title: The arthritic wrist. I--the degenerative wrist: surgical treatment approaches.
abstract: The primary goal in treating a degenerative wrist is to provide pain relief, while maintaining strength and mobility if possible. After failure of the recommended conservative treatment, the choice of approaches can be made from a large collection of techniques, some which are well validated. Partial wrist fusion, particularly the Watson procedure, results in a pain-free wrist in 80% of cases, with 50% of the mobility preserved, good grasping strength and stable results for at least 10 years. Proximal row carpectomy provides similar results if the cartilage on the head of the capitate is preserved and the patient is not involved in heavy manual labour. Complete denervation provides pain relief in almost 80% of cases while preserving motion and strength. This is a safe and effective option, with no age limit, that still allows other procedures to be performed in the future. Total wrist fusion also has its place in revision, and even as first-line treatment, because of the reliable outcome in terms of pain and strength, high satisfaction rates, little to no repercussions linked to the loss of mobility and fewer complications. Other techniques are now available. The partial or complete resection of a carpal bone and placement of an implant is back in vogue because of the availability of pyrocarbon. Such implants are an option in the future for localized osteoarthritis or even diffuse affections, and a useful alternative to more invasive procedures. The use of a rib cartilage graft to partially or completely replace a carpal bone or resurface the radius has promising results in terms of pain reduction and fusion. The role of total joint replacement must be defined relative to the classic, reliable techniques that have long-term outcome data.
  
  
  METHODS
  IV.
authors.affiliation: Service de Chirurgie Orthopédique, CHU de Brest, Hôpital de la Cavale-Blanche, 29200 Brest, France. Dominique.lenen@chu-brest.fr
authors.forename: D
authors.initials: D
authors.lastname: Le Nen
authors.forename: J
authors.initials: J
authors.lastname: Richou
authors.forename: E
authors.initials: E
authors.lastname: Simon
authors.forename: M
authors.initials: M
authors.lastname: Le Bourg
authors.forename: Najihi
authors.initials: N
authors.lastname: Nabil
authors.forename: C
authors.initials: C
authors.lastname: de Bodman
authors.forename: G
authors.initials: G
authors.lastname: Bacle
authors.forename: Y
authors.initials: Y
authors.lastname: Saint-Cast
authors.forename: L
authors.initials: L
authors.lastname: Obert
authors.forename: A
authors.initials: A
authors.lastname: Saraux
authors.forename: P
authors.initials: P
authors.lastname: Bellemère
authors.forename: T
authors.initials: T
authors.lastname: Dréano
authors.forename: J
authors.initials: J
authors.lastname: Laulan
mesh_terms: D001174:Arthrodesis; D019643:Arthroplasty, Replacement; D002348:Carpal Bones / Q000601:surgery; D002356:Cartilage / Q000637:transplantation; D003714:Denervation; D006801:Humans; D008875:Middle Aged; D010003:Osteoarthritis / Q000473:pathology / Q000601:surgery*; D010146:Pain / Q000209:etiology; D059408:Pain Management; D014955:Wrist Joint / Q000294:innervation / Q000473:pathology / Q000601:surgery*