Vihelä, Satu K. (2025) HEALTH-RELATED QUALITY OF LIFE IN PATIENTS UNDERGOING SALVAGE SURGERY FOR WRIST ARTHRITIS. thesis, Medicine.
Full text available on request.Abstract
Background: Wrist arthritis affects quality of life through progressive functional impairment and persistent pain. In this prospective cohort study, we aimed to determine the health-related quality of life (HRQoL) in patients with wrist arthritis and compare it to other diseases. Additionally, we aimed to assess the effects of salvage procedures on patient-reported and objective outcomes and determine the cost per quality-adjusted life year (QALY). Methods: We included 86 patients undergoing treatment with a proximal row carpectomy (PRC), four-corner fusion (4CF), total wrist arthroplasty (TWA), total wrist fusion (TWF), PRC with resurfacing capitate pyrocarbon implant (RCPI), or a 3D-modelled scaphoid prosthesis (3DS). The primary outcome was preoperative HRQoL, measured with the EQ-5D-3L questionnaire. Secondary outcomes included pain (NRS), functional scores (PRWHE, QuickDASH), and cost-utility analysis (€/QALY). Results: We found a baseline HRQoL of 0.64. PRC provided reliable pain relief and functional improvement for €2,863/QALY. 4CF, while functionally beneficial, provided limited pain relief for €37,239/QALY. TWA was cost-effective (€3,039/QALY) but had variable outcomes. RCPI offered significant pain relief for €77,088/QALY. 3DS showed the lowest cost per QALY (€959/QALY), while TWF had an unfavourable cost-utility ratio (€-1,101/QALY). Conclusions: Preoperative HRQoL was similar to epilepsy with convulsions; postoperatively, at 0.76, it compares to carpal tunnel syndrome or breast cancer. PRC and 3DS are cost-effective for early disease, while TWA benefits selected patients with advanced arthritis. RCPI may serve younger, active patients despite high costs. 4CF should be used with caution, and TWF was not cost-effective. A patient-centred approach is key to optimizing outcomes and resource allocation, while HRQoL measures help inform healthcare policy.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Kemler, dr. Marius A. |
| Faculty: | Medical Sciences |
| Date Deposited: | 19 May 2026 12:40 |
| Last Modified: | 19 May 2026 12:40 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3954 |
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