Distraction resection arthroplasty of the wrist

Proximal row carpectomy should not be done if wrist degeneration includes cartilage destruction of the capitate or lunate fossa of the radius; yet total wrist arthroplasty has been disappointing for treatment of osteoarthritis. We have used a technique we call distraction resection wrist arthroplasty in such cases. We retrospectively reviewed distraction resection wrist arthroplasty in 14 wrists and compared them to nine patients who had PRC; average follow-up was 32 months. Three patients had spastic contractures and 20 had operation for painful osteoarthritis. Patient satisfaction was high but there were four failures requiring arthrodesis (1 PRC, 3 DRA). Average postoperative wrist motion was 41 degrees of extension, 38 degrees of flexion, 11 degrees of radial deviation, and 13 degrees of ulnar deviation. Static strength averaged almost two thirds of the uninvolved side and dynamic power more than half. Differences between the DRA and PRC patients were not statistically significant in single or aggregate analysis. We believe that distraction technique extends the indications for biologic arthroplasty to patients whose only prior option was wrist arthrodesis.