The Journal of Bone and Joint Surgery (American). 2009;91:2180-2187.
doi:10.2106/JBJS.H.01445
© 2009 The Journal of Bone and Joint Surgery, Inc.
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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 and 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{at}ort.med.osaka-u.ac.jp

Investigation performed at the Department of Orthopaedic Surgery, Osaka University, Osaka, Japan

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.

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.


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