Surgical management of the rheumatoid wrist--fusion or arthroplasty

Forty-eight patients with 33 wrist fusions and 37 silicone wrist arthroplasties were reviewed and compared. Of those who had arthrodesis 97% showed a good or excellent result. Follow-up time averaged 82 months. All patients had a decrease in pain. Most patients had stronger wrists but complained of decreased dexterity. There were no pseudarthroses. The complication rate was 18%. Of patients in the arthroplasty group, 78% had a good or excellent result. Follow-up time averaged 51 months. Most patients in the arthroplasty group had improved dexterity and adequate wrist strength. Average flexion/extension was 32 degrees/29 degrees. The complication rate was 25%, which included four revisions. Of patients who had arthroplasties, 14% had bone resorption about the stem, and 11% of the patients with arthroplasties had x-ray evidence of settling. Factors that did not influence the result of the arthroplasty were patient age, duration of disease before surgery, finger extensor tendon rupture, preoperative motion, and hand dominance. Factors that were associated with failure and/or a fair result in arthroplasty patients were the use of ambulatory aids, the older and narrower prosthetic design, dislocated wrist preoperatively, and the chronic use of steroids.