Differential Surgery on the Rheumatoid Wrist: Patient Satisfaction and Clinical Outcome

Area of Science:

• Rheumaorthopedic surgery
• Hand and wrist surgery

Background:

• The wrist is a common site for rheumatic disease, leading to deformities.
• Surgical interventions aim to minimize harm and maximize patient benefit based on Larsen stages.
• This study reviews institutional experience with various surgical approaches for rheumatic wrist disease.

Purpose of the Study:

• To survey institutional experience with surgical treatments for rheumatic wrist disease.
• To describe functional outcomes and patient satisfaction across different surgical approaches.
• To evaluate the potential and limitations of surgical treatment in the pre-biological era.

Main Methods:

• Retrospective analysis of surgical techniques categorized by Larsen stages of wrist destruction.
• Evaluation of functional outcomes using scales like QuickDASH, FFbH, and Clayton score.
• Assessment of patient satisfaction, pain relief, strength, range of motion, and radiological changes.

Main Results:

• Significant improvements observed in Clayton scores for MPW® (+37) and APW® (+28).
• Marked reductions in Visual Analog Scale (VAS) pain scores post-surgery (e.g., MPW® from 7 to 1.8).
• Revision rates for most procedures were approximately 10-13%.

Conclusions:

• Surgical treatments for rheumatic wrists in the pre-biological era demonstrated functional and satisfaction improvements.
• Tendon and soft tissue function significantly impact patient-reported outcome measures (PROMs).
• Further examination of individual study results is needed to fully understand surgical potential and limitations.