| 2. |
- Clementson, Martin, et al.
(författare)
-
Clinical and Patient-Reported Outcomes After Total Wrist Arthroplasty and Total Wrist Fusion : A Prospective Cohort Study with 2-Year Follow-up
- 2024
-
Ingår i: Journal of Bone and Joint Surgery. - 1535-1386. ; 9:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The functional benefits of total wrist arthroplasty (TWA) over total wrist fusion (TWF) are unknown. The purpose of this prospective cohort study was to compare TWA and TWF with respect to functional outcomes and activitylimitations at up to 2 years postoperatively.Methods: Between 2015 and 2020, we enrolled all adult patients undergoing TWA or TWF for the management of symptomatic end-stage wrist arthritis at 1 hand surgery department. The primary outcome was the Patient-Rated Wrist Evaluation (PRWE). The secondary outcomes were the visual analog scale (VAS) for pain at rest, on motion, and on loading; grip strength; Disabilities of the Arm, Shoulder and Hand (DASH); and range of motion. Patients completed questionnairesand were examined by the same physiotherapist at baseline and at 3, 6, 12, and 24 months postoperatively. Mixed-model analyses adjusting for age, diagnosis, the preoperative value of the dependent variable, and time since surgery wereperformed to compare differences in PRWE scores, VAS pain scores, and grip strength between TWA and TWF.Results: Of the 51 patients who had been included at baseline, 47 (18 in the TWA group and 29 in the TWF group) responded to questionnaires and underwent examinations at up to 2 years postoperatively. At baseline, the 2 groups did not differ in terms of age, sex, diagnosis (inflammatory or noninflammatory arthritis), PRWE score, VAS pain score, grip strength, DASH score, or range of motion. No differences between the groups were found for the PRWE (b, 20.1; 95% confidence interval [CI], 214 to 13; p = 0.99), VAS pain at rest (b, 23.3; 95% CI, 215 to 9; p = 0.58), VAS pain on loading (b, 25.3; 95% CI, 222 to 11; p = 0.52), or grip strength (b, 20.02; 95% CI, 20.18 to 0.14; p = 0.80) on the adjusted mixed-model analyses.Conclusions: Among patients with symptomatic end-stage wrist arthritis, those who underwent TWA did not demonstrate short-term outcomes, including patient-reported disability, pain, and grip strength, superior to those of patients who underwent TWF. These findings call into question the widespread use of TWA.Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
|
|
