Related Experiment Videos
Proximal Row Carpectomy and 4-Corner Arthrodesis in Patients Younger Than Age 45 Years
Eric R Wagner1, Jean-David Werthel1, Bassem T Elhassan1
1Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN.
Insights
Proximal row carpectomy (PRC) and 4-corner arthrodesis (4CA) offer comparable long-term outcomes for young patients with wrist arthritis. PRC provides improved motion and fewer complications, making it a favorable surgical option.
Area of Science:
- Orthopedic Surgery
- Hand Surgery
- Wrist Arthritis Treatment
Background:
- Wrist arthritis significantly impacts young adults, necessitating effective surgical interventions.
- Proximal row carpectomy (PRC) and 4-corner arthrodesis (4CA) are surgical options for wrist arthritis in patients under 45.
- Long-term outcomes of these procedures in young populations require further investigation.
Purpose of the Study:
- To compare the long-term outcomes of proximal row carpectomy (PRC) versus 4-corner arthrodesis (4CA) in patients under 45 years old with wrist arthritis.
Main Methods:
- Retrospective cohort study of 89 patients (38 PRC, 51 4CA) under 45 years with wrist arthritis.
- Mean follow-up: 18 years for PRC, 11 years for 4CA.
- Evaluation of revision surgery, complications, pain, range of motion, grip strength, functional scores (DASH, WRIST), and radiographic arthritis.
Main Results:
- No significant difference in revision surgery rates or moderate/severe pain between PRC and 4CA.
- PRC demonstrated a greater mean flexion-extension arc (73°) compared to 4CA (54°).
- 4CA showed slightly improved grip strength (65%) versus PRC (54%), with similar 10-year radiographic arthritis outcomes (70% PRC, 71% 4CA).
Conclusions:
- Both PRC and 4CA are viable surgical options for young patients with wrist arthritis, offering similar long-term results.
- PRC is associated with improved wrist motion and a lower complication rate.
- The choice between PRC and 4CA should consider individual patient factors and desired functional outcomes.
Purpose:
To examine the long-term outcome of patients aged less than 45 years who underwent either proximal row carpectomy (PRC) or 4-corner arthrodesis (4CA) for wrist arthritis.
Methods:
We reviewed a retrospective cohort of 89 patients aged less than 45 years who underwent either 4CA (n = 51) or PRC (n = 38) for wrist arthritis. Mean follow-up was 11 years in the 4CA group and 18 years in the PRC group.
Results:
Overall, there were no differences between groups in the need for revision surgery. Complications included 6 nonunions in the 4CA group (12%), 1 infection in each group, and 11 patients who experienced radiocarpal impingement (8 4CA and 3 PRC). There was no difference in the number of patients reporting moderate or severe pain between the PRC and 4CA groups. Mean flexion-extension arc was 54° after 4CA, compared with 73° after PRC. Patients who underwent 4CA had slightly improved grip strength (65% of the opposite side) compared with those who had PRC (54%). Mean postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire scores were 32 versus 19 (PRC vs 4CA) and patient-rated wrist evaluation scores were 27 versus 28 (PRC vs 4CA). Comparing radiographic arthritis, the 10-year outcome, free of moderate/severe arthritis for the PRC and 4CA groups, was 70% and 71%, respectively.
Conclusions:
Both PRC and 4CA represent a good surgical option for young patients with wrist arthritis, with similar complication rates, postoperative pain levels, wrist function, and long-term outcomes free of arthrodesis. Proximal row carpectomy has improved motion and fewer complications.
Type Of Study/Level Of Evidence:
Therapeutic IV.