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Outcomes of Surgical Management Of Bilateral Rheumatoid Wrist Disease
K. Kailash, MCh, MRCS, MBBS; A. Raza, MCh, MRCS, MBBS; Senthil Mahalingam, MCh, MBBS; SC Talwakar, FRCS, Michael Hayton, FRCS; SR Murali, FRCS; I. Trail, FRCS
Wrightington Upper Limb Unit, Wrightington Hospital, Wigan, United Kingdom

Introduction: Total Wrist Arthroplasty when compared to arthrodesis allows preservation of the function but may leave patient with a weaker wrist. Arthroplasty is considered for the patients with low demand activities or for the non-dominant side.

Objectives and Specific Aims: Aim of the current study was to identify a system of management for bilateral rheumatoid wrist disease.

Methods: This was a retrospective review of 32 patients at the tertiary hospital. There were two groups of patients; Group-1 had bilateral arthroplasty (n=10) and Group-2 had TWA on one side and fusion on the other side (n=22). The follow-up included; pain score, patient satisfaction, assessment of range of movements and function.

Results: The mean age for the patients in both groups was 60 years and follow-up was of 59 months. Post-operatively pain relief was achieved in 70% within 6 months and movements were preserved with mean dorsiflexion and palmarflexion of 190. The mean DASH score for group-1 was 54.5, further; patients in group-2 who had arthroplasty also had similar DASH of 54. The DASH score was similar in arthrodesis patients. The PRWE score was also lower in patients with arthroplasty then arthrodesis. Complications of arthroplasty were; joint stiffness 10% (n=3), persistent wrist pain 13% (n=4) and revision arthroplasty in 6% (n=2).

Conclusion: Arthrodesis has been the gold standard for management of rheumatoid for predictable pain relief. Arthroplasty still remains an evolving procedure and the short to mid-term results are improving, longevity is yet to be established.

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