Factors Associated With Reoperation and Conversion to Wrist Fusion After Proximal Row Carpectomy or 4-Corner Arthrodesis

Abstract

Purpose Proximal row carpectomy (PRC) and 4-corner arthrodesis (FCA) are common salvage procedures for the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse. This study aimed to assess rates of reoperation and conversion to wrist fusion and to assess the factors associated with reoperation and conversion to wrist fusion for patients treated with PRC and FCA.Methods A retrospective chart review was performed evaluating 266 adult patients undergoing PRC or FCA at a single institutional system from 2002 to 2016. Demographic data, patient-and injury-specific data, reoperation and conversion rates, and complications were collected. Potential factors associated with reoperation or wrist fusion were evaluated using a bivariate, followed by a multivariable, analysis.Results Reoperation was more commonly performed in FCA (34%) than in PRC (11%) (odds ratio [OR], 3.4; 95% confidence interval [95% CI], 1.7e6.8) and occurred at a shorter postoperative interval. In a multivariable analysis for reoperation, manual labor was associated with reoperation in patients undergoing FCA (OR, 5.4; 95% CI, 1.5e19.1). In those undergoing PRC, anterior interosseous nerve (AIN) and/or posterior interosseous nerve (PIN) neurectomy was associated with a lower rate of reoperation (OR, 0.18; 95% CI, 0.06e0.57). In a multivariable analysis for conversion to wrist arthrodesis, intraoperative AIN and/or PIN neurectomy (OR, 0.18; 95% CI, 0.06e0.57) was associated with a lower rate of conversion to wrist fusion, and smoking (OR, 4.9; 95% CI, 1.8e13.5) was associated with a higher rate of conversion to wrist fusion. In the subanalysis of patients who underwent PRC, only AIN and/or PIN neurectomy was associated with lower rates of conversion to wrist arthrodesis (OR, 0.15; 95% CI, 0.04e0.56).Conclusions In our cohort, we observed that AIN and/or PIN neurectomy reduced the risk of reoperation and conversion to wrist arthrodesis after PRC. Smoking increased the odds of conversion to wrist arthrodesis in the combined PRC/FCA cohort; however, it is unclear whether this was due to smoking itself or whether the indications for PRC or FCA were affected, leading to this result.

The Biomechanical Effects of Simulated Radioscapholunate Fusion With Distal Scaphoidectomy, 4-Corner Fusion With Complete Scaphoidectomy, and Proximal Row Carpectomy Compared to the Native Wrist

“…35 Additionally, Wagner et al 18 reported similar 10-year total wrist arthrodesis-free and revision-free intervals for both PRC (84% and 81%, respectively) and 4-CF (88% and 80%, respectively). 18 However, these findings were contradicted by a recent study by van Hernan et al, 36 which reported higher revision rates in patients treated with 4-CF compared with those treated with PRC.…”

Proximal Row Carpectomy Modifications for Capitate Arthritis: A Systematic Review

“…7 38 With similar results between conventional outcomes, attention has been turned to other outcome measures to establish which technique provides optimal treatment. Proximal row carpectomy has been reported to have a better patient-reported outcomes ( Table 5 ), 39 lower complications, 38 less secondary procedures, 36 40 and less conversion to total wrist arthrodesis, 41 though this remains controversial. 36 40 Studies also indicate that PRC also has a cost benefit, 42 while generating lower direct costs to patients.…”

The role of routine radial styloidectomy in proximal row carpectomy: a retrospective review of 120 patients

“…In our cohort, a secondary radial styloidectomy was performed in eight out of 47 patients (17%). Van Hernen et al., (2020) investigated factors associated with reoperation after PRC and four-corner arthrodesis and found that a primary radial styloidectomy was performed in 66 of the 266 patients following both procedures. During follow-up, a wrist arthrodesis was not performed in any of the patients with a primary radial styloidectomy, while 20 of the 200 patients without primary radial styloidectomy required a secondary wrist fusion.…”

“…The incidence of wrist arthrodesis after PRC is well described, with incidences between 5% and 24% (Chedal-Bornu et al, 2017;Garcia et al, 2020;Kay et al, 2020;van Hernen et al, 2020;Williams et al, 2018). Less is known about secondary radial styloidectomy after PRC; Imbriglia et al (1990) performed a secondary radial styloidectomy in two out of 27 patients (7%).…”