Synovectomy of the wrist in rheumatoid arthritis and related diseases. A follow-up study of 97 consecutive cases.

Synovectomy of the wrist was done on 77 patients (97 wrists) during 1968-1981. The age of the patients at the time of operation ranged from 18 to 77 years, mean 44.9 yrs. Clinical and radiological follow-up examinations (90 wrists) or follow-up evaluation by questionnaire (7 wrists) were made by the authors in 1982. The mean length of the follow-up period was 8.5 years. Clinical symptoms of pain, swelling, restricted motion, instability and deformity of the wrist joint were evaluated and graded according to a special score. Radiological changes due to rheumatoid arthritis and osteoarthrosis were graded and analysed. Eight wrists were arthrodesed during the follow-up. Among the remaining wrists (89 cases) pain was absent or almost absent in 39%, was less than before the operation in 49% and was unchanged or worse in 12% of cases. The respective percentages for the presence of swelling were 47%, 36%, and 17%. The range of dorsiflexion was between 0 and 70 degrees, with an average of 27.9 degrees. The range of volar flexion was between 0 and 75 degrees, the mean being 28.2 degrees. The average ulnar and radial side motions were 12.9 degrees and 5.4 degrees, respectively. The radiological grading of RA remained about the same in 10 wrists and did not improve in a single wrist. In the other wrists the X-ray changes progressed. The results (patient's opinion) were subjectively good in 53%, fair in 32%, and poor in 15%.(ABSTRACT TRUNCATED AT 250 WORDS)