gms | German Medical Science

Objectives/Interrogation: We previously published early outcomes of arthroscopic resection arthroplasty of the radial column (ARARC) for scapholunate advanced collapse (SLAC) pattern of degenerative wrist arthritis. The purpose of this study was to report mid-term outcomes following ARARC for SLAC wrists.

Methods: Patients (N=31) who underwent ARARC for arthroscopic stage II-IIIB SLAC wrists were prospectively enrolled; 14 of these patients were included in the previous publication. General, regional, or wide-awake anesthesia was used based on patient preference and medical needs. Standard radiocarpal and midcarpal arthroscopy was performed using standard portals. A radiofrequency ablator was used for denervation. Resection of the styloid, arthritic portion of the scaphoid fossa of the radius, and the proximal 2/3rd of the scaphoid were performed using a 4 mm barrel bur. Data were prospectively collected before surgery, and at postoperative intervals of 1, 3, 6, and 12 months, and annually thereafter. Numeric Rating Scale (NRS) for pain (0=no pain, 10=worst pain) and satisfaction with outcomes (0=extremely dissatisfied, 5=extremely satisfied) were obtained. Functional outcomes of grip (position 2 on 5-stage dynamometer), wrist range of motion, and disabilities of the arm, shoulder and hand (DASH; 0=no disability, 100=severe disability) were evaluated. Total arc of motion was calculated by adding flexion, extension, and radial and ulnar deviation.

Results and Conclusions: Mean follow-up was 47 months (range 12-120). Mean age was 62 years (range 40-78) with an equal distribution of nonmanual and manual laborers. Mean pain score was 7 (range 3-10) before surgery and 0.3 (range 0-3) at final follow-up. Mean grip strength was 18 kg (range 5-36) before surgery and 23 kg (range 7-41) at final follow-up. Mean total arc of motion was 113 ° (range 63-170) before surgery and 127 ° (range 61-186) at final follow-up. Mean DASH was 42 (range 16-91) before surgery and 3 (range 0-38) at final follow up. Mean final satisfaction was 4.8 (range 4-5). There were 2 (7%) failures requiring revision surgery for persistent pain.

Mid-term outcomes with 4-year average follow-up demonstrate ARARC for arthroscopic stage II-IIIB SLAC wrists may give good pain relief and increase function. Mean pain, functional outcomes, and satisfaction have not deteriorated with additional follow-up and have improved since our original publication. Longer follow-up and prospective studies comparing ARARC to traditional surgical options should be considered.