Proximal Row Carpectomy in Degenerative Wrist Conditions. Our Medium-term Experience
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Published:
Aug 20, 2024
Keywords:
Carpectomy, row, resection
Main Article Content
Abstract
Objective: Examining the medium-term clinical and radiological outcomes of proximal carpectomy for treating degenerative wrist conditions.
Materials and Methods: Retrospective study of 33 patients who underwent proximal carpectomy between 2009 and 2019. Outcomes were assessed through range of motion measurements, pain evaluation using the Visual Analog Scale (VAS), and functional capacity using the Quick-DASH questionnaire. Biomechanical tests were performed and the rate of complications and reoperations was analyzed. Radiological progression of osteoarthritis and its impact on clinical outcomes were examined.
Results: The mean range of motion was 77.11º (range 51–80º) in flexion-extension and 36.7º (range 29–42º) in radioulnar deviation. VAS scores improved significantly from 7.9 (range 7–9) to 2.7 (range 0–7) post-surgery (p<0.003). The Quick-DASH score at the final follow-up was 24.3 (range 11–45). We observed an inverse relationship between preoperative radiocarpal osteoarthritis severity and clinical outcomes (p<0.03), but no link between postoperative osteoarthritis progression and poor outcomes (p<0.04). Four patients (12.12%) required reoperation with total wrist arthrodesis.
Conclusions: Proximal carpectomy demonstrates satisfactory medium-term outcomes for degenerative wrist conditions, offering good range of motion and a low complication rate. However, patients with more severe preoperative joint degeneration may lead to poorer clinical outcomes.
Materials and Methods: Retrospective study of 33 patients who underwent proximal carpectomy between 2009 and 2019. Outcomes were assessed through range of motion measurements, pain evaluation using the Visual Analog Scale (VAS), and functional capacity using the Quick-DASH questionnaire. Biomechanical tests were performed and the rate of complications and reoperations was analyzed. Radiological progression of osteoarthritis and its impact on clinical outcomes were examined.
Results: The mean range of motion was 77.11º (range 51–80º) in flexion-extension and 36.7º (range 29–42º) in radioulnar deviation. VAS scores improved significantly from 7.9 (range 7–9) to 2.7 (range 0–7) post-surgery (p<0.003). The Quick-DASH score at the final follow-up was 24.3 (range 11–45). We observed an inverse relationship between preoperative radiocarpal osteoarthritis severity and clinical outcomes (p<0.03), but no link between postoperative osteoarthritis progression and poor outcomes (p<0.04). Four patients (12.12%) required reoperation with total wrist arthrodesis.
Conclusions: Proximal carpectomy demonstrates satisfactory medium-term outcomes for degenerative wrist conditions, offering good range of motion and a low complication rate. However, patients with more severe preoperative joint degeneration may lead to poorer clinical outcomes.
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Matellanes Palacios, C., Cabanes Ferrer, I., Alfonso Porcar, M., Gázquez Gázquez, G., Losar Sogues Colom, A., Castillo Ruipérez, L., Garrido Ferrer, J., & Hernández Ferrando, L. (2024). Proximal Row Carpectomy in Degenerative Wrist Conditions. Our Medium-term Experience. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 89(4), 341-352. https://doi.org/10.15417/issn.1852-7434.2024.89.4.1843
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Clinical Research
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References
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scapholunate advanced collapse: A systematic literature review and meta-analysis. Ann Plast Surg 2020;85(6):699-703. https://doi.org/10.1097/SAP.0000000000002398
7. Rahgozar P, Zhong L, Chung KC. A comparative analysis of resource utilization between proximal row carpectomy and partial wrist fusion: A population study. J Hand Surg Am 2017;42(10):773-80. https://doi.org/10.1016/j.jhsa.2017.07.032
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generates better mid- to long-term outcomes than four-corner arthrodesis for post-traumatic wrist arthritis: A metaanalysis. Orthop Traumatol Surg Res 2022;108(7):103373. https://doi.org/10.1016/j.otsr.2022.103373
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adaptingsystem/intercambio/revistas/articulos/35_05_reseccion%20primera%20fila.pdf
12. Jebson PJL, Hayes EP, Engber WD. Proximal row carpectomy: a minimum 10-year follow-up study. J Hand Surg
Am 2003;28(4):561-9. https://doi.org/10.1016/s0363-5023(03)00248-x
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https://doi.org/10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L
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https://m.riunet.upv.es/bitstream/handle/10251/38483/MONTERO%3BBaydal%3BGarrido%20-%20Objetivamos%20los%20gestos%20caracter%C3%ADsticos%20de%20la%20mano.pdf?sequence=1&isAllowed=y
15. DiDonna ML, Kiefhaber TR, Stern PJ. Proximal row carpectomy: study with a minimum of ten years of follow-up. J Bone Joint Surg Am 2004;86(11):2359-65. PMID: 15523004
