Surgical Treatment in Rheumatoid Wrist

Kim, In; Kim, Jung Man; Lee, Seung Koo; Kim, Yang; Yoon, Hwa Ju

Abstract

The authors have analysed 39 rheumatoid wrists in 25 rheumatoid patients, who underwent vsrious surgeries including arthroscopic and open synovectomy, partial and total arthrodesis and total wrist arthroplasty at the department of orthopaedic surgery, St. Mary's Hospital from November 1985 to April 1988, and the effect of eaeh surgery on the wrist function and proper time of operation are discussed. The results were as follows; 1. The patients who were classified as a classical rheumatoid arthritis according to the ARA criteria were four males and twenty-one females, with a mean age of 43 yesrs, and the functional capacity of the patients before operation was graded in III for twenty-threeand in IV for two patients. 2. Out of 25 patients (39 wrists), 14 patients are in bilateral and II patients in unilateral involvement. The synovectomy in 13 wrists, arthrodesis in 24 wrists and total joint replacement in 2 wrists were performed and followed them for average 17 months after operation. 3. The synovectomy were done for 13 wrists in grade II and III according to the classification of rheumstoid arthritis by radiology(3). There were two cases of recurrence in the cases of synovectomy, but not in replacement and arthrodesis. 4. The arthrodesis of wrist was performed for 24 wrists-bilateral arthrodesis in 3 patient (6 wrists) and unilateral fusion in 18 patients. For 4 cases out of 24 cases of wrist arthrodesis, the second and third carpo-metacsrpal joints were fused simultaneously. 5. Protek total wrist arthroplasty was done in 2 cases snd followed them for more than9 months with relatively good clinical results. Finally, it is our beliefs for rheumatoid wrists that surgery is often indicated to control the various wrist problems, early synovectomy is strongly indicated, and partial wrist fusion has proven to be effective in patients with moderate destruction, deformity and pain, but the total wrist arthrodesis and arthroplasty is still in controversy. The proper surgery for rheumatoid wrist should be determined by the clinical severity of disease and radiological changes of wrist.