Proximal Row Carpectomy Modifications for Capitate Arthritis: A Systematic Review

Abstract

Introduction Proximal row carpectomy (PRC) is a motion-sparing procedure for radiocarpal arthritis with reliable results. Traditionally, proximal capitate arthritis is a contraindication to PRC; however, PRC with modifications are proposed to circumvent this contraindication. PRC modifications can be broadly grouped into capitate resurfacing (CR) and capsular interposition (CI) procedures which could expand PRC indications. Our primary question was to characterize the outcomes achievable with various PRC modifications. Our secondary question was to determine which PRC modification was the optimal procedure when capitate arthritis was present. Methods A systematic review was conducted to examine the outcomes of modified PRC procedures. Independent reviewers appraised multiple databases for PRC studies with modifications for capitate arthritis in adult patients (age >18 years) with a minimum of three cases and extractable outcomes. Modified PRC procedures included capsular/allograft interposition, resurfacing capitate pyrocarbon implants, and osteochondral grafting. Pertinent outcomes included patient demographics, range-of-motion, grip strength, patient-reported outcomes, and complications, including salvage rates. Results Overall, 18 studies met the inclusion criteria—10 studies (n = 147) on CI and 8 studies on CR (n = 136). PRC with CI had the greatest flexion–extension arc and grip strength. Complications were marginally higher in the CR group (4%), while the CI group had a higher conversion to total wrist arthrodesis (10%). Conclusion Techniques to address capitate arthritis center around resurfacing or soft tissue interposition. PRC modifications with CI produces better range-of-motion and grip strength but higher conversion to total wrist arthrodesis. Higher conversion rates may be attributable to longer follow-up periods in studies examining CI compared with CR. Level of Evidence This is a Level III study.

Radiocarpal Osteochondral Allografts for Wrist Pain Postproximal Row Carpectomy

“…When capitate arthritis exists, CR and CI can be used to reinforce the new articulation between the capitate and radius, allowing PRC to become a reasonable treatment option. 7 There are two reports of CR using autologous osteochondral grafts, an OAT procedure. 4 5 These grafts were harvested from the proximal carpal bones and incorporated into the arthritic, proximal capitate at the same time as the PRC.…”

Proximal Row Carpectomy with and without Capitate Resurfacing

“…Complications following PRC 1 RCPI were limited, indicating the need for future studies with longer Despite its theoretical benefits over PRC alone, few reports of patient outcomes after PRC 1 RCPI exist in the literature. Proponents of RCPI cite a lower rate of complications compared with 4CF, and it may benefit patients who otherwise may not have been candidates for PRC, such as patients with capitate cartilage degeneration 9,19 . PRC 1 RCPI is often reported for use in younger, higher demand patients 9 .…”

Proximal row carpectomy with interposition arthroplasty using both capsular flap and acellular human dermal matrix

“…It showed a higher incidence of conversion to total wrist arthrodesis in the interposition group. On the other side, postoperative complications were reported to be more frequent in the capitate resurfacing group [ 20 ].…”