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

Abstract

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.

Four-corner arthrodesis of the wrist using Variable Angle Locking Compression Intercarpal Fusion Plate (VA LCP ICF Plate; Synthes ® ): pre- and postoperative radiological analysis and clinical outcome in long-term evaluation

“…They saw no significant differences in conversion rate to total wrist arthrodesis in the PRC group versus 4 CF group patients [37]. In overall conclusion of a randomized clinical trial comparing proximal row carpectomy and four-corner fusion, Aita et al resumed no significant statistical differences in clinical and functional results between both salvage procedures [38].…”

Cost-Effectiveness Analysis Comparing Proximal Row Carpectomy and Four-Corner Arthrodesis

“…Articles that included appropriate data were reviewed for bibliographic citations related to the above keywords in a secondary search for complication and return-to-work rates. Data from 11 reports were used to define complication rates for PRC 3 , 9 , 18 , 22 , 23 , 29 , 34 , 36 - 39 , and 17 were used for FCA complication rates 3 , 9 , 18 , 19 , 22 , 27 , 29 , 34 , 36 - 38 , 40 - 45 (Table I). One of these sources was a published abstract that contained data on the timing of complications following the index surgical procedures 34 .…”

“…Clinical outcomes, or health states or utilities, are integral in determining the cost-effectiveness of a given treatment. Numerous studies have assessed the clinical outcomes of PRC and FCA 3 , 6 - 22 . Two systematic reviews of PRC and FCA outcomes did not identify any differences in patient-reported disability, subjective ratings of satisfaction, rate of conversion to total wrist arthrodesis, or increase in grip strength 7 , 8 .…”

Cartilage Injuries and Posttraumatic Osteoarthritis in the Wrist: A Review

“…64 However, several other studies have reported a significantly larger number of patients with secondary arthritic changes after PRC, although most are symptom free. 65 There is a lack of well-conducted studies, but Mulford et al 60 reported and confirmed in a systematic review that both 4CF and PRC produce a clear improvement in pain and subjective outcome measurements for patients with symptomatic SLAC wrists. PRC can perhaps provide a better postoperative ROM, with less risk of the potential complications specific to 4CF (10% more complications occurring; such as nonunion, hardware problems, and dorsal impingement).…”