1
|
Hones KM, Hao KA, Rakauskas TR, Densley S, Hampton H, Kim J, Wright TW, Chim H. Four-Corner Fusion Versus Proximal Row Carpectomy for Scapholunate Advanced Collapse and Scaphoid Nonunion Advanced Collapse Wrist: A Systematic Review and Meta-Analysis. J Hand Surg Am 2024; 49:633-638. [PMID: 38416092 DOI: 10.1016/j.jhsa.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/06/2024] [Accepted: 01/24/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Although proximal row carpectomy (PRC) has increasingly been shown to have superior features to four-corner fusion (4CF), individual surgeons may remain convinced of the superiority of one procedure based on personal experience and individual biases. Hence, we sought to perform an updated meta-analysis with some of the largest studies to date to compare outcomes and complications between these procedures in the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists. METHODS A systematic review and meta-analysis was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/MEDLINE, Embase, Web of Science, and Cochrane were queried for articles on PRC and 4CF performed for scapholunate advanced collapse and scaphoid nonunion advanced collapse wrist. Primary outcomes included wrist range of motion; grip strength; outcome measures, including Disabilities of Arm, Shoulder, and Hand and Quick Disabilities of Arm, Shoulder, and Hand scores, Patient-Rated Wrist and Hand Evaluation, and visual analog scale pain scores; and surgical complications. RESULTS Sixty-one studies reported on 3,174 wrists, of which 54% were treated with PRC and 46% were treated with 4CF. The weighted mean follow-up was 61 months (range, 12-216 months). Meta-analysis comparing PRC and 4CF demonstrated that PRC had significantly greater postoperative extension; ulnar deviation; postoperative improvement in extension, flexion, ulnar deviation; and visual analog scale score. No comparisons showed significant differences in grip strength. The percentage of wrists requiring arthrodesis was 5.2% for PRC and 11% for 4CF. There was an 8.9% (57/640 wrists) 4CF nonunion rate and 2.2% (17/789) hardware removal rate after 4CF. CONCLUSIONS In the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists, PRC results in better outcomes and a lower complication rate compared to 4CF. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Keegan M Hones
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, FL
| | | | | | - Hailey Hampton
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL
| | - Jongmin Kim
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL
| | - Thomas W Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL
| | - Harvey Chim
- Department of Plastic and Reconstructive Surgery, University of Florida, Gainesville, FL.
| |
Collapse
|
2
|
Chan R, Goursat J, Payen M, Lalevée M, Guelmi K. Proximal row carpectomy versus four-corner arthrodesis: a retrospective comparative study. J Plast Surg Hand Surg 2024; 59:77-82. [PMID: 38769788 DOI: 10.2340/jphs.v59.18338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 05/06/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Four-corner arthrodesis with scaphoid excision (FCA) and proximal row carpal resection (PRC) are frequently performed in wrists with post-traumatic Scaphoid Non- Union Advanced Collapse (SNAC)/Scapho-Lunate Advanced Collapse (SLAC) osteoarthritis. The aim of this study was to compare the clinical outcomes of these two procedures. METHODS This single-center, retrospective cohort study included all patients who had PRC or FCA between January 1st, 2009 and January 1st, 2019 and who were followed up. Follow-up included: mobility (radial deviation, ulnar deviation, flexion, extension), strength (grip test, pinch test), function (QuickDash, patient-rated wrist evaluation [PRWE]), subjective mobility, and global satisfaction scores. RESULTS Among 25 patients included, 11 had PRC and 14 had FCA with a mean follow-up of 69.5 months [12-132]. Radial deviation was 18° versus 14° (p = 0.7), ulnar deviation was 21° versus 22° (p = 0.15), flexion was 39° versus 30° (p = 0.32), extension was 32.5° versus 29.5° (p = 0.09), grip test compared to the controlateral side was 72% versus 62% (p = 0.53), Quick Dash score was 12.5 versus 17.6 (p = 0.84), PRWE was 18.7 versus 17.6 (p = 0.38), subjective mobility was 7.8 versus 7.5 (p = 0.23), and satisfaction score was 8.7 versus 9 (p = 0.76), respectively, in the FCA group and the PRC group. Re-operation rates were 14% patients in the FCA group and 0% in the PRC group. CONCLUSION This study found no significant difference between FCA and PRC on strength, mobility, and function in patients with post-traumatic SLAC or SNAC stage II wrist arthritis. Both FCA and PRC seem to be reliable surgical techniques with good outcomes with more revision in the FCA group.
