Proximal Row Carpectomy

Author(s): Didonna, M.L., Kiefhaber, T. R., Stern, P. J.

Source:  J Bone and Joint Surg 86A: 2359-2365, 2004

Summary:

This retrospective review evaluated 22 wrists in 21 patients that had undergone a proximal row carpectomy (PRC) for treatment of degenerative arthritis between 1980 and 1992.  There was a minimum of 10 year follow up with an average of 14 years.  The average age at the time of the operation was 38 years (range, 19-57 years).  The dominant hand was involved in 15 patients and 10 patients were laborers.  The etiology for degenerative arthritis included SLAC wrist in nine patients, scaphoid nonunion in six patients and Kienbock’s disease in seven.  No wrist had degenerative changes between the capitate and lunate during the initial follow-up visit.  Fifteen patients had at least one operation prior to the PRC.  A standard PRC was performed via a dorsal approach, although early in the series a Kirschner wire was used for four weeks, which had been discontinued later in the series.  Range of motion was initiated at four weeks postoperatively with all splinting discontinued at six weeks postoperatively.

There were four failures (18%) due to severe wrist pain with subsequent wrist arthrodesis at an average of seven years (range, 840 months) after the PRC.  The average age of the four patients at the time of the PRC was 29 years and none were more than 35 years of age.  Three patients did not return to their previous occupation, two had permanent restrictions, and one was limited to light duty.  All of the remaining 18 were able to return to their previous employment without restriction.  The average arc of flexion/extension was 72 degrees with averages 36 degrees of flexion, 36 degrees of extension, 9 degrees of radial deviation, and 31 degrees of ulnar deviation.  Grip strength averaged 91 % of that of the contralateral side.  Fourteen of the 18 patients were very satisfied and the remaining four were satisfied without any patients being dissatisfied.  Nine patients reported no pain, four mild pain, and five with moderate pain.  Six patients required infrequent pain medication, and one required daily medication.  Follow-up radiographs revealed degeneration of the radiocapitate articulation in all but three of the 17 wrists for which radiographic studies were available.  The average width of the radiocapitate space immediately postoperatively was 2 mm. and at final follow-up was 1 mm.  There were only two complications related to pin tract infections, which resolved with a short course of oral antibiotics.

This study adds to the growing body of literature of the long-term outcome of proximal row carpectomy.  Despite narrowing of the radiocapitate joint in all patients, failures were only noted in patients prior to the age of 35.  Overall, most patients can expect a high degree of pain relief with maintenance of a functional arc of motion and reasonable grip strength following PRC.  However, approximately 20% of these patients still failed this salvage procedure, with only total fusion the remaining encore.

 

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