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Palmar shelf arthroplasty for rheumatoid wrist arthritis: long-term follow-up.

Rheumatoid wrist arthritis is common and affects about 1.5 million people in the United States. For advanced disease, arthrodesis and implant arthroplasty have been recommended as treatment options. In 1970, palmar shelf arthroplasty was introduced, and initial results were encouraging but not reproducible. In 1990, Dr. Skoff modified the original procedure with good results in patients followed for 2 to 7 years. This study reports the results of 13 patients (9 women, 4 men; average age, 43 years) who were followed up for an average of 13.2 years (range, 10 to 20 years) after undergoing modified palmar shelf arthroplasty. The patients were interviewed and examined, and wrist radiographs were taken. The patients completed a questionnaire that used a 10-point pain analog scale and the Quick Disabilities of the Arm, Shoulder and Hand (DASH) and Modernized Activity Subjective Survey (MASS) Scoring Systems. Scoring results demonstrated improvement in pain at rest and with activity. MASS and Quick DASH scores improved by 76% (P < .001). Wrist range of motion averaged 35° extension and 32° flexion. One patient required wrist fusion; none of the remaining 12 patients required surgical revision. Patient satisfaction was very high, and radiographic results demonstrated maintenance of the radiocarpal pseudarthrosis without ankylosis. The long-term results of modified palmar shelf arthroplasty demonstrated enduring analgesia and mobility without the complications of an implant. Modified palmar shelf arthroplasty is a reasonable surgical alternative for advanced rheumatoid arthritis of the wrist.