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Proximal row carpectomy: minimum 20-year follow-up.

Lindley B Wall1, Michael L Didonna, Thomas R Kiefhaber

  • 1Washington University Orthopaedics, St. Louis, Missouri 63110, USA. lindley.wall@gmail.com

The Journal of Hand Surgery
|July 2, 2013
PubMed
Summary

Proximal row carpectomy (PRC) offers sustained patient satisfaction and function for wrist degeneration over 20 years. While 65% avoid further surgery, younger patients face higher risks, necessitating careful counseling.

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Area of Science:

  • Orthopedic Surgery
  • Hand Surgery
  • Musculoskeletal Disorders

Background:

  • Proximal row carpectomy (PRC) is a recognized motion-sparing procedure for proximal carpal row degenerative disorders.
  • Previous studies show good results at 10-year follow-up, with 12% conversion to radiocarpal arthrodesis.

Purpose of the Study:

  • To evaluate the long-term (minimum 20 years) efficacy and patient satisfaction following PRC.
  • To test the hypothesis that PRC maintains high satisfaction and function over two decades.

Main Methods:

  • A cohort of 17 wrists (16 patients) underwent PRC for degenerative wrist conditions.
  • Clinical and radiographic evaluations were performed, alongside subjective assessments using QuickDASH and Patient-Related Wrist Evaluation questionnaires.
  • Minimum follow-up was 20 years (average 24 years).
Keywords:
DegenerativeKienbockSLACSNACproximal row carpectomy

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Main Results:

  • 65% of wrists (11/17) had no further surgery at 20-year follow-up.
  • The average time to failure (conversion to radiocarpal arthrodesis) was 11 years.
  • Satisfied patients (10/11) maintained good motion (68° arc) and grip strength (72% of contralateral side), returning to work.

Conclusions:

  • PRC demonstrates a 65% survival rate at 20 years, providing sustained patient satisfaction.
  • A recommended minimum age for PRC is 35-40 years, though younger patients may be candidates with appropriate risk counseling.
  • No correlation was found between radiographic degeneration and satisfaction levels.