Proximal row carpectomy for the treatment of kienböck’s disease

Proximal row carpectomy (PRC) is an established and widely used procedure for treatment of degenerative conditions of the wrist. The procedure involves excision of the scaphoid, lunate, and triquetrum, with formation of a new articulation between the lunate fossa of the distal radius and the proximal aspect of the capitate. Relief of pain and preservation of wrist range of motion and grip strength have been demonstrated. Long-term studies have shown the durability of PRC as a salvage procedure for treatment of advanced Kienböck’s disease. In the presence of full-thickness cartilage defects of the proximal capitate or lunate fossa of the distal radius, an interposition flap from the dorsal capsule has been recommended as an adjunct to PRC to allow for wrist salvage in these complex cases; unfortunately long-term studies have been inconclusive to determine the benefits of capsular interposition in the presence of cartilage wear and arthritis in patients with Kienböck’s disease. Careful patient selection is critical for successful outcomes when choosing PRC. Optimal results are obtained in patients older than 40 years of age who do not engage in heavy manual labor.