Proximal Row Carpectomy and 4-Corner Arthrodesis in Patients Younger Than Age 45 Years

Eric R. Wagner, Jean David Werthel, Bassem T. Elhassan, Steven Lawrence Moran

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Purpose: To examine the long-term outcome of patients aged less than 45 years who underwent either proximal row carpectomy (PRC) or 4-corner arthrodesis (4CA) for wrist arthritis. Methods: We reviewed a retrospective cohort of 89 patients aged less than 45 years who underwent either 4CA (n = 51) or PRC (n = 38) for wrist arthritis. Mean follow-up was 11 years in the 4CA group and 18 years in the PRC group. Results: Overall, there were no differences between groups in the need for revision surgery. Complications included 6 nonunions in the 4CA group (12%), 1 infection in each group, and 11 patients who experienced radiocarpal impingement (8 4CA and 3 PRC). There was no difference in the number of patients reporting moderate or severe pain between the PRC and 4CA groups. Mean flexion-extension arc was 54° after 4CA, compared with 73° after PRC. Patients who underwent 4CA had slightly improved grip strength (65% of the opposite side) compared with those who had PRC (54%). Mean postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire scores were 32 versus 19 (PRC vs 4CA) and patient-rated wrist evaluation scores were 27 versus 28 (PRC vs 4CA). Comparing radiographic arthritis, the 10-year outcome, free of moderate/severe arthritis for the PRC and 4CA groups, was 70% and 71%, respectively. Conclusions: Both PRC and 4CA represent a good surgical option for young patients with wrist arthritis, with similar complication rates, postoperative pain levels, wrist function, and long-term outcomes free of arthrodesis. Proximal row carpectomy has improved motion and fewer complications. Type of study/level of evidence: Therapeutic IV.

Original languageEnglish (US)
JournalJournal of Hand Surgery
DOIs
StateAccepted/In press - Mar 6 2017

Keywords

  • Arthrodesis
  • Carpectomy
  • Corner
  • Proximal
  • Row
  • Young

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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