Factors Associated with Conversion to Wrist Arthrodesis or Arthroplasty after Proximal Row Carpectomy or Four Corner Arthrodesis
Jan Jonas van Hernen, Bsc1; Jonathan Lans, MD1; Neal C Chen, MD2
1Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Massachusetts General Hospital/Harvard Medical School, Boston, MA, 2Massachusetts General Hospital, Boston, MA
Introduction: This study aimed to investigate the rate of conversion to total wrist fusion (arthrodesis or arthroplasty) in patients that underwent either proximal row carpectomy (PRC) or four-corner arthrodesis (FCA). Additionally, we evaluated the factors associated with conversion to wrist fusion for patients treated with PRC or FCA.
Methods: We retrospectively identified patients that underwent a PRC or FCA using ICD-9 procedure and CPT codes and verified these by chart review. We included all adult patients (n=266) that were treated at a single institutional system from 2002-2016. The median age was 54 (IQR:45–62) years, and the median follow up was 8.0 (IQR:4.8–12.0) years. Eighty patients underwent FCA, and 186 underwent a PRC. We performed a multivariable logistic regression to evaluate factors associated with wrist fusion, including all explanatory variables with a p<0.10 in bivariate analysis.
Results: There was an increased progression of lunate fossa osteoarthritis in the PRC cohort (48% vs. 29%, p=0.044). The median time to wrist fusion was 15.6 months (IQR:12–37) for PRC and 32 months (IQR:19–45) for FCA. Intraoperative posterior interosseous and anterior interosseous neurectomy was independently associated with a lower rate of conversion to wrist fusion (OR:0.08, 95% CI:0.01-0.66, p=0.019) after PRC and progression of radiographic lunate fossa osteoarthritis was independently associated with higher conversion rates to wrist fusion (OR:6.28, 95% CI:1.27-31.0, p=0.024). Smoking was associated with a higher rate of conversion to wrist fusion (p=0.009) after FCA. The most common indication for conversion to wrist fusion was wrist pain (90%).
Conclusions: PRC and FCA had similar conversion rates to wrist fusion, where PRC lead to increased lunate fossa osteoarthritis progression. Progression of radiographic lunate fossa osteoarthritis and not performing intraoperative neurectomy were independently associated with a higher conversion rate to wrist fusion. Smoking was independently associated with higher rates of conversion to wrist fusion after FCA.
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