[Impact of Total Wrist Arthrodesis on Occupational Ability]

Total wrist arthrodesis is a well-established salvage procedure, but it results in the loss of wrist mobility. It is indicated in cases of painful, advanced osteoarthritis of both the radiocarpal and midcarpal joints (panarthrosis of the wrist) after all conservative treatment options have failed. The same indication applies to total wrist arthroplasty, which has gained increasing popularity due to the advantage of preserving wrist motion. However, total wrist arthroplasty is generally not indicated for younger patients engaged in heavy manual labor. One aim of our study was to investigate the impact of total wrist arthrodesis on patients' occupational abilities.A total of 71 wrists in 68 patients were retrospectively evaluated at a mean follow-up time of 11.7 years (range: 10-16 years). In addition to assessing long-term functional outcomes, identifying potential causes of persistent pain and applying multiple Patient-Reported Outcome Measures (PROMs), data on pre- and postoperative professional activities were collected and analyzed.Preoperatively, a large proportion of patients (83%) were in manual labor. Of these, 32 individuals (46%) performed heavy physical work, whereas only 10 patients (14%) were employed in office-based roles. Following surgery, 12 patients (17%) had to change their profession, and the same number had to retire from work. Within the group of manual workers, further subgroups were formed based on occupational load (return to work: heavy labor 22/32, moderate 12/21, light 6/6). Regarding occupational capacity, nearly half of the patients (n=35) reported work-related impairments. Only 13 patients described their work ability as fully restored.Even in cases of uneventful healing after total wrist arthrodesis, a return to the original occupation cannot be guaranteed. Male patients engaged in physically demanding manual labor appear to have an increased risk of developing posttraumatic panarthrosis of the wrist and consequently require surgical fusion. The high level of patient satisfaction observed in our study, especially considering the results measured with Patient-Reported Outcome Measures (PROMs), demonstrates that total wrist arthrodesis remains the gold standard for treating unilateral, painful panarthrosis of the wrist.