RESUMO
Thirty-two patients underwent 38 arthroplasties for advanced rheumatoid arthritis and marked soft tissue losses. Seven wrists required repair or transfer of at least one tendon for rebalancing. All patients were improved by the implants. Thirty-four of the 38 patients were improved beyond the functional level of a painless wrist arthrodesis. Overall, there were 23 excellent, 10 good, 3 fair, and 2 poor results. The average wrist score was 90.3 points, and the average arc of motion was 38 degrees. There were three cases of migration of the third metacarpal stem and nine cases of lucency about the stems, three of which were progressive or greater than 1 mm. There were no deep infections. There was one reoperation for persistent pain and one for component loosening. There were no cases of implant failure. These results indicate that this total wrist arthroplasty is a safe, reproducible procedure for radiographic class III and IV rheumatoid disease and should be considered a first line of therapy for that group.
Assuntos
Artrite Reumatoide/cirurgia , Prótese Articular , Articulação do Punho , Adulto , Idoso , Artrite Reumatoide/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Movimento , Desenho de PróteseRESUMO
In a study of the impact of selected patient factors and alignment variables on functional results of total wrist arthroplasty, functional score and range of motion were found to be improved and incidence of component shift and progressive radiolucent lines decreased by proper positioning of the implant center of rotation and restoration of carpal height. Angulation of the implant stems was secondary in importance to the other positioning variables with respect to overall function and durability. A neutral alignment range for this implant arthroplasty was proposed. Within this neutral range, functional score averaged 94 points and range of motion averaged 68 degrees. There were no reoperations, component shifting, or progressive radiolucent lines, and all wrists rated an excellent score.
Assuntos
Prótese Articular , Articulação do Punho/fisiopatologia , Artrite Reumatoide/cirurgia , Fenômenos Biomecânicos , Ossos do Carpo/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Métodos , Movimento , Desenho de Prótese , Radiografia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgiaRESUMO
Dorsal stabilization was performed on 85 rheumatoid wrist in 62 patients for an average follow-up of 6.8 years. Of these, 37 wrists were followed an average of 10 years. The chief component was pain in 79 of the wrists. Pain, on a scale of 0 to 100, showed a preoperative score of 32 and postoperative ratings of 89 for the total group and 96 for the long-term group. Range of motion decreased in virtually all patients. Spontaneous ankylosis occurred in eight wrists. Because of the presence of associated deformities, usually subluxated metacarpophalangeal joints, evaluation of functional improvement of the wrist was difficult. Those hands in which metacarpophalangeal subluxations were corrected or prevented showed maximum functional improvements. The procedure is beneficial for long-term relief of pain and maintenance of a range of motion which arthrodesis would eliminate.
Assuntos
Artrite Reumatoide/cirurgia , Luxações Articulares/complicações , Articulação do Punho/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Movimento , Cuidados Paliativos/métodos , Complicações Pós-Operatórias , Sinovectomia , Sinovite/cirurgia , Tendões/cirurgiaRESUMO
A long-term follow-up (average, eight years) of surgical treatment of thirteen cases of Madelung's deformity in eight patients showed that the Darrach procedure was successful when there was mild deformity and that biplane osteotomy of the radius combined with the Darrach procedure was needed for severe deformity. Subluxation of the lunate bone ulnarward occurred after the Darrach procedure but was not clinically symptomatic.
