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Kato T, Suzuki T, Kameyama M, Okazaki M, Morisawa Y, Nishiwaki M, Nakamura T, Sato K, Iwamoto T. Range of Motion after the Sauvé-Kapandji and Darrach Procedures without Extensor Tendon Rupture. J Wrist Surg 2021; 10:190-195. [PMID: 34109060 PMCID: PMC8169168 DOI: 10.1055/s-0040-1721452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/28/2020] [Indexed: 10/22/2022]
Abstract
Background Previous study demonstrated that distal radioulnar joint (DRUJ) plays a biomechanical role in extension and flexion of the wrist and suggested that fixation of the DRUJ could lead to loss of motion of the wrist. Little is known about the pre- and postoperative range of motion (ROM) after the Sauvé-Kapandji (S-K) and Darrach procedures without tendon rupture. To understand the accurate ROM of the wrist after the S-K and Darrach procedures, enrollment of patients without subcutaneous extensor tendon rupture is needed. Purpose This study aimed to investigate the pre- and postoperative ROM after the S-K and Darrach procedures without subcutaneous extensor tendon rupture in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Methods This retrospective study included 36 patients who underwent the S-K procedure and 10 patients who underwent the Darrach procedure for distal radioulnar joint disorders without extensor tendon rupture. Pre- and postoperative ROMs after the S-K and Darrach procedures were assessed 1 year after the surgery. Results In the S-K procedure, the mean postoperative ROM of the wrist flexion (40 degrees) was significantly lower than the mean preoperative ROM (49 degrees). In wrist extension, there were no significant differences between the mean preoperative ROM (51 degrees) and postoperative ROM (51 degrees). In the Darrach procedure, the mean postoperative ROM of the wrist flexion and extension increased compared with the mean preoperative ROM; however, there were no significant differences. Conclusion In the S-K procedure, preoperative ROM of the wrist flexion decreased postoperatively. This study provides information about the accurate ROM after the S-K and Darrach procedures. Level of Evidence This is a Level IV, therapeutic study.
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Affiliation(s)
- Tomoyuki Kato
- Department of Orthopaedic Surgery, Ogikubo Hospital, Suginami-ku, Tokyo, Japan
| | - Taku Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Makoto Kameyama
- Department of Orthopaedic Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Masato Okazaki
- Department of Orthopaedic Surgery, Ogikubo Hospital, Suginami-ku, Tokyo, Japan
| | - Yasushi Morisawa
- Department of Orthopaedic Surgery, National Hospital Organization Saitama Hospital, Wako, Saitama, Japan
| | - Masao Nishiwaki
- Department of Orthopaedic Surgery, Kawasaki Municipal Hospital, Kawasaki, Japan
| | - Toshiyasu Nakamura
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Tokyo, Japan
| | - Kazuki Sato
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takuji Iwamoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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Motomiya M, Nishimoto N, Urita A, Kawamura D, Shimizu Y, Iwasaki N. Patient characteristics affecting knowledge of the possibility of surgical reconstruction for rheumatoid hand and wrist deformities. Mod Rheumatol 2020; 31:614-620. [PMID: 32615835 DOI: 10.1080/14397595.2020.1790779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We aimed to investigate patient characteristics affecting their knowledge of surgical reconstruction for rheumatoid hand and wrist deformities, and to investigate such characteristics affecting their hope of receiving hand surgery if patients with rheumatoid arthritis (RA) knew surgical reconstruction options. METHODS We carried out a questionnaire survey for all patients with RA who came to our outpatient department of rheumatology. Multivariate logistic regression analysis was performed to examine significant characteristics associated with the knowledge of surgical reconstruction and patients' hope of receiving hand surgery. RESULTS In total, 687 patients were evaluated in this study and 337 (49%) reported knowledge about surgical reconstruction. A multivariate logistic regression analysis showed that patients with good control of disease activity and with long-lasting hand and wrist deformities were significantly associated with having knowledge of surgical reconstruction. Among the 337 patients with knowledge, only 122 (36%) expressed a hope of receiving hand surgery. The statistical analysis showed that younger age and surgical history were significantly associated with the hope of receiving surgery. CONCLUSION Surgeons and rheumatologists should enlighten patients about the importance of hand surgery to achieve functional remission in this new era of treatment for patients with RA.