Collapse
Affiliation(s)
- Richard Chan
- Chirurgie Orthopédique Adulte, CHU Charles Nicolle, Rouen, France; Chirurgie de la main et plastique adulte, CHU Charles Nicolle, Rouen, France
| | - Justine Goursat
- Chirurgie Orthopédique Adulte, CHU Charles Nicolle, Rouen, France
| | - Mathilde Payen
- Chirurgie Orthopédique Pédiatrique, CHU Charles Nicolle, Rouen, France.
| | - Matthieu Lalevée
- Chirurgie Orthopédique Adulte, CHU Charles Nicolle, Rouen, France; CETAPS UR3832, Research Center for Sports and Athletic Activities Transformations, Université de Rouen, Mont-Saint-Aignan, France
| | - Kamel Guelmi
- Chirurgie Orthopédique Adulte, GHH Monod, Montivilliers, France
| |
Collapse
|
3
|
Schriever T, Swärd E, Wilcke M. Lunocapitate versus four-corner fusion in scapholunate or scaphoid nonunion advanced collapse: a randomized controlled trial. J Hand Surg Eur Vol 2024; 49:601-607. [PMID: 37903310 DOI: 10.1177/17531934231209872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
This pragmatic randomized controlled trial compared lunocapitate fusion (LCF) and four-corner fusion (4CF) for scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) in 64 patients. The primary outcome was change in grip strength from preoperative to 1 year postoperatively. The secondary outcomes were Disability of the Hand, Arm, and Shoulder score, Patient Rated Wrist Evaluation score, EuroQol-5D-3L, range of motion, key pinch strength and complications 12 months postoperatively. Grip strength improved only to a small extent and there was no difference between the groups. No differences were found in the secondary outcomes. In conclusion, LCF is not inferior to 4CF regarding strength, range of motion or patient-reported outcome measures.Level of evidence: I.
Collapse
Affiliation(s)
- Thorsten Schriever
- Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
- Department of Hand Surgery Södersjukhuset, Stockholm, Sweden
| | - Elin Swärd
- Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
- Department of Hand Surgery Södersjukhuset, Stockholm, Sweden
| | - Maria Wilcke
- Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
- Department of Hand Surgery Södersjukhuset, Stockholm, Sweden
| |
Collapse
|
4
|
Hones KM, Rakauskas TR, Hao KA, Densley S, Kim J, Wright TW, Chim H. Proximal Row Carpectomy with and without Capitate Resurfacing: A Preliminary Systematic Review and Meta-Analysis. JBJS Rev 2024; 12:01874474-202404000-00008. [PMID: 38648294 DOI: 10.2106/jbjs.rvw.24.00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND In wrist salvage, proximal row carpectomy (PRC) has increasingly shown superior outcomes to four-corner fusion (4CF). Furthermore, PRC with resurfacing capitate pyrocarbon implants (PRC + RCPIs) provides a treatment option that may allow patients to avoid 4CF or wrist arthrodesis and help restore natural joint function and distribute loads evenly across the implant, though RCPI has yet to be evaluated on a large scale. We aimed to compare outcomes between PRC and PRC + RCPI for the treatment of scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrists. METHODS A systematic review and meta-analysis was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/MEDLINE, Embase, Web of Science, and Cochrane were queried for articles on PRC and PRC + RCPI performed for SLAC and SNAC wrist with minimum 12-month follow-up. Primary outcomes included wrist range of motion (ROM), grip strength, and outcome scores including Disabilities of Arm, Shoulder, and Hand (DASH) and QuickDASH scores, Patient-Rated Wrist and Hand Evaluation (PRWHE), and visual analog scale pain scores. RESULTS Twenty-two studies reporting on 1,804 wrists were included (1,718 PRC alone, 86 PRC + RCPI). PRC + RCPI was associated with greater postoperative radial deviation, but poorer flexion. PRC + RCPI also had significantly lower postoperative QuickDASH (less disability and symptoms) and postoperative PRWHE (lower pain and disability) scores and an improvement in PRWHE compared with PRC. There was no significant difference in grip strength. CONCLUSION PRC + RCPI demonstrated similar postoperative ROM to PRC alone. While PRC + RCPI was associated with more favorable outcome scores, further research is needed to confirm these findings and assess the incidence and profile of complications related to RCPIs. LEVEL OF EVIDENCE Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Keegan M Hones
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida
| | | | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, Florida
| | - Sebastian Densley
- College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Jongmin Kim
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida
| | - Thomas W Wright
