Outcomes Following Standard Proximal Row Carpectomy versus Proximal Row Carpectomy with Dorsal Capsular Interposition for Treatment of Late-Stage Wrist Arthropathy
Patrick M. Kane, MD; Michael P. Gaspar, MD; Peter P. Pham, MS; Sidney M. Jacoby, MD; Eon K. Shin, MD; A. Lee Osterman, MD; Thomas Jefferson University, Philadelphia, PA
To compare midterm outcomes of patients with late-stage wrist arthropathies treated with proximal row carpectomy (PRC) and dorsal capsular interposition (DCI) arthroplasty to a matched cohort treated with standard PRC alone.
Patients and Methods
Twenty-five arthritic wrists (24 patients) with preexisting degeneration of the proximal capitate and/or lunate facet were treated with PRC+DCI over a 10-year treatment interval. Patients from the PRC+DCI treatment group were matched 1:2 to a comparison group of 50 wrists (48 patients) without capitate or lunate facet degeneration that were treated with standard PRC alone over the same period. The mean patient age at the time of surgery was 56.8 years (range, 25 to 81), and both cohorts were similar with regards to their demographics and baseline wrist motion, grip strength, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score and Patient-Rated Wrist Evaluation (PRWE) score. Follow-up evaluation was performed at a prospective study visit for comparison to preoperative data.
At a mean follow-up interval of 5.9 years (range, 1.8 to 11.8), significant improvements were observed across the full study cohort in QuickDASH (49.4 ± 14.0 preoperatively vs. 16.8 ± 14.8 postoperatively; P < 0.001) and PRWE (67.4 ± 17.4 preoperatively vs. 25.2 ± 22.1 postoperatively; P < 0.001) outcome scores, grip strength (62 ± 30% of contralateral side preoperatively vs. 73 ± 30% postoperatively; P = 0.008) and wrist flexion-extension arc (74° ± 24° preoperatively vs. 81° ± 23° postoperatively; P < 0.001), while no significant difference was found between the PRC and PRC+DCI groups. Seventeen of 75 patients (23%) were found to have interval progression of radiocapitate disease on postoperative radiographs, although there was no significant difference between the PRC and PRC+DCI groups. Satisfaction was high across the full study cohort with 93% of patients saying they would definitely or likely have surgery again. One patient in the PRC+DCI group required additional surgery for a deep infection, while two patients experienced complications in the PRC group (one wound dehiscence requiring revision wound closure, one transient radial sensory neuritis that was treated conservatively). One patient in each group was converted to total wrist arthrodesis for progression of radiocarpal disease.
PRC with DCI is an effective treatment option for late-stage wrist arthritis involving the capitolunate joint, with midterm outcomes that are similar to those in patients without lunate facet or proximal capitate disease treated with standard PRC alone.
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