The surgical treatment of the rheumatoid wrist. Current perspectives.

The authors stress the prevalence and severity of wrist involvement in rheumatoid disease. Improved knowledge of aetiopathogenesis and deformities had led to identification of the importance of the distal consequences on the digital joints of decentralization of the wrist. Synovectomy retains an important place at the onset of the disease. This may be completed by stabilization procedures (tendon transfer and partial arthrodesis). At the advanced stage of the disease, arthroplasty is currently overtaking arthrodesis. Interposition arthroplasty, with its rare indications, is now well developed. Although the solution of the future, arthroplasties lack sufficient follow up in terms of their results. The Swanson implant offers limited mobility but ensures freedom from pain and a good wrist axis. The ideal treatment of the rheumatoid wrist is oriented towards early conservative surgery and later, at an advanced stage, towards arthroplasty, the ideal technique of which remains to be discovered.