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Long Term Clinical Outcomes of Proximal Row Carpectomy
Tom Hong, MD; Mary Beth Cermak, MD; John Hood, MD; John Lubahn, MD;
UPMC Hamot

Introduction: Once considered a salvage procedure, proximal row carpectomy (PRC), first described by Stamm in 1944, has gained acceptance as a primary surgical intervention over the past two decades. Neviaser’s impressive results, reinforced by several other studies, has positioned PRC as a viable alternative to limited and total wrist arthrodesis as well as prosthetic arthroplasty.

The advantages of PRC are that it maintains wrist motion, ameliorates the need for bony fusion to occur, provides functional grip strength, and most importantly, offers significant pain relief.

Material and Methods: The charts of 21 patients who underwent 22 proximal row carpectomies from 1987 to 2007 were retrospectively reviewed. Informed consent for study participation was obtained. Subjective assessment included Mayo Wrist Score and the MOS 36-Item Short-Form Health Survey (SF-36). Clinical assessment included measurement of range of motion, grip strength, and radiographic analysis. Wrist arc of motion comprised of flexion-extension as well as radial-ulnar deviation, measured with a hand-held goniometer. Grip strength was measured using the JAMAR dynamometer in position #2.

Results: In total 21 patients (7 female, 14 male) were followed with an average age of 54 (range 21-81 years) and average follow up period of 76 months (range 13-200 months). Surgery was performed for Kienbock’s, scapholunate dissociation with periscaphoid arthritis, scaphoid nonunion advanced collapse, and scapholunate advanced collapse. Average flexion-extension and radial-ulnar arc of motion were 64% each, respectively, compared with the contralateral wrist. Average grip strength was 65% of the contralateral wrist. Short form mental and physical summary scores were 75 (range 52-96) and 64 (range 5-100) respectively. Both low outlier SF-36 scores was present in a patient with concurrent flexion contractures in the operated extremity secondary to traumatic brain injury. Average Mayo Wrist score was 60 (range 35-100). Secondary proximal capitate degenerative changes developed in five wrists three to 13 years out from the index procedure, one of which was painful and subsequently fused. A second wrist continued to have chronic pain and was fused despite showing no radiographic signs of radiocapitate arthritis.

Conclusions: Consistent with past and contemporary literature, proximal row carpectomy remains a viable treatment option for arthritic disease of the proximal carpal row, regardless of the etiology. Our long term follow up study with average follow up of 6+ years continues to document its success at providing pain relief, restoring useful function and wrist range of motion.

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