Palmar shelf arthroplasty in the rheumatoid wrist. Results of long-term follow-up.

Sixty-three palmar-shelf arthroplasties (so-called pseudofusions of the wrist) that had been performed between 1970 and 1978 in forty-nine patients were evaluated. The length of follow-up averaged eighty-three months (minimum, twelve months for the wrists that fused and twenty-four months for those that did not). Preoperatively, all wrists were painful, with 96 per cent being moderately or severely so. Carpal subluxation was present in 79 per cent of the wrists. Postoperatively, pain recurred in 84 per cent of the wrists, but it was less severe (mild in 48 per cent, moderate in 35 per cent, and severe in 2 per cent). Sixty-eight per cent of the wrists fused spontaneously and were no longer painful. Of the twenty wrists (32 per cent) that did not fuse, 70 per cent were mildly or moderately painful. In patients who have rheumatoid arthritis, we found that palmar shelf arthroplasty was followed by a high rate of delayed spontaneous fusion and an unacceptably high rate of recurrent pain, although the pain was less severe.