The application of decision analysis to the surgical treatment of early osteoarthritis of the wrist

Osteoarthritis of the wrist is a complication of a number of common traumat ic conditions. Arthrodesis of the radiocarpal joint, proximal row carpectom y and excision of the scaphoid, combined with midcarpal arthrodesis, have a ll been reported as surgical options. There have been no randomised studies comparing these procedures, and the feasibility of conducting this type of trial is limited. We used decision analysis to compare the three surgical techniques, The var iables for the model used were based principally on data from the literatur e. Extensive sensitivity analyses were carried out to test the impact of th e values given to these variables on the outcome of the model. The model in dicated that the preferred treatment is proximal row carpectomy. Decision analysis allows a comparison between alternative treatments, when evidence from a randomised trial is lacking or unobtainable. The decision-a nalysis model may also provide insight into aspects of a problem which woul d be difficult, or impossible, to evaluate by a cohort study.