaluated with the average age of 62.3 (range 32-86) at the time of surgery. Specific diagnoses of patients undergoing this procedure included twelve with SLAC wrist and five patients with rheumatoid arthritis.  The remaining ten patients were previously diagnosed with other conditions including SNAC wrist, post-traumatic arthritis and osteoarthritis.

Results: Our data indicates that 25/27 patients achieved reductions of pain and 18/27 patients had no pain at their final follow up (28.5 +/- 13.4 wks). On average, post-operative flexion (28.7° +/- 12.0) and extension (34.4° +/- 9.3) both increased to near pre-operative flexion (37.8° +/- 16.1) and extension (34.5° +/- 21.3) by 6 months while post-operative grip strength (29.6 +/-16) surpassed pre-operative levels (30.1 +/- 17.1) by 12 weeks follow up. Patientsí overall mean PRWE and QuickDASH scores were 49.0 (+/- 28.1) and 46.1 (+/- 24.4) respectively with an average follow up of 72 weeks.

Conclusion: Distal radius hemiarthroplasty combined with PRC provides improved range of motion and grip strength compared to wrist arthrodesis, increased stability compared to total wrist arthroplasty and finally, better pain relief than PRC alone.

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