Introduction: The optimum surgical treatment for severe rheumatoid arthritis of the wrist is controversial. Recent advances in total wrist replacement make it a reasonable alternative to arthrodesis, however very little is known about the functional differences between these treatments. In this study, we compared the patient generated, subjective results of total wrist arthroplasty to wrist arthrodesis for the treatment of severe rheumatoid arthritis of the wrist.

Materials and Methods: Retrospective data were collected on 46 patients with 51 wrists (24 arthrodesis and 27 arthroplasty). Patients were matched using criteria for disease severity (age, duration of disease, radiographic stage, use of immunosuppressive medications and number of other joints involved). Patients completed the DASH (disabilities of the arm, shoulder and hand questionnaire), the PRWE (patient rated wrist evaluation) and a study-specific questionnaire. The incidence and type of complications were recorded. A minimum one-year and maximum of five-year follow-up was required.

Results: No statistical differences were found between the two groups with respect to preoperative disease severity, however there was a trend towards slightly worse disease severity and longer follow-up in the arthrodesis group. There were no statistical differences between the two groups for the DASH and PRWE subscores. Overall satisfaction with the operation and willingness to undergo the surgery again was statistically equivalent in the two groups. However, there was a trend towards less impairment and higher satisfaction due to preserved wrist motion in the arthroplasty group. Two specific questions on the PRWE showed significantly higher function in the arthroplasty group: personal hygiene and buttoning a shirt. There was no difference in major or minor complications between the groups.

Discussion: The results demonstrated a trend towards better function with arthroplasty, however these surveys did not demonstrate a substantial overall difference between the treatments. Statistical analysis indicates that 200-300 patients would be required to reach 80% power. Thus, either the functional differences between these treatments are minimal in the rheumatoid populations or the surveys are not properly designed to test satisfaction and function from wrist impairment. More valid differences would be found by comparing the two treatments in the same patient or by comparing changes in survey scores from pre to postoperative for each treatment. Both treatments appear to provide good function and satisfaction; however further investigations are required to better define the functional differences.