Issue: October 2018
September 19, 2018
1 min read
Save

Proximal row carpectomy may yield better results for scapholunate advance collapse, scaphoid non-union advanced collapse wrists

Issue: October 2018
You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

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 Tyser headshot
Andrew R. Tyser

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.