Abstract
Keywords
The use of the Swanson silastic arthroplasty for the treatment of the rheumatoid hand has been shown to correct deformities and improve function. Silastic arthroplasty has a tendency to fracture requiring revision, while wrist fusion is thought to be a more durable solution. We conducted a retrospective case note analysis of all patients undergoing wrist arthroplasty or wrist fusion for clinical follow-up. Radiographic imaging was reviewed. Patient records on the combined GP/Hospital database were reviewed for the purpose of community follow-up.
In the cohort of patients who underwent silastic arthroplasty, the indications for surgery were 14 rheumatoid arthritis, 2 psoriatic arthritis, 2 juvenile arthritis, and 3 osteoarthritis. Of the 21 patients, 17 were older than 65 years of age. There were 3 reported complications: a postoperative wound infection that required debridement, a complex regional pain syndrome, and an ongoing symptoms of pain requiring debridement of the distal radius. There were no implant fractures at last radiographic review. The 5-year survivorship was 100% with reoperation as the end point with 2 implants lasting up to 15 years.
A total of 38 patients underwent a wrist fusion, with a mean age of 52 years, with 6 patients older than 65 years of age. In all, 17 were undertaken for osteoarthritis, with 1 case of avascular necrosis of the capitate in a patient with calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia (CREST) syndrome. Eleven patients reported time off work as a direct result of their symptoms. Postoperative complications include hematoma, complex regional pain syndrome, distal radial ulnar joint pain requiring Darrach procedure in 4 patients, screw revision following prominence, and 4 cases where the metal ware was removed. All fusions went onto unite. Survivorship at 5 years was 91% with reoperation as the end point.
This small case series shows that for this highly selected group of patients with an inflammatory arthropathy, silastic arthroplasty remains a viable option. For elderly patients having rheumatoid with low demand, this treatment has a lower reoperative rate at 5 years and therefore may often be the final treatment they require.