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[Arthroscopic Synovectomy of the Wrist in Chondrocalcinosis]
1Handchirurgie, Plastische und Rekonstruktive Chirurgie, Klinikum Mittelbaden, Baden-Baden.
Background:
Operative treatment of chondrocalcinosis (calcium pyrophosphate dihydrate deposition disease=CPPD disease) of the wrist is hardly ever mentioned in the literature. Since the chronic, recurrent type of this disease resembles rheumatoid arthritis (RA) as well as osteoarthritis, the author has performed arthroscopic synovectomy of the wrist, which achieves excellent results in RA und offers high patient comfort as an atraumatic procedure with low morbidity. This article presents the experience made with arthroscopic synovectomy in CPPD disease of the wrist.
Patients And Methods:
Out of 74 arthroscopic synovectomies in 71 patients with symptomatic CPPD disease of the wrist, 46 operations in 43 patients were followed for an average of 26.6 months after surgery. 15 women and 28 men at an average age of 64.5 (42-90) years had a telephone interview and were asked for pain, functional impairment and satisfaction with the intervention. Intraoperative and histologic findings were recorded. According to the Romano Classification, there was SCAC (scaphoid chondrocalcinosis advanced collapse) I in 6 cases (13%), SCAC II in 18 (39%), SCAC III in 9 (19.5%) and SCAC IV in 3 cases (6.5%). In 10 X-rays, classification according to Romano was not possible.
Results:
There was a significant reduction in pain at rest and on weight-bearing as well as a significant improvement in hand function. 74% of patients would chose to undergo the intervention again. Arthroscopy revealed the typical symptoms of CPPD disease in all cases. In 38 out of the 46 operations, a histologic examination was performed and was positive in 20 cases.
Conclusions:
Arthroscopic synovectomy of the wrist in patients with CPPD disease provides high patient satisfaction regardless of the radiologic stage. The procedure is atraumatic with low morbidity and high patient comfort. The Romano Classification should be supplemented by an additional early stage, SCAC 0. More often than suspected, CPPD disease may be responsible for wrist pain of unknown origin even in middle-aged patients.
