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.
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).
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.
At the time of long-term followup, all patients older than thirtyfive 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.