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida
| | - Harvey Chim
- Department of Plastic and Reconstructive Surgery, University of Florida, Gainesville, Florida
| |
Collapse
|
5
|
Maris S, Apergis E, Apostolopoulos A, Melissaridou D, Koulouvaris P, Papagelopoulos PJ, Savvidou O. Scapholunate Advanced Collapse (SLAC) and Scaphoid Nonunion Advanced Collapse (SNAC): A Review of Treatment Options for Stage II. Cureus 2024; 16:e59014. [PMID: 38800268 PMCID: PMC11127752 DOI: 10.7759/cureus.59014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) represent clinical entities identified by a pattern of predictable degenerative changes. They are the most common causes of wrist arthritis. Both entities can remain asymptomatic for many years and may go undiagnosed. Diagnosis is usually confirmed through clinical examination, which reveals progressive wrist pain and instability. Radiographically, degenerative changes in the radiocarpal and midcarpal joints are present, as well as nonunion of the scaphoid fracture in SNAC. The management differs according to the stage. Particularly in this review article, we reviewed the treatment options for stage II SLAC and SNAC wrist. In addition to the well-described surgical techniques such as proximal row carpectomy and four-corner fusion, alternatives such as capitolunate arthrodesis, three-corner fusion, and soft tissue procedures like capsulodesis and tenodesis are available. Proximal row carpectomy and partial arthrodeses yield comparable results. Soft tissue procedures are viable alternatives and are preferred in younger patients to avoid early salvage operations.
Collapse
Affiliation(s)
- Spyridon Maris
- Department of Orthopaedics and Traumatology, General Hospital Hellenic Red Cross Korgialenio Benakio, Athens, GRC
| | - Emmanouil Apergis
- Department of Orthopaedics, General Hospital Hellenic Red Cross Korgialenio Benakio, Athens, GRC
| | - Alexandros Apostolopoulos
- Department of Orthopaedics, East Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, Redhill, GBR
| | - Dimitra Melissaridou
- First Department of Orthopaedic Surgery, Attikon University General Hospital, Athens, GRC
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Panagiotis Koulouvaris
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Panayiotis J Papagelopoulos
- First Department of Orthopaedic Surgery, Attikon University General Hospital, Athens, GRC
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Olga Savvidou
- First Department of Orthopaedic Surgery, Attikon University General Hospital, Athens, GRC
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| |
Collapse
|
6
|
Almigdad A, Al-Zoubi A, Mustafa A, Al-Qasaimeh M, Azzam E, Mestarihi S, Khair Y, Almanasier G. A review of scaphoid fracture, treatment outcomes, and consequences. INTERNATIONAL ORTHOPAEDICS 2024; 48:529-536. [PMID: 37880341 DOI: 10.1007/s00264-023-06014-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/15/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE Scaphoid fractures are the most common carpal fracture and can lead to severe complications like carpal collapse and osteoarthritis. This study reviewed scaphoid fracture patterns, outcomes, and consequences in conservative and surgical management. METHODS Sixty-four patients with scaphoid fracture who attended the hand clinic at King Hussein Medical City from January 2022 to December 2022 were included and reviewed regarding the anatomical fracture site, the associated injury, the treatment modality (conservative versus surgical), the healing time, and fracture sequelae such as nonunion and scaphoid nonunion advanced collapse. RESULTS Most patients were males (62 patients, 96.9%), and most (47, 73.4%) fell within 25 to 40 years. Scaphoid waist fracture was the most common location (40, 52.5%). Most patients (47, 73.4%) received conservative treatment and 17 (26.6%) were fixed acutely. However, nonunion complicated 53 fractures (82.8%). Notably, there were no differences in the union rate or time between cases of scaphoid nonunion treated with vascularized or nonvascularized grafts. Furthermore, there were no variations in union rates among genders, extremities, age, fracture locations, or among smokers. However, a higher union rate was noted in office workers and those who received conservative treatment. CONCLUSION Nonunions were higher in our study than in the literature, as our department is a referral center for established nonunion cases. For conservative treatment, we recommend aggressive management and follow-up with a clinical and CT scan at three months and early referral of non-united fractures to the hand clinic to avoid the advanced collapse of the scaphoid.
