Proximal Row Carpectomy Modifications for Capitate Arthritis: A Systematic Review

Area of Science:

• Orthopedic Surgery
• Hand and Wrist Surgery
• Arthritis Treatment

Background:

• Proximal row carpectomy (PRC) is a recognized motion-sparing treatment for radiocarpal arthritis.
• Traditionally, arthritis in the capitate bone has been a contraindication for PRC.
• Modifications to PRC aim to extend its applicability to patients with capitate involvement.

Purpose of the Study:

• To evaluate the outcomes of various modified proximal row carpectomy (PRC) procedures.
• To determine the optimal PRC modification for managing capitate arthritis.

Main Methods:

• A systematic review of 18 studies (147 patients for capsular interposition [CI], 136 for capitate resurfacing [CR]) was conducted.
• Studies included adult patients with capitate arthritis undergoing modified PRC.
• Outcomes assessed included range of motion, grip strength, patient-reported outcomes, and complications.

Main Results:

• Modified PRC procedures, specifically CI, yielded greater flexion-extension arc and grip strength compared to CR.
• Capitate resurfacing (CR) had a marginally higher complication rate (4%) than CI.
• Capsular interposition (CI) showed a higher rate of conversion to total wrist arthrodesis (10%).

Conclusions:

• Both capsular interposition (CI) and capitate resurfacing (CR) are effective techniques for addressing capitate arthritis in conjunction with PRC.
• CI offers superior functional outcomes (range of motion, grip strength) but carries a higher risk of requiring subsequent wrist fusion.
• The higher conversion rate for CI may be influenced by longer follow-up periods in relevant studies.