Radiolunate arthrodesis in the rheumatoid wrist-FESSH 2006

Since first described in 1983, radiolunate arthrodesis has become an asset to rheumatoid wrist surgery. Chamay found spontaneous radiolunate fusion in 13% of wrists and successfully imitated this naturally occurring condition by radiolunate arthrodesis. His concept of stabilizing the rheumatoid wrist has not only increased the treatment options but has also limited the indication for total wrist fusion and for wrist arthroplasty. It has meanwhile been shown that radiolunate arthrodesis can stop ulnar translation and dorsopalmar instability in the rheumatoid wrist even in the long run while maintaining a limited but functional wrist mobility. The loss of wrist motion is on average 38% for extension/flexion and 45% for radial and ulnar deviation. In combination with wrist synovectomy, an important pain reduction is achieved. However, radiolunate arthrodesis cannot stop the progress of the wrist disease nor can it maintain carpal height, as has been shown for synovectomy alone. 10% of patients need a second operation, usually complete wrist fusion, but have no or few symptoms for a postoperative interval of 5 years on average.