0
Scientific Articles   |    
Three-Dimensional Kinematics of the Rheumatoid Wrist After Partial Arthrodesis
Sayuri Arimitsu, MD1; Tsuyoshi Murase, MD, PhD1; Jun Hashimoto, MD, PhD1; Hideki Yoshikawa, MD, PhD1; Kazuomi Sugamoto, MD, PhD1; Hisao Moritomo, MD, PhD1
1 Department of Orthopaedic Surgery, Osaka University, 2-2 Yamadaoka, Suita-shi, Osaka 565-0871, Japan. E-mail address for H. Moritomo: moritomo@ort.med.osaka-u.ac.jp
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from the Nakatani Foundation of Electronic Measuring Technology Advancement. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Department of Orthopaedic Surgery, Osaka University, Osaka, Japan

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Sep 01;91(9):2180-2187. doi: 10.2106/JBJS.H.01445
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

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.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    [Acromelic arthritis: a new entity]. Rev Chir Orthop Reparatrice Appar Mot 2007;93(6):571-81.
    [Wrist joint arthroplasty: results after 41 prostheses]. Handchir Mikrochir Plast Chir 2009;41(3):141-7.
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    04/16/2014
    Georgia - Choice Care Occupational Medicine & Orthopaedics
    03/26/2014
    Massachusetts - Boston University Orthopedic Surgical Associates
    04/16/2014
    OH - OhioHealth Research and Innovation Institute (OHRI)