Modern approaches in rheumatoid hand surgery: Results of soft tissue stabilizing operations for transposition of the tendons of the long radial and ulnar extensors of the wrist

Background. The prevalence of rheumatoid arthritis (RA) and associated disability as a result of a joint damage is a pressing issue in both rheumatology and rheumoorthoedics. The most common surgical techniques for correcting wrist deformities are traumatic and do not allow fully restoring the life quality of patients. In recent years, new joint-saving techniques have been actively developed to preserve hand function and prevent the development of severe deformities.
The aim of the study – to compare the results of soft tissue stabilizing operations and arthrodesis of the wrist joint in patients with rheumatoid arthritis.
Materials and methods. The study included 69 patients operated on at the V.A. Nasonova Research Institute of Rheumatology in the period from 2018 to 2023. 24 patients underwent transposition of the long radial wrist extensor and ulnar wrist extensor (ECU+ECRL, extensor carpi ulnaris + extensor carpi radialis longus) with subsequent tenodesis. The control group consisted of 45 patients who underwent arthrodesis of the wrist joint. The DASH (The Disabilities of the Arm, Shoulder and Hand) questionnaire was used to assess functional status before and after surgery. To assess quality of life we used EQ-5D (EuroQol 5 Dimensions) index, pain – visual analogue scale (VAS), disease activity was assessed using the DAS28 (Disease Activity Score 28) index. The average follow-up period for patients after surgery was 6 months.
Results. The functional status of patients after surgery, assessed by the DASH scale, was significantly better in the group of patients who underwent transposition of the tendons of the long radial wrist extensor and ulnar wrist extensor (39.41±10.17 compared to the control group of wrist arthrodesis – 46.4±15.8; p<0.05). In both groups, there was a positive dynamics of pain according to VAS, as well as an improvement in the quality of life. In the group of patients with transposition of ECU+ECRL, performed at early Rg. stages (Larsen II, III) the functional status of the hand according to DASH after surgery was significantly better compared to patients who underwent tendon transposition at stages IV–V.
Conclusions: ECU+ECRL tendon transpositions are an efficient method for stabilizing the wrist joints and correcting hand deformities, but they have a number of limitations, the most important of which is the degree of damage to the wrist joints and the severity of the deformities. The effectiveness of soft tissue techniques is significantly reduced when performing surgical interventions on stages IV and V according to Larsen.

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