Background: Proximal row carpectomy is an accepted motion-sparing
surgical procedure for the treatment of degenerative conditions of the wrist.
However, there is little information regarding the long-term clinical and
radiographic results following this procedure.
Methods: Twenty-two wrists in twenty-one patients underwent proximal
row carpectomy for the treatment of degenerative arthritis between 1980 and
1992. Objective and subjective function was assessed after a minimum duration
of follow-up of ten years (average, fourteen years).
Results: There were four failures (18%) requiring fusion at an
average of seven years. All four failures occurred in patients who were
thirty-five years of age or less at the time of the proximal row carpectomy (p
= 0.03). The wrists that did not fail had an average flexion-extension arc of
72°, associated with an average grip strength of 91% of that on the
contralateral side. The patients were very satisfied with fourteen of the
eighteen wrists that did not fail and were satisfied with the remaining four.
The patients rated nine wrists as not painful, four as mildly painful, five as
moderately painful, and none as severely painful. The average Disabilities of
the Arm, Shoulder and Hand score was 9 points. Radiographs revealed no loss of
the radiocapitate space in three of the seventeen wrists for which radiographs
were made, reduced space in seven, and complete loss of the space in seven.
With the numbers available, there was no significant association between loss
of joint space seen on radiographs and subjective and objective function.
Conclusions: At the time of long-term follow-up, all patients older
than thirty-five years of age at the time of a proximal row carpectomy had
maintained a satisfactory range of motion, grip strength, and pain relief and
were satisfied with the result. Caution should be exercised in performing the
procedure in patients younger than thirty-five years of age. Although
degeneration of the radiocapitate joint was seen radiographically in fourteen
of the seventeen wrists, it did not preclude a successful clinical result.
Level of Evidence: Therapeutic study, Level IV (case
series [no, or historical, control group]). See Instructions to Authors for a
complete description of levels of evidence.