We reviewed retrospectively outcome after intracarpal arthrodesis for advanced-stage osteoarthritis of the wrist.
Among the 20 patients who underwent a four-bone fusion between 1989 and 1998 in our unit, 17 were available for analysis. Mean age of the study population was 41.5 years. These young patients had an occupational activity and 80% of them were manual laborers. Preoperatively, pain was the main complaint; 95% of the patients considered pain to be invalidating. Grip force was 48.5% compared to the healthy side. Joint amplitudes were limited in all patients: flexion-extension 85 degrees, radio-ulnar inclination 22.5 degrees with 12.5 degrees for the ulnar side. Mean loss of motion compared with the healthy side was 32.5% for flexion-extension, and 44% for radio-ulnar inclination. The preoperartive radiograph showed degenerated capito-lunate joints in 63% of the cases, degenerative scapho-capital joints in 58% and total loss of the radio-scaphoid joint space in 100%. Degeneration was considered to be global in 58% of the wrists.
Mean follow-up for the 17 wrists studied was 3.4 years (range 1-10). At last follow-up, 41% of the wrists were pain free, 24% were painful occasionally, and 35% were bothersome for heavy work. The patients did not express any difficulties in daily activities. Grip force was only slightly improved with a 7.5% gain over the preoperative value. Joint motion at last follow-up was, on the average, 70 degrees flexion-extension (40 degrees flexion and 30 degrees extension) and 35 degrees radio-ulnar inclination (17.5 degrees ulnar). Eleven patients (65%) had resumed their occupational activities at the same level two months after surgery. Outcome was deemed satisfactory by 65% of the patients, fair by 17.5%, and poor by 17.5% (3 patients). Radiological fusion was achieved in 16 wrists at a mean 4.5 weeks. Mean carpal height was 0.42 compared with 0.52 for the healthy side and 0.47 preoperatively. There was no significant relationship between carpal height and poor outcome.
Data in the literature are in agreement with the good results obtained for pain and activity level despite the inconstant effect on grip force and joint amplitude.
Four-bone fusion is an effective treatment for patients with advanced-stage osteoarthritis of the wrist where the level of degeneration rules out resection. The consequences of total wrist arthroplasty are much more invalidating.