gms | German Medical Science

Clinical issue/s: For patients with painful and advanced wrist osteoarthritis (OA) total wrist fusion (TWF) is the standard surgical treatment, although total wrist arthroplasty (TWA) has become a plausible alternative.

Clinical reasoning: Previous studies have addressed the consequences of living with advanced wrist OA and how being treated with a TWF or TWA affects a person's daily activities. However, an in-depth understanding of what the patients experience and wish for, and how they evaluate their surgical options, has not previously been studied.

Our aim was to explore the impact of living with advanced wrist OA and how the participants experienced their involvement in the decision to undergo surgery with TWF or TWA. Furthermore, we explored the participants' appraisal of the results as well as adaptive strategies used.

Innovative, analytical or new approach: Advanced wrist OA affects patients' lives on many levels, and before surgery the participants experienced functional impairments and changes in life roles which was described as provoking feelings of loss and inadequacy. The main expectation of surgery was pain relief and improvements in range of motion was desired but seen as secondary. Our findings show an overall satisfaction with both TWF and TWA. A procedure that maintains mobility should be favoured, but not at any price; pain reduction should not be compromised to preserve motion. Resourceful coping strategies were developed by participants to adapt to their new wrist and enabled them to function in ordinary daily activities.

Contribution to advancing HT practice: Having reasonable expectations about the outcome of the surgery and shared decision making between the surgeon and the patient are imperative in order to prevent possible dissatisfactions with surgery. The compensatory mechanisms and coping strategies described can now be passed on to therapists who meet patients with wrist OA in order to reduce activity limitations, strengthen patient's abilities to achieve independence and serve as an educational base for patients about what to expect post-surgery.