Swanson implant arthroplasty of the wrist in rheumatoid arthritis.

Severe involvement of the wrist in rheumatoid arthritis poses great functional restrictions in eating, maintaining personal hygiene, and in performing general daily activities. Twenty-six Swanson radiocarpal implant arthroplasties were performed in 23 patients. Patients' average age was 57 years, with a preoperative diagnosis in all patients of rheumatoid arthritis. Follow-up averaged 33 months (range, 5-47 months). The principal indication for surgery was pain in 23 wrists and wrist deformity in three wrists. Particular attention was paid to postoperative functional status and to any changes in performance of routine activities of daily living pertinent to the wrist. Employing a pain rating scale of 1-4, preoperative scores averaged 3.71 on the operated side and postoperative scores, 1.75. Postoperative activities of daily living that benefited from the improved extension capability of the wrist showed significant improvement. No significant improvement resulted in those activities necessitating strength or fine motor control. Prosthesis fracture in one patient, and recurrence of ulnar deviation in two patients, were the major complications. Capsular reconstruction and tendon transfer to balance the wrist were integral components of the procedure.