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American Association for Hand Surgery

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Is DRUJ Arthritis a Problem After Total Wrist Arthrodesis? A Single-Institution Case Series.
Lauren E Dittman, MD, Mayo Clinic, Rochester, MN, Alexander Y. Shin, MD, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN and Peter C Rhee, MD, Orthopaedic Surgery, Mayo Clinic, Rochester, MN

Introduction
Concomitant radiocarpal (RC) and distal radioulnar joint (DRUJ) arthritis can be debilitating for patients and the approach to surgical management of these combined arthritides can be challenging for surgeons. The purpose of this study was to examine patients with radiographic evidence of both radiocarpal and DRUJ arthritis preoperatively who underwent total wrist arthrodesis alone, to determine the need for reoperation to address their DRUJ arthritis.

Materials & Methods
A retrospective chart review was performed for all patients who underwent primary total wrist arthrodesis (TWA) from 2008-2018 at a single institution. A total of 183 patients underwent TWA during the study period. Only patients with radiographic evidence of DRUJ arthritis preoperatively were included. Patients who underwent TWA for inflammatory arthritis, infection, previous failed total wrist arthrodesis, or with less than 1 year follow-up were excluded, as well as any patient who underwent a procedure involving the distal ulna or DRUJ prior to or at the time of TWA. Primary outcome measure was subsequent surgical management of symptomatic DRUJ arthritis.

Results
A total of 31patients who underwent isolated TWA for RC arthritis with concomitant DRUJ arthritis were included in this study. Mean follow-up was 5.3 years (range 18-152 months). Seven patients developed symptomatic DRUJ arthritis after TWA (23%), of which 4 underwent a surgical procedure for the DRUJ arthritis (12.9%) which was performed at an average of 20 months postoperatively (range 3-60 months). Additionally, 2 patients received a corticosteroid injection alone into their DRUJ for pain relief after initial TWA.

Conclusion
A small subset of patients (13%) who presented with radiographic evidence of both radiocarpal and DRUJ arthritis required a secondary surgery to treat their symptomatic DRUJ arthritis after initial TWA. As such, treating the RC arthritis in isolation is a reasonable initial approach despite the presence of concomitant DRUJ arthritis. However, patients should be counseled preoperatively that subsequent surgical management of progressive symptomatic DRUJ arthritis may be necessary.


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