Purpose Proximal row carpectomy is a well-established technique for the management of wrist arthritis; however, patient selection and long-term durability of proximal row carpectomy is still a matter of controversy. Hence, we conducted a systematic review of the English literature to determine the best evidence on long-term outcomes following proximal row carpectomy.
Methods A MEDLINE search using the term “proximal row carpectomy” was performed. A total of 192 studies were identified. All studies with 10 or more years of follow-up were included in the review. Data extracted included patient demographics, indications for surgery, previous surgery, outcome assessment, and information on complications and failures.
Results A total of 147 patients from six studies met the inclusion criteria and were included in the study. The majority of patients were male and involved in manual labor. There was no significant difference between the preoperative and long-term postoperative motion. The weighted mean for postoperative grip strength was 68.4% compared with the contralateral side. Disabilities of the arm, shoulder, and hand; patient-rated wrist examination; and Mayo wrist scores were comparable to those reported for four-corner arthrodesis. There were 21 failures (14.3%) requiring re-operation. Failures were not associated with a specific preoperative diagnosis but distributed among patients with Kienböck disease, scaphoid nonunion advanced collapse, and scapholunate advanced collapse arthritis.
Conclusions This systematic review confirms the long-term durability of proximal row carpectomy when used for the treatment of wrist arthritis. Although radiocapitate arthritis develops over time in most patients, the clinical significance of this finding is undetermined and does not necessarily correlate with failure of proximal row carpectomy. Poorer long-term outcomes are likely to result in patients engaged in heavy manual labor, whereas better outcomes may be obtained in patients undergoing proximal row carpectomy for trauma or earlier-stage Kienböck disease.
4 Baumeister S, Germann G, Dragu A, Tränkle M, Sauerbier M. Functional results after proximal row carpectomy (PRC) in patients with SNAC-/SLAC-wrist stage II. [in German]. Handchir Mikrochir Plast Chir 2005; 37 (2) 106-112
5 Dacho AK, Baumeister S, Germann G, Sauerbier M. Comparison of proximal row carpectomy and midcarpal arthrodesis for the treatment of scaphoid nonunion advanced collapse (SNAC-wrist) and scapholunate advanced collapse (SLAC-wrist) in stage II. J Plast Reconstr Aesthet Surg 2008; 61 (10) 1210-1218
6 Laulan J, Bacle G, de Bodman C , et al. The arthritic wrist. II—the degenerative wrist: indications for different surgical treatments. Orthop Traumatol Surg Res 2011; 97 (4, Suppl) S37-S41
7 Mulford JS, Ceulemans LJ, Nam D, Axelrod TS. Proximal row carpectomy vs four corner fusion for scapholunate (Slac) or scaphoid nonunion advanced collapse (Snac) wrists: a systematic review of outcomes. J Hand Surg Eur Vol 2009; 34 (2) 256-263
10 DiDonna ML, Kiefhaber TR, Stern PJ. Proximal row carpectomy: study with a minimum of ten years of follow-up. J Bone Joint Surg Am 2004; 86-A (11) 2359-2365
12 Liu M, Zhou HT, Yang ZM, Huang FG, Pei FX, Xiang Z. Clinical evaluation of proximal row carpectomy revealed by follow-up for 10–29 years. Int Orthop 2009; 33 (5) 1315-1321
13 Lumsden BC, Stone A, Engber WD. Treatment of advanced-stage Kienböck's disease with proximal row carpectomy: an average 15-year follow-up. J Hand Surg Am 2008; 33 (4) 493-502
14 Hudak P, Amadio P, Bombardier C. The Upper Extremity Collaborative Group (UECG). Development of an upper extremity outcome measure: the DASH (disability of the arm, shoulder and hand). Am J Ind Med 1996; 29: 602-608
15 Beaton DE, Wright JG, Katz JN. Upper Extremity Collaborative Group. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am 2005; 87 (5) 1038-1046
16 MacDermid JC, Tottenham V. Responsiveness of the disability of the arm, shoulder, and hand (DASH) and patient-rated wrist/hand evaluation (PRWHE) in evaluating change after hand therapy. J Hand Ther 2004; 17 (1) 18-23
20 Dacho A, Grundel J, Holle G, Germann G, Sauerbier M. Long-term results of midcarpal arthrodesis in the treatment of scaphoid nonunion advanced collapse (SNAC-Wrist) and scapholunate advanced collapse (SLAC-Wrist). Ann Plast Surg 2006; 56 (2) 139-144
21 Espinoza DP, Schertenleib P. Four-corner bone arthrodesis with dorsal rectangular plate: series and personal technique. J Hand Surg Eur Vol 2009; 34 (5) 609-613
22 Merrell GA, McDermott EM, Weiss AP. Four-corner arthrodesis using a circular plate and distal radius bone grafting: a consecutive case series. J Hand Surg Am 2008; 33 (5) 635-642
24 Cohen MS, Kozin SH. Degenerative arthritis of the wrist: proximal row carpectomy versus scaphoid excision and four-corner arthrodesis. J Hand Surg Am 2001; 26 (1) 94-104
28 Hawkins-Rivers S, Budoff JE, Ismaily SK, Noble PC, Haddad J. MRI study of the capitate, lunate, and lunate fossa with relevance to proximal row carpectomy. J Hand Surg Am 2008; 33 (6) 841-849
29 Tang P, Gauvin J, Muriuki M, Pfaeffle JH, Imbriglia JE, Goitz RJ. Comparison of the “contact biomechanics” of the intact and proximal row carpectomy wrist. J Hand Surg Am 2009; 34 (4) 660-670
30 Yazaki N, Burns ST, Morris RP, Andersen CR, Patterson RM, Viegas SF. Variations of capitate morphology in the wrist. J Hand Surg Am 2008; 33 (5) 660-666
31 Bain GI, Watts AC. The outcome of scaphoid excision and four-corner arthrodesis for advanced carpal collapse at a minimum of ten years. J Hand Surg Am 2010; 35 (5) 719-725
32 Mulford JS, Ceulemans LJ, Nam D, Axelrod TS. Proximal row carpectomy vs four corner fusion for scapholunate (Slac) or scaphoid nonunion advanced collapse (Snac) wrists: a systematic review of outcomes. J Hand Surg Eur Vol 2009; 34 (2) 256-263