Functional and patient-reported outcome of partial wrist denervation versus the Mannerfelt wrist arthrodesis in the rheumatoid wrist

• Published in: Archives of orthopaedic and trauma surgery 2014-07, Vol.134 (7), p.1037-1044
• Main Authors: Riches, Philip L., Elherik, Firas K., Breusch, Steffen J.
• Format: Article
• Language: English
• Subjects: Aged; Arthritis, Rheumatoid - diagnostic imaging; Arthritis, Rheumatoid - surgery; Arthrodesis - methods; Denervation - methods; Female; Handsurgery; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Orthopedics; Pain; Pain Measurement; Patient Outcome Assessment; Patient Satisfaction; Patients; Prospective Studies; Questionnaires; Radiography; Surveys and Questionnaires; Wrist Joint - innervation; Wrist Joint - surgery
• ISSN: 0936-8051; 1434-3916
• DOI: 10.1007/s00402-014-2018-4

Introduction Wrist arthrodesis offers high success rates in patients with rheumatoid arthritis; however, loss of residual mobility may cause unnecessary disability. This makes wrist denervation an appealing alternative. However, there is a distinct lack of patient-reported outcome measure studies comparing these two procedures. The aim of this study was to report any change in function, pain and satisfaction following wrist arthrodesis compared to denervation in a single surgeon series of rheumatoid patients. Patients and methods The results of 16 wrist arthrodesis in 15 patients and 14 partial (PIN) wrist denervations in 13 patients were compared with a mean follow-up period of 39 and 22 months, respectively. The primary outcome measures were the same for both groups and included the validated patient-rated wrist evaluation questionnaire and a satisfaction questionnaire. Results Wrist arthrodesis significantly improved the mean total pain and functional outcome scores by 54 and 36 %, respectively, at the time of follow-up. Wrist denervation patients also reported significant improvements of 44 and 42 % in total pain and functional outcomes, respectively; 87 % reported being very satisfied with their wrist arthrodesis procedure compared to 78 % in the denervation group. No statistically significant difference in response between the groups was observed in this series of patients. Conclusions Both procedures enjoyed favourable results amongst patients with excellent satisfaction outcomes. PIN denervation is a simple procedure with low complication rates and we therefore consider it a valid alternative to more difficult treatment options, such as partial or total wrist arthrodesis.