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Prevalence of Radiocarpal and Midcarpal Arthritis
Pedro Beredjiklian, MD; Matt Cantlon, MD; Andrew Miller, MD; Jonathan Shearin, MD
Thomas Jefferson University Hospital, Philadelphia, PA

Introduction: Radiocarpal and midcarpal osteoarthritis (RC/MC OA) are debilitating degenerative diseases, and their prevalence is poorly defined. While the most common forms of arthritis have traditionally been considered to be scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC), not all forms of OA fit these patterns. The goals of our study were to 1) to elucidate the prevalence and patterns of RC/MC OA; and 2) to evaluate the reliability of a modified carpal zone-specific typing of this degenerative condition.

Methods: We searched the radiology database at a single institution for Current Procedural Terminology (CPT) codes 73100 and 73110 to identify all patients who had wrist radiographs for any reason. Visualization of both the mid-carpal and radio-carpal joints on a minimum of 2 views was required for inclusion. All radiographs were classified according to the SLAC and SNAC patterns and a modified carpal zone-specific classification system (Figure 1). The prevalence and types of RC/MC OA were tabulated, and observer reliability of these patterns were calculated between four hand surgeons.

Results: 1,007 patient x-rays were reviewed. The overall prevalence of RC/MC OA in this population was found to be 5.4%. The prevalence among women was 3.5% and among men was 9%. The average age of the patients with RC/MC OA was 65 years (range 23-96). Twelve patients (21%) had degenerative changes consistent with SLAC pattern (1 Type 1, 8 Type 2, 2 Type 3 and 1 Type 4) while 6 patients (11%) had changes consistent with SNAC pattern (4 Type 1, 1 Type 2 and 1 Type 3). The remainder (69%) had RC/MC OA patterns which did not fit the SLAC/SNAC classification schemes (Table 1). Logistic regression demonstrated that male gender and increasing age were predisposing factors to arthritis (p < 0.001). The kappa coefficients for inter and intra-observer reliability for the carpal zone typing of degenerative changes were 0.69 and 0.86.

Conclusion: Overall, the prevalence of RC/MC OA in this study was 5.4%. Contrary to the conventional wisdom, the SLAC and SNAC degenerative patterns were not the most common forms of arthritis. The more common, non-typical patterns may be better defined by denoting the zone of carpal joint involvement. Table 1: Radiocarpal and Midcarpal Zones of Degenerative Changes


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