Individualized outcome measures of daily activities are sensitive tools for evaluating hand surgery in rheumatic diseases

Clinical, Radiographic, and Patient-Perceived Outcome After Radial Hemi-Wrist Arthroplasty With a New Implant: 20 Cases With 5-Year Follow-up

BACKGROUND

Distal component loosening is a common mode of failure in total wrist arthroplasty (TWA). A radial hemi-wrist arthroplasty (RHWA) has the potential to avoid problems related to the distal component in TWA. The aim of this study is to investigate clinical outcomes following surgical treatment with a new RHWA design.

METHODS

In this pilot study of 20 consecutive RHWAs, patients were assessed preoperatively and postoperatively for range of motion, grip strength, Visual Analog Scale (VAS) pain scores, and functional scoring using Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder, and Hand (DASH), and Canadian Occupational Performance Measure. Radiographs were analyzed at 12 months and 5 years (mean, 5.1 years) postoperatively.

RESULTS

A total of 46 secondary surgeries were undertaken in 16 wrists, including 7 revisions. Another 6 patients are waiting for revision to radiocarpal arthrodesis. In non-revised patients, the DASH and PRWE scores improved, and wrist range of motion remained largely unchanged except for wrist flexion, which decreased. The VAS pain score during activity was reduced, and hand grip strength remained largely unchanged.

CONCLUSIONS

The new implant resulted in improved functional scoring and improved VAS pain scores in non-revised patients, but many cases needed secondary surgery due to persistent pain. The high revision rate is a major concern, and further use of the implant in its current form cannot be recommended.

Total Wrist Arthroplasty With a New Design, 20 Cases With 8-Year Follow-Up

PURPOSE

Total wrist arthroplasty (TWA) is an established motion-preserving alternative to arthrodesis in the treatment of wrist arthritis, but post-TWA complications requiring additional surgery remain an issue. A new TWA design has been proposed. The purpose of this study was to report the outcome of a cohort study of 20 patients who underwent surgery using the new TWA design.

METHODS

Patients were assessed before surgery and at 1, 2, and 8 years after surgery for visual analog scale (VAS) pain scores, wrist range of motion, hand grip strength, and patient-reported outcome measures (PROMs). Radiographic examination was conducted for evidence of prosthetic loosening. Reasons for revision were analyzed.

RESULTS

In total, 24 reoperations were performed, including 12 revisions in 6 patients. Patient-reported outcome measures improved significantly at the 2-year follow-up compared with preoperative values. Hand grip strength, wrist extension, and VAS pain scores improved significantly at the 2-year follow-up. No radiographic loosening of the components was observed, but backing out of the carpal screws was noted in 16 of the 20 cases.

CONCLUSIONS

The new TWA resulted in improved VAS pain scores, PROMs, wrist extension, and hand grip strength. The high frequency of reoperation is a concern, and modification of the implant is needed.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Self-identified functional limitations improve in patients with degenerative wrist arthritis after surgery

STUDY DESIGN

This is a prospective cohort pilot study.

BACKGROUND

Degenerative wrist arthritis leads to pain, loss of strength, mobility, function, and impairments in psychological well-being. Accurate assessment of functional limitations that are unique to the individual is essential for successful treatment that best meets those specific needs.

PURPOSE OF THE STUDY

To identify and determine if self-identified functional limitations improve in patients who underwent surgery for degenerative wrist arthritis.

METHODS

Patients with degenerative wrist arthritis who were scheduled for surgery were prospectively recruited (n = 14, mean age + SD = 42 + 16, 10 males, 4 females) into a pilot study that measured self-identified functional limitations and outcomes. Inclusion criteria included a diagnosis of scapholunate advanced collapse, scaphoid nonunion advanced collapse, scapholunate interosseous ligament tear, or Kienböck disease. Exclusion criteria included a history of neuromuscular disease or concomitant ipsilateral musculoskeletal injury. Data were collected during two 20-minute sessions, preoperatively and one year postoperatively, utilizing the Patient-Rated Wrist Evaluation and the Canadian Occupational Performance Measure.

RESULTS

All patients reported significant decreases (P < .001) in total pain (mean change = 17.6, SD = 8.5) and total disability (mean = 17.8, SD = 9.1) on the Patient-Rated Wrist Evaluation from presurgery to postsurgery, with a large effect size of d > 0.8. Patients also reported significant improvements (P < .001) in mean performance (mean = 3.5, SD = 1.5) and mean satisfaction (mean = 4.0, SD = 2.1) with self-identified activities on the Canadian Occupational Performance Measure, with an effect size of d > 0.8.

CONCLUSION

Patients with degenerative wrist arthritis reported significant postoperative improvement in both performance and satisfaction in self-identified activities. Consideration of patient-specified goals can inform both patients and clinicians during the surgical decision-making process and allow for more individualized care.

Psychometric properties of the Assessment of Motor and Process Skills in patients undergoing rehabilitation following hand-related disorders

Introduction

Assessment of Motor and Process Skills (AMPS) has been proven to be a suitable measurement tool for assessing performance-based ADL ability; however, its reliability and validity have not been tested on patients with hand-related disorders.

Methods

Patients referred for outpatient hand rehabilitation were assessed with AMPS, The Canadian Occupational Performance Measure (COPM), dynamometer and goniometer at baseline and after eight weeks of hand therapy. Construct validity and responsiveness of AMPS were assessed by hypothesis testing. Construct validity was assessed by correlating the baseline score of AMPS with the baseline score of the other measurement tools. Responsiveness was assessed by correlating the change scores of each measurement tool with a Global Rating Scale.

Results

Fifty-one patients were recruited. The construct validity of AMPS indicated that the various measurement tools captured different aspects to functioning from the AMPS, as the correlations between AMPS and the other measurement tools were generally weak to low (r < 0.25 to 0.49). AMPS was less responsive than COPM when correlated with the GRS. The correlation between COPM and GRS was r = 0.62 compared with the AMPS motor, r = 0.45 and AMPS process, r = 0.33. Relative responsiveness of AMPS is similar to that of the dynamometer (r = 0.39) and goniometer (r = –0.34).

Discussion

In a sample of 51 patients, this study found that the construct validity of AMPS seemed to be moderate, while the responsiveness of AMPS seemed to be poor. However, due to the small sample size no conclusions can be made, and should be further assessed in larger studies.