Three-Dimensional Kinematics of the Rheumatoid 'Wrist After Partial Arthrodesis

Arimitsu, Sayuri; Murase, Tsuyoshi; Hashimoto, Jun; Yoshikawa, Hideki; Sugamoto, Kazuomi; Moritomo, Hisao
September 2009
Journal of Bone & Joint Surgery, American Volume;Sep2009, Vol. 91-A Issue 9, p2180
Academic Journal
Background: Partial arthrodesis of the wrist, such as radiolunate and radioscapholunate arthrodesis, is intuitively more appealing for the treatment of the rheumatoid wrist than total arthrodesis is because it preserves some motion. However, wrist kinematics after partial arthrodesis are incompletely understood. The purpose of the present study was to evaluate the kinematics of the radiocarpal and midcarpal joints of rheumatoid wrists with use of three-dimensional computed tomography before and after partial arthrodesis. Methods: We selected ten wrists that were affected by rheumatoid arthritis in which the radiolunate joint was severely damaged but the midcarpal joint congruities were relatively well preserved. Six radiolunate and four radioscapholunate arthrodeses were then performed, with preservation of the joint congruity between the scaphoid, lunate, and capitate. We acquired in vivo three-dimensional kinematic data during wrist flexion-extension preoperatively and postoperatively with use of computed tomography and a markerless bone-registration technique. Postoperative midcarpal joint congruity and range of motion were compared with preoperative values. Results: The mean range of global wrist motion was 48° ± 21° after radiolunate arthrodesis and 47° ± 14° after radioscapholunate arthrodesis. Midcarpal joint congruities and motion between the scaphoid, lunate, and capitate were well preserved in all ten wrists. The postoperative range of capitate motion relative to the lunate was 109% of the preoperative value after radiolunate arthrodesis and 88% after radioscapholunate arthrodesis. The directions of capitate motion relative to the lunate after both types of partial arthrodesis were significantly more oblique than before the arthrodeses, changing from radiodorsal to ulnopalmar along the so-called dart-throwing motion plane (p < 0.05). Conclusions: The results of this kinematic analysis, which showed that midcarpal motion occurred in the dart-throwing motion plane, may support the use of radiolunate and radioscapholunate arthrodeses as an alternative to total wrist arthrodesis in patients with symptomatic rheumatoid arthritis of the wrist. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


Related Articles

  • Partial tarsal arthrodesis for rheumatoid feet. Tanaka, Yasuhito; Takakura, Yoshinori; Taniguchi, Akira; Sugimoto, Kazuya; Kumai, Tsukasa; Fukui, Akihiro // Modern Rheumatology (Springer Science & Business Media B.V.);Jun2004, Vol. 14 Issue 2, p130 

    Partial intertarsal joint arthrodesis was performed on 12 feet of 11 patients as a surgical treatment for planovalgus deformity of the foot and lesions of the intertarsal joints caused by rheumatoid arthritis. Single arthrodesis was performed on the talocalcaneal joint in eight feet, two of...

  • Corrective Osteotomy for Intra-Articular Malunion of the Distal Part of the Radius. Prommersberger, Karl-Josef; Ring, David; González del Pino, Juan; Capomassi, Miguel; Slullitel, Miguel; Jupiter, Jesse B. // Journal of Bone & Joint Surgery, American Volume;Sep2006 Supplement 1, Vol. 88-A, p202 

    BACKGROUND: Corrective osteotomy is an appealing treatment for malunited articular fractures of the distal part of the radius since articular incongruity may be the factor most strongly associated with arthrosis and diminished function after such fractures. Enthusiasm for osteotomy has been...

  • Computer Tomography assessment of the fusion rate after posterior arthroscopic subtalar arthrodesis. Thaunat, Mathieu; Bajard, Xavier; Boisrenoult, Philippe; Beaufils, Philippe; Oger, Philippe // International Orthopaedics;May2012, Vol. 36 Issue 5, p1005 

    Purpose: The purpose of this study was to assess the fusion rate on CT examinations and to correlate clinically the functional result with the degree of bone fusion in the subtalar joint after posterior arthroscopic subtalar arthrodesis (PASTA). Methods: Fourteen cases, from 36 to 84 years old,...

  • Surface replacement of the humeral head in rheumatoid arthritis. Fink, Bernd; Singer, Joachim; Lamla, Ulrich; Rüther, Wolfgang // Archives of Orthopaedic & Trauma Surgery;Jul2004, Vol. 124 Issue 6, p366 

    Introduction: The concept of a newly developed cup arthroplasty (Durom Cup) involves the replacement of the destroyed joint surface of the humeral head with minimal bone resection. In cases of additional massive cuff tear, the cup can be placed in a more valgic position to articulate with the...

  • An Assessment of Histopathological Criteria for Infection in Joint Arthroplasty in Rheumatoid Synovium. Kataoka, M.; Torisu, T.; Tsumura, H.; Yoshida, S.; Takashita, M. // Clinical Rheumatology;May2002, Vol. 21 Issue 2, p159 

    : Intraoperative frozen section is reported to be a reliable means of identifying occult infection for preoperative evaluation of arthroplasty. The aim of this study was to determine whether the reported histopathological criteria – the existence of more than 10 polymorphonuclear cells...

  • Adipokines as Potential Biomarkers in Rheumatoid Arthritis. Del Prete, Annalisa; Salvi, Valentina; Sozzani, Silvano // Mediators of Inflammation;2014, Vol. 2014, p1 

    Rheumatoid arthritis (RA) is a chronic systemic inflammatory autoimmune disease characterized by severe joint injury. Recently, research has been focusing on the possible identification of predictor markers of disease onset and/or progression, of joint damage, and of therapeutic response. Recent...

  • Ankle Arthrodesis with External Fixation. Trouillier, Hans; Pellengahr, Christoph; Maier, Markus; Refior, Hans Jürgen // European Journal of Trauma;Dec2003, Vol. 29 Issue 6, p385 

    Background: This retrospective study discusses the results of 16 years of follow-up for 32 ankle arthrodesis treatments that were performed between January 1977 and December 1994. Patients and Methods: All patients were treated by external fixation. Not only the radiologic results but also the...

  • Isolated talonavicular arthrodesis in patients with rheumatoid arthritis of the foot and tibialis posterior tendon dysfunction. Popelka, Stanislav; Hromádka, Rastislav; Vavøík, Pavel; Štursa, Pavel; Pokorný1, David; Jahoda, David; Sosna, Antonín // BMC Musculoskeletal Disorders;2010, Vol. 11, p38 

    Background: The foot is often affected in patients with rheumatoid arthritis. Subtalar joints are involved more frequently than ankle joints. Deformities of subtalar joints often lead to painful flatfoot and valgus deformity of the heel. Major contributors to the early development of foot...

  • Functional and patient-reported outcome of partial wrist denervation versus the Mannerfelt wrist arthrodesis in the rheumatoid wrist. Riches, Philip; Elherik, Firas; Breusch, Steffen // Archives of Orthopaedic & Trauma Surgery;Jul2014, Vol. 134 Issue 7, p1037 

    Introduction: Wrist arthrodesis offers high success rates in patients with rheumatoid arthritis; however, loss of residual mobility may cause unnecessary disability. This makes wrist denervation an appealing alternative. However, there is a distinct lack of patient-reported outcome measure...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics