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

Background and Objectives: The wrist is one of the most common sites of rheumatic disease. Based on the graded deformities of Larsen et al., surgery has been adapted to minimize harm while maximizing benefit to the individual. This study aims to survey the institutional experience, describing functional outcomes and patient satisfaction across several surgical approaches, without formal statistical comparison. Materials and Methods: The studies and results presented here are from one center specialized in rheumaorthopedic surgery and reflect the above concepts. The studies cover a broad spectrum of surgical techniques, which were categorized according to the Larsen stages of wrist destruction. All studies were retrospective or retrospective-like, and follow-up data were analyzed collectively. The primary endpoints were functional outcome scales and patient satisfaction, supplemented by pain relief, as well as strength and range of motion. The assessment utilized, amongst others, the QuickDASH, FFbH and Clayton score, as well as appropriate patient-reported measures such as ADL and SF-36. Radiological follow-ups were classified according to the Larsen-Dale-Eek classification; for endoprostheses/arthrodesis, carpal height was determined according to Youme. Results: Significant improvements in the Clayton score (consistently greater postoperatively than preoperatively) are evident for several procedures, particularly MPW^® (+37 points) and APW^® (+28 points). Postoperative reductions in VAS pain scores are marked for most procedures, e.g., MPW^® from 7 to 1.8. The revision rates for most procedures are around 10-13% during the follow-up periods. In addition, the tendon and soft tissue functions of the hand(s) play critical roles in these PROMs. Conclusions: The studies present the results and limitations of surgical treatment for rheumatic wrists in the prebiological era. The results of individual studies need to be examined more closely to better assess the potential and limitations of surgery for patients.