kindness part 2

I hoped I would not have to update this so soon.

I recently shared how upset I was at my limits, not just of my body, but of what my reality is in terms of treatment.

I was responded to with being told what to do, with the overt suggestion that I hadn’t already exhausted my limits of understanding my own disease. This happens every single time I post about this.

I am facing wrist fusion ( WF, arthrodesis) rather than Total Wrist Arthroplasty (TWA). The only glimmer of hope has come out this year:

Loosening Still Plagues Wrist Implants
Type of implant used was a contributing factor
by Nancy Walsh, March 04, 2016
But this is an overview, not novel research, it needs to be reviewed and that could take a long time before my District Health Board (WDHB) can actually do this. For future patients? Good news. For current? It’s too far out to even hope for. Or rather it’s why i am really struggling with a lack of access to physio to hopefully preserve my hands long enough to benefit.

Otherwise the current state right now is my surgeons are keen to cut my tendons and bones and fuse not replace.

Waitemata DHB Orthopaedic Services
PUBLIC SERVICE Joint Replacement Surgery (Arthroplasty) – Including Patient Information Videos
The very first words indicate the primary focus for arthroplasty.

Intern Med J. 2012 Jun;42(6):620-6. doi: 10.1111/j.1445-5994.2012.02815.x.
Increasing productivity, reducing cost and improving quality in elective surgery in New Zealand: the Waitemata District Health Board joint arthroplasty pilot.
Cullen J1, Bramley D, Armstrong D, Butler L, Rouse P, Ashton T.
It’s not like my health board isn’t trying, it’s just basically the Red Queen hypothesis in action (running faster and faster to keep up.)

Auckland, New Zealand Clinical Trials
I keep up to date with clinical trials in my location.

Wrist Joint Replacement (Wrist Arthroplasty)
There is a reason you see patient hands over a certain age:
The typical candidate for wrist replacement surgery has severe arthritis but does not need to use the wrist to meet heavy demands in daily use.

J Wrist Surg. 2016 Aug;5(3):211-6. doi: 10.1055/s-0036-1571841. Epub 2016 Feb 9.
Trends in the Utilization of Total Wrist Arthroplasty versus Wrist Fusion for Treatment of Advanced Wrist Arthritis.
Melamed E1, Marascalchi B2, Hinds RM1, Rizzo M3, Capo JT1.
Sounds great until “WF was performed nearly four times more frequently than TWA. A trend was demonstrated toward a decreasing number of TWA being implanted, and in patients with more underlying comorbidities. TWA was associated with a higher hospitalization charge, which may be expected given the higher implant costs associated with arthroplasty.

Clinical Management of the Rheumatoid Hand, Wrist, and Elbow
A very good easy to read up to date understanding of the disease, especially of the prognosis. I have had this disease for 15 1/2 years. But I will have it for another 15 years, if not more. I have high Rf and systemic involvement.

A Comparison of Complications of Total Wrist Fusion and Silastic Arthroplasty
S. Hassan1⇑, C. Carpenter1, P. Estridge1, A. Malhas1, C. Wigderowitz1
Geriatric Orthopaedic Surgery & Rehabilitation December 2014 vol. 5 no. 4 213
For elderly patients having rheumatoid with low demand, this treatment has a lower reoperative rate at 5 years and therefore may often be the final treatment they require.

ASSH Manual of Hand Surgery
edited by Warren C. Hammert, David J. Bozentka, Martin I. Boyer

Journal of Orthopaedic Surgery 2014;22(3):399-405
Review Article: Total wrist arthroplasty (PDF!)
Rajesh Nair
“TWA tends to fail earlier than hip or knee
arthroplasties, but TWA has better short-term
outcome.25 The ideal candidates for TWA are frail,
low-demand patients with RA or osteoarthritis
seeking pain relief and moderate wrist motion.”
“Both patients and physicians prefer surgical over

non-surgical management for wrists with RA. ”
I don’t, I’d rather wear splints, but they are not really an options due to a lack of types available to me. But I will see about other physio centers as I have seen a few better.

Total Wrist Arthroplasty in Patients Younger than 60 Years of Age: An Analysis of 261 Consecutive Primary Arthroplasties
Level 4 Evidence
Eric R. Wagner, MD, Casey M. DeDeugd, MD, Marco Rizzo, MD
Paper 72
Even for an implant that was considered low risk, “The 5, 10, and 20-year implant survival rates for the patients <60 years were 80%, 70%, and 60%, respectively, which was significantly lower the older patients ”

Clinical and Biomechanical Analysis of Total Wrist Arthroplasty Devices
Studies to explain how implants are designed to mimic most common range of motion vs maximum range of motion.

Operative Techniques: Hand and Wrist Surgery
By Kevin C. Chung

That’s only a quick search today. I have been hunting out information for more than 15 years.