16. Green DP, Perreira AC, Longhofer LK. Proximal row carpectomy. J Hand Surg Am 2015;40(8):1672-6.
https://doi.org/10.1016/j.jhsa.2015.04.033
17. França Bisneto EN, Freitas MC, Paula EJL de, Mattar Jr R, Zumiotti AV. Comparison between proximal row
carpectomy and four-corner fusion for treating osteoarthrosis following carpal trauma: a prospective randomized study. Clinics (Sao Paulo) 2011;66(1):51-5. https://doi.org/10.1590/s1807-59322011000100010.13
18. El-Mowafi H, El-Hadidi M, El-Karef E. Proximal row carpectomy: a motion-preserving procedure in the treatment of advanced Kienbock’s disease. Acta Orthop Belg 2006;72(5):530-4. PMID: 17152414
19. Renart IP, Gómez CL, Pujals JI, Rodríguez JDC. Resección de la primera fila del carpo (Carpectomía proximal).
Revista Iberoamericana de Cirugía de la Mano 2005;33(67):22-30. https://doi.org/10.1055/s-0037-1606674
20. Richou J, Chuinard C, Moineau G, Hanouz N, Hu W, Le Nen D. Proximal row carpectomy: Long-term results.
Chir Main 2010;29(1):10-5. https://doi.org/10.1016/j.main.2009.10.003
21. Ali MH, Rizzo M, Shin AY, Moran SL. Long-term outcomes of proximal row carpectomy: a minimum of 15-year
follow-up. Hand (N Y) 2012;7(1):72-8. https://doi.org/10.1007/s11552-011-9368-y
22. Bijon C, Saab M, Amouyel T, Sturbois-Nachef N, Guerre E, Chantelot C. Long-term radiological changes and
functional outcomes after proximal row carpectomy: Retrospective study with 3 years’ minimum follow-up. Orthop Traumatol Surg Res 2020;106(8):1589-95. https://doi.org/10.1016/j.otsr.2020.03.038
23. Hogan CJ, McKay PL, Degnan GG. Changes in radiocarpal loading characteristics after proximal row carpectomy. J Hand Surg Am 2004;29(6):1109-13. https://doi.org/10.1016/j.jhsa.2004.07.006
24. Stern PJ, Agabegi SS, Kiefhaber TR, DiDonna ML. Proximal row carpectomy. J Bone Joint Surg Am 2005;87 Suppl 1(Pt 2):166-74. https://doi.org/10.2106/JBJS.E.00261
25. Rabinovich RV, Lee SJ. Proximal row carpectomy using decellularized dermal allograft. J Hand Surg Am 2018;43 (4):392.e1-392.e9. https://doi.org/10.1016/j.jhsa.2018.01.012
26. Ishida O, Tsai TM, Atasoy E. Long-term results of denervation of the wrist joint for chronic wrist pain. J Hand Surg Br 1993;18(1):76-80. https://doi.org/10.1016/0266-7681(93)90202-q
traumatología. 2ª ed. Madrid: Panamericana; 2010, p. 978-85.
2. Uceda Carrascosa P, Izquierdo Fernández A, Múñoz Reyes F, Carpintero R, Peces Gonjar D, Serrano Lázaro P, et
al. Carpectomía proximal en osteoartritis de muñeca. Rev Soc Andal Traumatol Ortop 2011;28(2):100-9. Disponible en: https://www.portalsato.es/documentos/revista/Revista11-2/Rev.%202011-2-03.pdf
3. Montiel V, Payo-Ollero J, Amillo S. Resección de la primera fila del carpo en pacientes mayores de 50 años: 3 a 16 años de seguimiento. Rev Esp Cir Ortop Traumatol 2019;63(4):295-9. https://doi.org/10.1016/j.recot.2019.02.001
4. Stamm TT. Excision of the proximal row of the carpus. Proc R Soc Med 1944;38(2):74-5. PMID: 19992990
5. Berkhout MJL, Bachour Y, Zheng KH, Mullender MG, Strackee SD, Ritt MJPF. Four-corner arthrodesis versus proximal row carpectomy: A retrospective study with a mean follow-up of 17 years. J Hand Surg Am 2015;40(7):1349-54. https://doi.org/10.1016/j.jhsa.2014.12.035
6. Amer KM, Thomson JE, Vosbikian MM, Ahmed I. Four-corner arthrodesis versus proximal row carpectomy for
scapholunate advanced collapse: A systematic literature review and meta-analysis. Ann Plast Surg 2020;85(6):699-703. https://doi.org/10.1097/SAP.0000000000002398
7. Rahgozar P, Zhong L, Chung KC. A comparative analysis of resource utilization between proximal row carpectomy and partial wrist fusion: A population study. J Hand Surg Am 2017;42(10):773-80. https://doi.org/10.1016/j.jhsa.2017.07.032
8. Chammas PE, Hadouiri N, Chammas M, Ramos-Pascual S, Stirling P, Nover L, et al. Proximal row carpectomy
generates better mid- to long-term outcomes than four-corner arthrodesis for post-traumatic wrist arthritis: A metaanalysis. Orthop Traumatol Surg Res 2022;108(7):103373. https://doi.org/10.1016/j.otsr.2022.103373
9. Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand
Surg Am 1984;9(3):358-65. https://doi.org/10.1016/s0363-5023(84)80223-3
10. De Carli P, Zaidenberg E. Enfermedad de Kienböck: conceptos actuales. Rev Asoc Argent Ortop Traumatol
2020;85(Supl.):S26-S35. https://doi.org/10.15417/issn.1852-7434.2020.85.4S.1170
11. Escribano Rey R, Flórez Alvarez F, Duart J, Amillo S. Resección de la primera fila del carpo: indicaciones y resultados. Rev Esp Cir Osteoartic 2008;43(234):60-4. Disponible en: http://www.cirugia-osteoarticular.org/
adaptingsystem/intercambio/revistas/articulos/35_05_reseccion%20primera%20fila.pdf
12. Jebson PJL, Hayes EP, Engber WD. Proximal row carpectomy: a minimum 10-year follow-up study. J Hand Surg
Am 2003;28(4):561-9. https://doi.org/10.1016/s0363-5023(03)00248-x
13. Hudak PL, Amadio PC, Bombardier C, Beaton D, Cole D, Davis A, et al. Development of an upper extremity
outcome measure: The DASH (disabilities of the arm, shoulder, and head). Am J Ind Med 1996;29(6):602-8.
