Abstract
Purpose: The synovectomy-reaxation-stabilisation (SRS) procedure classically involves tenosynovectomy of the extensors, articulr synovectomy, partial deinnervation of the wrist, and tendon transfer. The purpose of this study was to: 1) evaluate functional and radiographic results, 2) search for possible correlations between results and the extent of articular synovectomy or type of tendon transfer.
Material and methods: Between 1984 and 1998, an SRS procedure was performed in 75 patients, 14 were excluded: seven had died, five were lost to folow-u and two had had wrist arthrodesis. A total of 73 wrists were analysed in 61 patients. Mean follow-up was 70 months and mean patient age was 53 years. Functional assessment was based on the Gschwend pain scale.
Results: Before surgery, 94% of the patients had grade III or IV pain. At last follow-up, 93% of them grade 0 or I. The gain in pain was greatest for patients with severe carpitis. At last follow-up, the wrist was stiff; stiffness basically involved flexion with 43° pre and 27° postoperatively, radial inclination 13° pre and 9° postoperatively, and pronation in patients with advanced Larsen grade preoperatively. Extension, ulnar inclination, and supination were improved 5° to 10°. Extension of the synovectomy to carpal joints had a stiffening effect. Before the operation, 25 wrists were in Larsen grades 0, 1 and 2 and 48 wrists were in Larsen grades 3 or 4. At last follow-up, there were nine wrists in Larsen grades 0, 1, or 2 and 64 in Larsen grades 3 or 4. Carpitis thus continued to evolve and the height of the carpus declined. Ulnar translation of the carpus progressed a mean 2 mm. Spontaneous radial inclination of the wrist was aggravated by a mean 3°. The frontal position of the wrist was better after transfer of the long radial extensor of the carpus on the short radial extensor of the carpus than for transfer on the ulnar extensor of the carpus or without transfer.
Discussion: Our pain results are in agreement with data in the literature but we did not observe preserved or improved mobility. Extended synovectomy appeared to have a stiffening effect. Progression of the ulnar translation of the carpus was less pronounced with simple resection of the head of the ulna. It was better to transfer the long radial extensor of the carpus on the short radial extensor of the carpus to correct for frontal deviation of the carpus.
The abstracts were prepared by Pr. Jean-Pierre Courpied (General Secretary). Correspondence should be addressed to him at SOFCOT, 56 rue Boissonade, 75014 Paris, France
