New surgical option for wrist arthritis reduces pain, improves hand function

For patients who develop wrist arthritis, a new surgical option known as osteochondral resurfacing in proximal row carpectomy (OCRPRC) reduces pain and improves hand function, according to a New York orthopedist who helped develop the technique.

“I often see patients who had a wrist injury who either did not seek medical attention or whose original injury was not diagnosed,” said Peter Tang, MD, PhD, orthopedic hand surgeon at New York-Presbyterian Hospital/Columbia University Medical Center and assistant professor of orthopedic surgery at Columbia University College of Physicians and Surgeons.

“As with most things in medicine, the earlier a diagnosis is made, the better the outcome, so if you continue to have pain after a month, you should make an appointment to see a hand surgeon for an evaluation,” he said in a press release.

The two most common operations for wrist arthritis are a partial fusion of the small wrist bones (intercarpal fusion) and excision of the first row of carpal bones (proximal row carpectomy, or PRC). There are various reasons to choose one operation over the other, but PRC has a quicker recovery, it may be better for older patients, it offers grip strength comparable to that gained from intercarpal fusion and it usually results in more wrist motion, Tang said in the press release.

Once the three carpal bones are removed in the PRC procedure, the capitate bone becomes the point where the wrist articulates with the arm; as such, it is important that the arthritis has not progressed to the capitate bone, he said.

For these patients whose arthritis has progressed, Tang has adapted a cartilage-grafting technique that is used effectively in sports medicine treatments for cartilage disorders in the knee, ankle and elbow. The results are promising, as demonstrated by improvements in grip strength and a decrease in pain levels, according to a preliminary 2007 study in the Journal of Hand Surgery.

“The goal of this new procedure is to give the best possible outcome by improving the cartilage status of the capitate bone,” he said in the press release. “Another plus is that we do not have to take the graft from another part of the body. Even though we take out the three carpal bones for arthritis, there is usually one area of the bones where we can find undamaged cartilage for grafting.”

The initial study followed eight patients who underwent osteochondral resurfacing over 18 months. Seven patients described their preoperative pain as moderate to severe, but postoperatively they had mild or no postoperative pain. One patient described the pain as moderate.

Patients’ grip strength increased from 62% preoperatively to 71% postoperatively. Mayo wrist scores improved from a preoperative score of 51, which rates as poor, to a postoperative score of 68, rated as fair, according to the press release.

Reference:
Tang P, Imbriglia JE. Osteochondral resurfacing (OCRPRC) for capitate chondrosis in proximal row carpectomy. J Hand Surg. 32;9:1334-1342.