Four-Corner Arthrodesis Versus Proximal Row Carpectomy: A Retrospective Study With a Mean Follow-Up of 17 Years

Berkhout, Merel J.L.; Bachour, Yara; Zheng, Kang; Mullender, Margriet G.; Strackee, Simon D.; Ritt, Marco J.P.F.

doi:10.1016/j.jhsa.2014.12.035

Cited by 60 publications

(38 citation statements)

References 25 publications

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“…For example, FCA carries with it the risks associated with attempted limited arthrodesis, most notably nonunion, symptomatic hardware, infection, and a more prolonged postoperative immobilization. 15 Nonunion has been reported to range from 3 to 10% in most studies, although there have been other studies with higher nonunion rates, up to 63%. 3,[11][12][13]16,27,28 PRC has been reported to lead to higher rates of osteoarthritis progression radiographically, though most patients with progression may be asymptomatic.…”

Section: Discussionmentioning

confidence: 94%

“…5 In a smaller but long-term study of 22 wrists with a 17-year follow-up, Berkhout et al showed that 7 and 27% of PRC and FCA patients, respectively, underwent wrist arthrodesis. 15 In a systematic review by Mulford et al, the authors reported that 3.9 and 2.9% of PRC and FCA patients underwent total wrist arthrodesis, a finding that was not statistically significant. 13 This study describes the clinical outcomes of PRC and FCA in a cohort of 122 patients at a mean follow-up of 8.2 years, with particular focus on the rate of conversion to wrist arthrodesis.…”

Section: Discussionmentioning

confidence: 95%

“…3,6,[9][10][11][12][13][14][15][16] PRC is considered to be a technically simpler operation that avoids the risks of nonunion or symptomatic hardware associated with FCA and may lead to better wrist motion. 15,17 FCA may offer greater grip strength and a lower predisposition to the development of radiocarpal arthritis when compared with PRC, although this benefit is unclear. 11,13 Overall, the published differences between PRC and FCA outcomes with regard to wrist motion and grip strength appear small and of questionable clinical significance.…”

mentioning

confidence: 99%

“…11,13 Overall, the published differences between PRC and FCA outcomes with regard to wrist motion and grip strength appear small and of questionable clinical significance. 15,18,19 Despite overall good early results, there are a number of patients who undergo PRC or FCA and develop persistent pain or have other complications, which lead to an undesirable outcome. In the setting of a failed PRC or FCA, total wrist arthrodesis is a commonly accepted surgical salvage option.…”

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confidence: 99%

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Long-Term Outcome and Secondary Operations after Proximal Row Carpectomy or Four-Corner Arthrodesis

2017

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Proximal row carpectomy (PRC) and four-corner arthrodesis (FCA) are common surgical procedures used to treat degenerative wrist conditions; however, complications and failures can occur. This study aimed to investigate and compare the long-term rate of secondary surgeries including conversion to total wrist arthrodesis in patients who underwent PRC or FCA. A retrospective chart review of all patients who underwent PRC or FCA in the past 20 years at a tertiary referral institution and associated Veterans Affairs (VA) hospital was performed. Patient demographics, comorbidities, surgical indications, and associated complications were tabulated. Patients were contacted via phone to obtain additional follow-up information regarding any additional surgeries, 10-point visual analog scale (VAS) for pain, quick Disabilities of the Arm, Shoulder, and Hand (quickDASH) scores, hand dominance, and occupational data. A total of 123 wrists made up the final dataset. Sixty-two wrists treated with PRC and 61 wrists treated with FCA were reviewed at a mean follow-up of 8.2 years. We did not find a significant difference in the rate of conversion to total wrist arthrodesis between the PRC (14.5%) and FCA (19.5%, = 0.51) cohorts. Secondary operations were significantly greater in the FCA group (34.4%) compared with the PRC group (16.1%, = 0.02). Females were 2.6 times more likely than males to undergo secondary operations when controlling for surgical procedure and smoking status ( = 0.04). We did not detect a significant difference in VAS pain or in quickDASH scores between the two groups ( = 0.35, 0.48, respectively). PRC and FCA have comparable patient reported outcomes and wrist arthrodesis conversion rates at a mean follow-up of 8.2 years. In contrast, the FCA patient group had a significantly higher rate of secondary operations, including those for nonunion, symptomatic hardware, and other implant-related issues, when combined with wrist arthrodesis conversion. Level IV, therapeutic study.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 95%

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confidence: 99%

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confidence: 99%

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Long-Term Outcome and Secondary Operations after Proximal Row Carpectomy or Four-Corner Arthrodesis

2017

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“…12 The postoperative arc of motion was only slightly less than preoperative motion; both operations therefore resulted in preservation of the already limited preoperative wrist motion. Note that several studies show mildly better motion after PRC than after scaphoidectomy with 4CF, 1,[13][14][15][16][17] although not all studies support this distinction. 18,19 One clear difference between PRC and scaphoidectomy with 4CF is the complication rate needed for postoperative immobilization: complications were significantly more common after scaphoidectomy with 4CF, including nonunion, delayed union, and hardware-related problems, and the period of immobilization is greater for scaphoidectomy with 4CF.…”

Section: Four-corner Arthrodesis Versus Proximal Row Carpectomymentioning

confidence: 99%