Proximal row carpectomy: Long-term results

Richou, J.; Chuinard, Christopher; Moineau, G.; Hanouz, N.; Hu, W.; Nen, D. Le

doi:10.1016/j.main.2009.10.003

Cited by 70 publications

(35 citation statements)

References 36 publications

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“…Despite patient dissatisfaction and ongoing wrist pain, our patient's DASH scores are comparable other shorter term outcome studies. Richou and colleagues reported a final DASH score of 31 in 24 patients followed for an average of 116 months [26]. Dacho noted a DASH score of 25 in 30 patients followed for 27 months [6].…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes of Proximal Row Carpectomy: A Minimum of 15-Year Follow-up

Ali

Rizzo

Shin

et al. 2011

Hand (New York, N,Y.)

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Introduction Proximal row carpectomy (PRC) is a popular procedure for the treatment of wrist arthritis; however, the long-term clinical outcomes of this procedure are not wellcharacterized. The purpose of this study was to evaluate long-term results with PRC and to identify factors that may improve clinical outcomes. Methods A retrospective study was performed on all patients who underwent proximal row carpectomy between January 1967 and January 1992. Medical records and available radiographs were reviewed. The Disabilities of the Arm, Shoulder and Hand, and Patient Rated Wrist Exam, as well as hand motion diagrams were sent to all surviving patients. The contralateral extremity was used as a control. Data was analyzed using multivariant analysis and a Student's t test. Results Eighty-one patients underwent PRC. Average age at the time of surgery was 41 years. Average follow-up was 19.8 years. Sixty-one patients responded to the questionnaires. On final follow-up, wrist motion and grip strength were not significantly different from preoperative values. Radiographic follow-up beyond 2 years revealed joint narrowing and arthritic changes within the radiocapitate joint. Forty-six patients (74%) were not satisfied with the results of their surgery due to persistent pain or inability to return to previous occupational activities. Fifty-two patients required daily pain medication for wrist pain. Twelve patients had undergone a wrist arthrodesis. Conclusions Post-operative motion and grip strength values following PRC appear to remain stable over time. Surgical failure rates with conversion to wrist fusion occurred early within the post-operative follow-up. Many patients continued to complain of pain requiring daily medication and were unable to return to manual labor type jobs. The results of this study suggest that long-term patient satisfaction following PRC can be poor and the surgeon may wish to consider alternative treatment options for younger patients and those with high-demand jobs.

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Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes of Proximal Row Carpectomy: A Minimum of 15-Year Follow-up

Ali

Rizzo

Shin

et al. 2011

Hand (New York, N,Y.)

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“…We specifically studied SE4CF and PRC, two wrist surgeries that unintentionally result in long-term impairments in hand function (Bain and Watts 2010; Richou et al 2010). Through simulations, we demonstrate that surgically altering wrist kinematics and muscle moment arms substantially influences the joint torques, muscle force transmission, and muscle control strategies associated with the production of lateral pinch force.…”

Section: Discussionmentioning

confidence: 99%

“…While effective at reducing pain, these surgeries degrade kinematic motion at the wrist and also impair functional performance at the hand (Wolff et al 2015). Loss of grip and pinch strength, in particular, are widely reported as debilitating functional impairments (Nagelvoort et al 2002; Bain and Watts 2010; Richou et al 2010). Yet, the biomechanical mechanisms by which isolated wrist surgery alters force production at the hand remain largely unknown.…”

Section: Introductionmentioning

confidence: 99%

Connecting the wrist to the hand: A simulation study exploring changes in thumb-tip endpoint force following wrist surgery

Nichols

Bednar

Wohlman

et al. 2017

Journal of Biomechanics

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The wrist is essential for hand function. Yet, due to the complexity of the wrist and hand, studies often examine their biomechanical features in isolation. This approach is insufficient for understanding links between orthopaedic surgery at the wrist and concomitant functional impairments at the hand. We hypothesize that clinical reports of reduced force production by the hand following wrist surgeries can be explained by the surgically-induced, biomechanical changes to the system, even when those changes are isolated to the wrist. This study develops dynamic simulations of lateral pinch force following two common surgeries for wrist osteoarthritis: scaphoid-excision four-corner fusion (SE4CF) and proximal row carpectomy (PRC). Simulations of lateral pinch force production in the nonimpaired, SE4CF, and PRC conditions were developed by adapting published models of the nonimpaired wrist and thumb. Our simulations and biomechanical analyses demonstrate how the increased torque-generating requirements at the wrist imposed by the orthopaedic surgeries influence force production to such an extent that changes in motor control strategy are required to generate well-directed thumb-tip end-point forces. The novel implications of our work include identifying the need for surgeries that optimize the configuration of wrist axes of rotation, rehabilitation strategies that improve post-operative wrist strength, and scientific evaluation of motor control strategies following surgery. Our simulations of SE4CF and PRC replicate surgically-imposed decreases in pinch strength, and also identify the wrist's torque-generating capacity and the adaptability of muscle coordination patterns as key research areas to improve post-operative hand function.

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“…Reports initially demonstrating relatively superior grip strength in FCF vs PRC, and superior motion preservation in PRC vs FCF, have been supplemented by long-term results suggesting that these objective results are perhaps more comparable than originally thought. [12][13][14][15][16] A recent systematic review of the literature found that the FCF was associated with a higher complication rate related to hardware, dorsal impingement, and nonunion, whereas more patients undergoing PRC developed postoperative degenerative changes. 17 An important consideration in the decisionmaking process is the status of the cartilage of the capitate head.…”

Section: Treatmentmentioning

confidence: 99%