A Comparative Analysis of Resource Utilization Between Proximal Row Carpectomy and Partial Wrist Fusion: A Population...

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Musculoskeletal Research

Background:

• Chronic wrist arthritis significantly impacts patient quality of life.
• Proximal row carpectomy (PRC) and partial wrist arthrodesis (PWA) are surgical options for wrist arthritis.
• Understanding comparative outcomes and costs is crucial for treatment decisions.

Purpose of the Study:

• To compare proximal row carpectomy (PRC) and partial wrist arthrodesis (PWA) in treating chronic wrist arthritis.
• To analyze national practice patterns for these procedures.
• To determine conversion rates to total wrist arthrodesis (TWA) and associated direct costs.

Main Methods:

• Population-level analysis using Truven MarketScan databases (2009-2015).
• Inclusion of patients aged 18+ with wrist osteoarthritis undergoing PRC or PWA, followed for 18 months.
• Statistical analysis including Chi-square and logistic regression to assess TWA conversion and cost.

Main Results:

• Partial wrist arthrodesis (PWA) was more common (61%) than proximal row carpectomy (PRC) (39%).
• Total wrist arthrodesis (TWA) conversion rates were higher for PWA (19.2%) versus PRC (4.9%).
• PWA resulted in more procedures and higher average direct costs ($10,842) compared to PRC ($7,171).

Conclusions:

• Partial wrist arthrodesis (PWA) shows significantly higher conversion rates to total wrist arthrodesis (TWA) and greater costs than proximal row carpectomy (PRC).
• These findings challenge the traditional indications for PWA, even in younger patients.
• A potential paradigm shift towards considering PRC more often for wrist arthrosis salvage treatment is suggested.