A Systematic Review of Radiolunate and Radioscapholunate Arthrodesis

Omolola P Fakunle; Emily L DeMaio; Corey C Spencer; Anjali D Kumar; Michael B Gottschalk; Eric R Wagner

doi:10.1016/j.jhsg.2020.12.003

A Systematic Review of Radiolunate and Radioscapholunate Arthrodesis

J Hand Surg Glob Online. 2021 Feb 1;3(2):81-87. doi: 10.1016/j.jhsg.2020.12.003. eCollection 2021 Mar.

Authors

Omolola P Fakunle¹, Emily L DeMaio¹, Corey C Spencer², Anjali D Kumar², Michael B Gottschalk^{2

3}, Eric R Wagner^{2

3}

Affiliations

¹ School of Medicine, Emory University, Atlanta, GA.
² Department of Orthopaedic Surgery, Emory University, Atlanta, GA.
³ Department of Hand and Upper Extremity, Emory University, Atlanta, GA.

Abstract

Purpose: The aims of this systematic review were to examine the use of radiolunate (RL) or radioscapholunate (RSL) arthrodesis as surgical management for patients with advanced radiocarpal arthritis that failed conservative management and to assess postoperative outcomes.

Methods: We reviewed articles from PubMed, EMBASE, and Web of Science from inception through December 2019. We identified complete manuscripts written in English reporting on RL or RSL arthrodesis for treatment of wrist pathology that included the primary outcomes (pain or grip strength) and at least 2 secondary outcomes (range of motion, patient-reported outcomes, or nonunion). Data pooling was used to calculate weighted averages.

Results: We identified 2,252 articles and selected 13 for inclusion. Across all studies, RSL arthrodesis was performed for 180 patients (49% female; 45 years old) and RL for 94 (87% female; 50 years old). Both procedures exhibited improvements in pain score and grip strength. Both cohorts demonstrated postoperative changes in flexion-extension arc, flexion, extension, ulnar deviation, supination, and pronation after data pooling. The nonunion rate for RSL was 15% versus 2% for RL, whereas the rate of progression to total wrist arthrodesis for RSL and RL was 4% and 0%, respectively.

Conclusions: Both RL and RSL arthrodesis can be successfully used to manage debilitating radiocarpal arthritis by affording patients with pain reduction. Each has its own benefits, in which RSL arthrodesis provides a total arc of motion within the functional demands of most activities of daily living, and RL arthrodesis has low rates of nonunion and progression to total wrist arthrodesis. Further research is needed to compare the 2 surgeries directly and prospectively in comparable patient groups.

Type of study/level of evidence: Therapeutic III.

Keywords: Radiolunate arthrodesis; Radiolunate fusion; Radioscapholunate arthrodesis; Radioscapholunate fusion; Wrist arthritis.