gms | German Medical Science

Objectives/Interrogation: Management of the pancarpal arthritis in rheumatoid wrist is controversial. The most common treatment is total wrist fusion, but total wrist replacement offers a motion-preserving alternative. The purpose of this study is to present the results of the interposition arthroplasty with the Amandys pyrocarbon implant in rheumatoid wrist.

Methods: We performed a retrospective review of 28 interposition arthroplasties for rheumatoid wrist arthritis. Eighteen females and 5 males were included, with a mean age of 55.7 years. The mean follow-up was 45 months. We measured range of motion, grip strength, pain (VAS). Function was evaluated preoperatively and at the last follow-up with the DASH and PRWE scores.

Results and Conclusions: Mean range of motion in flexion-extension was maintained while mean inclination and rotation range of motion, mean grip strength, pain and function scores who showed significant improvement. The mean range of motion increase postoperatively from 65° to 70° in flexion-extension, from 25° to 35° in inclination and from 130° to 147° in rotation. The mean grip strength increase from 10kg (54% of the contralateral side) to 17 kg (78%). The mean pain score decreased from 6,3/10 to 2,5/10. The mean PRWE score decreased from 62/100 to 27/100.The mean QuickDash score decreased from 63/100 to 33/100. All patients were satisfied or very satisfied. Three patients had an early reoperation for repositioning their dislocated implant. No implant had to be removed.

Amandys arthroplasty is a reliable alternative to total arthrodesis or total wrist prosthesis in rheumatoid wrist. The implantation technique must be rigorous in order to avoid technical errors that can lead to potential implant instability. Indications must be limited to a well-aligned wrist with competent capsular structures.