Perspective from Curtis M. Henn, MD
Perspective from Sanjeev Kakar, MD
Disclosures: The authors report no relevant financial disclosures.
July 28, 2020
4 min read
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Proximal row carpectomy preferable to four-corner arthrodesis in wrist arthritis treatment

Perspective from Curtis M. Henn, MD
Perspective from Sanjeev Kakar, MD
Disclosures: The authors report no relevant financial disclosures.
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Proximal row carpectomy may be preferable in treating patients with stage 2 scapholunate advanced collapse and scaphoid nonunion advanced collapse wrist arthritis, according to a published study.

“Four-corner arthrodesis (FCA) and proximal row carpectomy (PRC) are commonly used, motion-sparing surgical treatments for the scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) patterns of wrist arthritis,” Brittany N. Garcia, MD, department of orthopedic surgery at University of Utah Hospital, and colleagues wrote. “In the early stage of SLAC/SNAC wrist osteoarthritis in which the cartilage on the proximal pole of the capitate remains preserved (stage 2), it is unclear whether FCA and PRC is the optimal surgical treatment option.”

In a manual chart review, 1,168 patients with stage 2 SLAC/SNAC who underwent PRC (n = 933 wrists) or FCA (n = 257 wrists) were analyzed for conversion from the index procedure to total wrist arthrodesis and subsequent surgical procedures. Propensity score analyses with matching weights were used to balance the cohorts for comparison and outcome rates were calculated.

Results showed no significant difference in incidence rate for conversion to total wrist arthrodesis between the cohorts at 10-year follow-up (94.3% PRC vs. 94.1% FCA). Conversely, incidence of subsequent surgical procedure rates yielded 99.7% (95% CI, 99.3- 100.0%) in the PRC cohort vs. 83.5% (95% CI, 78.2- 88.8%) in the FCA cohort.

“Although the present study did not detect a signicant difference in the rate of conversion to total wrist arthrodesis between PRC and FCA for stage 2 SLAC/SNAC wrist, the study did show that PRC is much less likely to require a secondary surgical procedure compared with FCA,” Garcia and colleagues concluded. “On the basis of the results of this study, and in light of other recently published data on the topic, we believe that PRC may be preferable to FCA in patients with symptomatic stage 2 SLAC/SNAC wrist arthritis.”