Dorsal wrist synovectomy in rheumatoid arthritis--a long-term study

Dorsal wrist synovectomy, tenosynovectomy of the extensor tendons, excision of the distal ulna, ulnar-side stabilization of the wrist, and placement of the extensor retinaculum underneath the extensor tendons is an effective procedure in wrists with rheumatoid arthritis. Twenty-seven patients who had surgery on 38 wrists were followed for 5 to 14 years, with an average of 7.4 years. There were 25 female and two male patients with an average age of 54 years. Over 95% had excellent pain relief. There was significant reduction of wrist motion, but the arc of motion was within a functional range. Subsequent tendon rupture was minimal and even tendons found to be thinned out at the time of surgery remained intact. There was no recurrence of synovitis. Carpal measurements were done by using the pisiform bone as a reference point. The carpal height was maintained in 70% of the wrists. Carpal translocation occurred in 44% of the wrists. Three patients required wrist arthrodesis, and five, arthroplasty. Carpal collapse and translocation could not be predicted by preoperative x-rays. Progressive carpal collapse was associated with increasing ulnar deviation of fingers. Progression of carpal collapse and ulnar translocation occurred in a linear fashion with the years of follow-up.