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Affiliation(s)
- Makoto Motomiya
- Department of Orthopaedic Surgery, Obihiro Kosei Hospital Hand Center, Obihiro, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Naoki Nishimoto
- Division of Biostatistics, Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan
| | - Atsushi Urita
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Daisuke Kawamura
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuka Shimizu
- Department of Internal Medicine III, Obihiro Kosei Hospital, Obihiro, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Okabayashi R, Ishikawa H, Abe A, Otani H, Funamura K, Kakutani R, Ito S, Kurosawa Y, Sakai S, Nakazono K, Suzuki M, Matsuyama Y, Murasawa A. Twenty years' follow-up of radiocarpal arthrodesis for rheumatoid wrists. Mod Rheumatol 2020; 31:312-318. [PMID: 32530346 DOI: 10.1080/14397595.2020.1782565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES A pain-free stable wrist is a prerequisite for patients with rheumatoid arthritis to improve their activity of daily life. The present study investigated whether or not radiocarpal arthrodesis yielded good results for more than 20 years. METHODS A retrospective study was performed on 20 unstable wrists in 17 patients with rheumatoid arthritis. Radiocarpal arthrodesis combined with synovectomy and the Darrach procedure was performed. Wrist pain, grip power, the range of motion, pharmacotherapy, ESR, CRP, and serial radiographs were investigated at the baseline and 20 years after the operation. Patient-reported outcomes using the mHAQ, DASH and patient's satisfaction level were investigated at the final follow-up. RESULTS Pain had disappeared completely in all patients at 20 years after the operation. The average grip power increased in 16 wrists (80%) and decreased in 4 wrists (20%). Wrist extension and flexion significantly decreased, and supination and pronation remained within the functional range. Radiographically, ulnar shift and palmar subluxation initially improved and remained unchanged for a long time. Fourteen patients (82.4%) with 17 wrists were satisfied with this operation. CONCLUSION Radiocarpal arthrodesis for rheumatoid wrists provided painless stability for a long period for 20 years or more.
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Affiliation(s)
- Ryo Okabayashi
- Department of Rheumatology, Niigata Rheumatic Center, Shibata City, Japan.,Department of Orthopedic Surgery, Hamamatsu Medical University Hospital, Hamamatsu City, Japan
| | - Hajime Ishikawa
- Department of Rheumatology, Niigata Rheumatic Center, Shibata City, Japan
| | - Asami Abe
- Department of Rheumatology, Niigata Rheumatic Center, Shibata City, Japan
| | - Hiroshi Otani
- Department of Rheumatology, Niigata Rheumatic Center, Shibata City, Japan
| | - Kei Funamura
- Department of Rheumatology, Niigata Rheumatic Center, Shibata City, Japan
| | - Rika Kakutani
- Department of Rheumatology, Niigata Rheumatic Center, Shibata City, Japan
| | - Satoshi Ito
- Department of Rheumatology, Niigata Rheumatic Center, Shibata City, Japan
| | - Youichi Kurosawa
- Department of Rheumatology, Niigata Rheumatic Center, Shibata City, Japan
| | - Shunsuke Sakai
- Department of Rheumatology, Niigata Rheumatic Center, Shibata City, Japan
| | - Kiyoshi Nakazono
- Department of Rheumatology, Niigata Rheumatic Center, Shibata City, Japan
| | - Motohiro Suzuki
- Department of Orthopedic Surgery, Hamamatsu Medical University Hospital, Hamamatsu City, Japan
| | - Yukihiro Matsuyama
- Department of Orthopedic Surgery, Hamamatsu Medical University Hospital, Hamamatsu City, Japan
| | - Akira Murasawa
- Department of Rheumatology, Niigata Rheumatic Center, Shibata City, Japan
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Arboucalot M, Rongières M, Bonnevialle N, Delclaux S, Mansat M, Mansat P. Radioscapholunate arthrodesis versus radiolunate arthrodesis in rheumatoid wrist surgery: Clinical and radiographic outcomes. HAND SURGERY & REHABILITATION 2020; 39:363-374. [PMID: 32334078 DOI: 10.1016/j.hansur.2020.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- M Arboucalot
- Service d'orthopédie-traumatologie, CHU de Toulouse-Purpan, place du Dr Baylac, 31059 Toulouse cedex, France.
| | - M Rongières
- Service d'orthopédie-traumatologie, CHU de Toulouse-Purpan, place du Dr Baylac, 31059 Toulouse cedex, France
| | - N Bonnevialle
- Service d'orthopédie-traumatologie, CHU de Toulouse-Purpan, place du Dr Baylac, 31059 Toulouse cedex, France
| | - S Delclaux
- Service d'orthopédie-traumatologie, CHU de Toulouse-Purpan, place du Dr Baylac, 31059 Toulouse cedex, France
| | - M Mansat
- Service d'orthopédie-traumatologie, CHU de Toulouse-Purpan, place du Dr Baylac, 31059 Toulouse cedex, France
| | - P Mansat
- Service d'orthopédie-traumatologie, CHU de Toulouse-Purpan, place du Dr Baylac, 31059 Toulouse cedex, France
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