David Chan MD PT Suncoast Orthopaedic Surgery amp Sports Medicine Venice FL FINANCIAL DISCLOSURES DISCUSSION GOALS REVIEW COMMON ARTHRITIS PATTERNS REVIEW HISTORICAL SURGICAL INTERVENTIONS ID: 814741
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Slide1
Wrist Arthritis Update: Treatment Options
David Chan, MD, PTSuncoast Orthopaedic Surgery & Sports MedicineVenice, FL
Slide2FINANCIAL DISCLOSURES
Slide3DISCUSSION GOALS
REVIEW COMMON ARTHRITIS PATTERNSREVIEW HISTORICAL SURGICAL INTERVENTIONSREVIEW NEWER SURGICAL INTERVENTIONS
Slide4EDUCATION / EXERCISE LIMITED
SPLINTING MIXED
Slide5THUMB CMC
Slide6STT / TRISCAPHE
Slide7STT ARTHRODESIS
Slide8STT ARTHRODESIS
COMPLICATION RATE
NONUNION 4-29%
PERSISTENT PAIN 35%
DRSN NEURITIS
SECONDARY SURGERIES
Slide9SCAPHOID DISTAL POLE EXCISION
COMPLICATIONS
DISI CARPAL INSTABILITY
ANT STT LIG
DIC LIGAMENT
Slide10STT NEWER OPTIONS
EXCISIONAL INTERPOSITION ARTHROPLASTY FCR TENDON
PYROCARBON IMPLANT
Slide11STT EXCISIONAL ARTHROPLASTY
FCR
PALMAR RSC
LIGAMENT ADVANCEMENT
Slide12PYROCARBON IMPLANT INTERPOSITION
3-4 YEAR OUTCOMES GOOD
2 YEAR RESULTS COMPARABLE
SIMPLE ARTHROSCOPIC DISTAL
POLE EXCISION
ARTHROSCOPY
Slide13S-
capho L-unate A-dvanced C-ollapse
(SLAC)
I
Radioscaphoid
/ Distal pole
II Scaphoid Fossa / Proximal Pole
III Midcarpal /
Capitolunate
Slide14S-
capho L-unate A-dvanced C-ollapse
(SLAC)
Slide15S-
caphoid N-onunion A-dvanced C-ollapse
(SNAC)
Slide16SLAC I
RADIAL STYLOIDECTOMY
Slide17SLAC II –
Proximal Row Carpectomy (PRC)
Slide18SLAC II & III
Scaphoid Excision & 4 Corner Fusion
Slide19PRC vs 4-Corner
PRC earlier motion no fusion or hardware4 Corner
better grip strength
less risk lunate fossa wear
Slide20PRC
slightly better motion less complications
No differences
grip strength
xray
degenerative changes
pt
satisfaction
Slide21PRC: Minimum 20-Year Follow-Up. Stern et al. JHS, 2013
65% survival rateFlexion extension arc 68 degreesContralateral grip 72%
Mild to moderate pain
Slide22NEWER OPTIONS
STAPLES
INTRAOSSEOUS SCREWS
CIRCULAR PLATES
3 CORNER FUSIONS
Slide23OSTEOCHONDRAL RESURFACING PRC
Slide24T G T N M W
Slide25Slide26TOTAL WRIST ARTHRODESIS
LOW COMPLICATION RATE
ADL’S DIFFICULT
Slide27WRIST FUSION NAIL
Slide28TOTAL WRIST ARTHROPLASTY
MOTION SPARING
RA
POSTTRAUMATIC ARTHRITIS
Slide29TOTAL WRIST ARTHROPLASTY
COMPLICATIONSCARPAL COMPONENT LOOSENING
DISLOCATION
Slide30TOTAL WRIST ARTHROPLASTY
4TH
GENERATION – DESIGN CHANGES
5-7 YR MIDTERM RESULTS GOOD
ACUTE COMMINUTED DR FRACTURES
Slide31REVISION
LOSS OF BONE STOCKREVISION ARTHROPLASTY
REVISION ARTHRODESIS
Slide32DRUJ
Slide33DARRACH
Slide34SAUVE-KAPANDJI
Slide35NEWER OPTIONS
ULNAR HEAD ARTHROPLASTY INTERMEDIATE RESULTS MIXED
LOW DEMAND BETTER
Slide36NEWER OPTIONS
DRUJ ARTHROPLASTY UP TO 35% COMPLICATION RATE < 5 YRS RA < 40 YO
95% SURVIVAL RATE 5 YRS
Slide37WRIST DENERVATION
PALLIATIVE
LOW RISK
Slide38WRIST DENERVATION
71% NONOP AT 6.5 YRS29% SALVAGE PROCEDURE ~ 2 YRS
Slide39PLATELET RICH PLASMA
7 RCTs 5/7 PRP significantly better than HAKNEE & HIP OA
high variability in study designs
Slide40MESENCHYMAL STEM CELLS
EARLY CLINICAL TRIALS / BASIC SCIENCE JOURNALSHIGH VARIABILITYSMALL SAMPLE SIZES AND SHORT TERM F/U
EARLY DATA SAFE, EFFICACIOUS,
BUT NO QUALITY RCT
Slide41THANK YOU
Slide42Slide43KIENBOCK’S DISEASE
Slide44PREISER’S DISEASE