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Proximal row carpectomy may yield better results for scapholunate advance collapse, scaphoid non-union advanced collapse wrists
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BOSTON — Results presented at the American Society for Surgery of the Hand Annual Meeting showed proximal row carpectomy may yield better outcomes among patients with stage 2 scapholunate advanced collapse or scaphoid non-union advanced collapse patterns of wrist arthritis compared with four-corner arthrodesis.
Andrew R. Tyser, MD, and colleagues identified 1,148 wrists with type 2 scapholunate advanced collapse or scaphoid non-union advanced collapse arthritis patterns in the National Veterans Health Affairs database who underwent either proximal row carpectomy or four-corner arthrodesis between 1992 and 2016. After propensity matching, Tyser noted the study population included 462 wrists. This cohort included 234 four-corner arthrodeses and 229 proximal row carpectomies.
At a median follow-up of 5 years for the four-corner arthrodesis cohort and 6 years for the proximal row carpectomy group, Tyser noted the groups had no significant differences in the rate of wrist arthrodesis at any of the measured follow-up time points. Patients had a failure rate of slightly less than 5% at the 10-year follow-up, according to Tyser, with Kaplan Meier curves revealing no significant difference in, as well as relatively high, survival rates.
“The mean time to failure was 30 months in the [four-corner arthrodesis] FCA cohort and 41.9 months in the [proximal row carpectomy] PRC cohort,” Tyser said.
When conversion to wrist fusion was excluded, he noted a significant difference in the rate of reoperation between the proximal row carpectomy and four-corner arthrodesis groups when looking at all reoperations at all measured time points. Tyser added a reoperation rate of 20% and 1% for patients in the four-corner arthrodesis and proximal row carpectomy groups, respectively, at the 10-year follow-up.
“Similarly, Kaplan Meier curves illustrated a higher rate of reoperation for FCA when you exclude wrist arthrodesis,” Tyser said. “Mean time to reoperation was 10.3 months for the FCA and 1.5 months for the PRC.” – by Casey Tingle
Reference:
Tyser AR, et al. Paper 5. Presented at: American Society for Surgery of the Hand Annual Meeting; Sept. 13-15, 2018; Boston.
Disclosure: Tyser reports no relevant financial disclosures.