Radioscapholunate arthrodesis versus radiolunate arthrodesis in rheumatoid wrist surgery: Clinical and radiographic outcomes

• Published in: Hand surgery and rehabilitation 2020-10, Vol.39 (5), p.363-374
• Main Authors: Arboucalot, M., Rongières, M., Bonnevialle, N., Delclaux, S., Mansat, M., Mansat, P.
• Format: Article
• Language: English
• Subjects: Arthrodèse radio-lunaire; Arthrodèse radio-scapho-lunaire; Clinical outcomes; Life Sciences; Poignet rhumatoïde; Radiographic outcomes; Radiolunate arthrodesis; Radioscapholunate arthrodesis; Rheumatoid wrist; Résultats cliniques; Résultats radiographiques
• ISSN: 2468-1229; 2468-1210
• DOI: 10.1016/j.hansur.2020.04.002

Radiolunate arthrodesis is a validated surgical technique in rheumatoid wrist surgery. When the radioscaphoid joint is involved or when there is radiolunate instability, a radioscapholunate arthrodesis must be preferred. The objective was to compare clinical and radiographic outcomes for both types of arthrodesis. Patients were evaluated retrospectively at a minimal follow-up of 12 months after radiolunate arthrodesis (RL-A group) or radioscapholunate arthrodesis (RSL-A group). Mean follow-up was 10.7 years (1–25 years). One hundred and one patients were included in RL-A group and 26 in RSL-A group. At follow-up, pain level was significantly reduced by 3.7 points and by 2.9 points in RL-A and RSL-A groups, respectively. Mobility in flexion/extension was significantly reduced by 25° in both groups. DASH and PRWE scores were 42.9 and 41.4 in RL-A group, 41.8 and 20.6 in RSL-A group, respectively. Larsen stage for the midcarpal joint increased significantly in both groups (+0.8 in RL-A group; +0.9 in RSL-A group), carpal height index decreased (−0.03 in RL-A group (significant); −0.02 in RSL-A group (non-significant)), carpal ulnar translation index increased (+0.038 in RL-A group; +0.037 in RSL-A group), without significant difference between both groups. Nonunion rate was significantly higher in RSL-A group (62%) than in RL-A group (30%). A pain free and functional wrist can be obtained after radiolunate and radioscapholunate arthrodesis. However, arthritis lesions and carpal deformities increased with follow-up similarly with both surgical techniques. Our results have shown that radiolunate arthrodesis remains a reliable surgical procedure for advanced rheumatoid wrist. L’arthrodèse radio-lunaire est une des techniques de référence dans la chirurgie du poignet rhumatoïde dorsal. En cas d’atteinte de l’interligne radio-scaphoïdien ou d’instabilité scapho-lunaire, il est nécessaire d’élargir l’arthrodèse à l’interligne radio-scaphoïdien. L’objectif était de comparer les résultats cliniques et radiographiques de ces deux arthrodèses. Il s’agissait d’une étude comparative rétrospective. Les patients étaient évalués au recul minimum de 12 mois après arthrodèse partielle radio-lunaire (groupe RL-A) ou radio-scapho-lunaire (groupe RSL-A). Au recul moyen de 10,7 ans (1–25 ans), 101 patients ont été inclus dans le groupe RL-A et 26 dans le groupe RSL-A. La douleur était significativement diminuée de 3,7 points et de 2,9 points respectivement dans les groupes RL-A e