https://doi.org/10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L
14. Montero Vilela J, Baydal Bertomeu JM, Garrido Jaen JD, Bermejo Bosch I, Page Del Pozo AF, Porcar Seder RM,
et al. Objetivamos los gestos característicos de la mano. Revista de Biomecánica 2012;(58):47-0. Disponible en:
https://m.riunet.upv.es/bitstream/handle/10251/38483/MONTERO%3BBaydal%3BGarrido%20-%20Objetivamos%20los%20gestos%20caracter%C3%ADsticos%20de%20la%20mano.pdf?sequence=1&isAllowed=y
15. DiDonna ML, Kiefhaber TR, Stern PJ. Proximal row carpectomy: study with a minimum of ten years of follow-up. J Bone Joint Surg Am 2004;86(11):2359-65. PMID: 15523004
16. Green DP, Perreira AC, Longhofer LK. Proximal row carpectomy. J Hand Surg Am 2015;40(8):1672-6.
https://doi.org/10.1016/j.jhsa.2015.04.033
17. França Bisneto EN, Freitas MC, Paula EJL de, Mattar Jr R, Zumiotti AV. Comparison between proximal row
carpectomy and four-corner fusion for treating osteoarthrosis following carpal trauma: a prospective randomized study. Clinics (Sao Paulo) 2011;66(1):51-5. https://doi.org/10.1590/s1807-59322011000100010.13
18. El-Mowafi H, El-Hadidi M, El-Karef E. Proximal row carpectomy: a motion-preserving procedure in the treatment of advanced Kienbock’s disease. Acta Orthop Belg 2006;72(5):530-4. PMID: 17152414
19. Renart IP, Gómez CL, Pujals JI, Rodríguez JDC. Resección de la primera fila del carpo (Carpectomía proximal).
Revista Iberoamericana de Cirugía de la Mano 2005;33(67):22-30. https://doi.org/10.1055/s-0037-1606674
20. Richou J, Chuinard C, Moineau G, Hanouz N, Hu W, Le Nen D. Proximal row carpectomy: Long-term results.
Chir Main 2010;29(1):10-5. https://doi.org/10.1016/j.main.2009.10.003
21. Ali MH, Rizzo M, Shin AY, Moran SL. Long-term outcomes of proximal row carpectomy: a minimum of 15-year
follow-up. Hand (N Y) 2012;7(1):72-8. https://doi.org/10.1007/s11552-011-9368-y
22. Bijon C, Saab M, Amouyel T, Sturbois-Nachef N, Guerre E, Chantelot C. Long-term radiological changes and
functional outcomes after proximal row carpectomy: Retrospective study with 3 years’ minimum follow-up. Orthop Traumatol Surg Res 2020;106(8):1589-95. https://doi.org/10.1016/j.otsr.2020.03.038
23. Hogan CJ, McKay PL, Degnan GG. Changes in radiocarpal loading characteristics after proximal row carpectomy. J Hand Surg Am 2004;29(6):1109-13. https://doi.org/10.1016/j.jhsa.2004.07.006
24. Stern PJ, Agabegi SS, Kiefhaber TR, DiDonna ML. Proximal row carpectomy. J Bone Joint Surg Am 2005;87 Suppl 1(Pt 2):166-74. https://doi.org/10.2106/JBJS.E.00261
25. Rabinovich RV, Lee SJ. Proximal row carpectomy using decellularized dermal allograft. J Hand Surg Am 2018;43 (4):392.e1-392.e9. https://doi.org/10.1016/j.jhsa.2018.01.012
26. Ishida O, Tsai TM, Atasoy E. Long-term results of denervation of the wrist joint for chronic wrist pain. J Hand Surg Br 1993;18(1):76-80. https://doi.org/10.1016/0266-7681(93)90202-q