Collapse
Affiliation(s)
- Ahmad Almigdad
- Department of Hand and Upper Limb Surgery, Department of Orthopedic, King Hussein Medical City, King Abdullah II St, Amman, 230, Jordan.
| | - Ahmad Al-Zoubi
- Department of Hand and Upper Limb Surgery, Department of Orthopedic, King Hussein Medical City, King Abdullah II St, Amman, 230, Jordan
| | - Ayman Mustafa
- Department of Hand and Upper Limb Surgery, Department of Orthopedic, King Hussein Medical City, King Abdullah II St, Amman, 230, Jordan
| | - Motaz Al-Qasaimeh
- Department of Hand and Upper Limb Surgery, Department of Orthopedic, King Hussein Medical City, King Abdullah II St, Amman, 230, Jordan
| | - Ehab Azzam
- Department of Hand and Upper Limb Surgery, Department of Orthopedic, King Hussein Medical City, King Abdullah II St, Amman, 230, Jordan
| | - Saab Mestarihi
- Department of Hand and Upper Limb Surgery, Department of Orthopedic, King Hussein Medical City, King Abdullah II St, Amman, 230, Jordan
| | - Yousef Khair
- Department of Hand and Upper Limb Surgery, Department of Orthopedic, King Hussein Medical City, King Abdullah II St, Amman, 230, Jordan
| | - Ghandi Almanasier
- Department of Hand and Upper Limb Surgery, Department of Orthopedic, King Hussein Medical City, King Abdullah II St, Amman, 230, Jordan
| |
Collapse
|
7
|
Solgård L, Gvozdenovic R. Single- and Bicolumn Limited Intercarpal Fusion: A Solution for the SLAC or SNAC Wrist. J Wrist Surg 2024; 13:16-23. [PMID: 38264130 PMCID: PMC10803153 DOI: 10.1055/s-0043-1762932] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/16/2023] [Indexed: 01/25/2024]
Abstract
Background Single- or bicolumn limited intercarpal fusion, also called one- or two-column fusion, has been introduced as an alternative to four-corner fusion. The rationale behind this is obtaining less need for bone grafting and consequently improving the chances of the union. Method From August 2014 to October 2020, 45 consecutive patients (15 women), with a mean age of 58.4 years (range: 35-79), have been treated for scapholunate advanced collapse or scaphoid nonunion advanced collapse wrist. In 33 cases, the surgery was performed as two-column fusion, and in 12 cases as one-column fusion. The union was determined by a computed tomography (CT) scan or X-ray follow-up studies. The pain assessments (visual analog score: 0-100), range of motion (ROM), grip strength, and Quick Disabilities of the Arm, Shoulder, and Hand score were prospectively included. Results Of 45 patients, 43 were available for the follow-up, at a mean of 35 months (range: 12-68). All patients but two achieved union at a mean of 9.5 weeks (range: 5-25 weeks). Pain diminished from 60.3 (mean) preoperatively to 16.7 (mean) postoperatively ( p = 0.0001). Grip strength slightly increased from 28.2 KgF (mean) to 29 KgF (mean) (not significantly, p = 0.86). Quick Disability of the Arm, Shoulder, and Hand score improved from 39.5 (median) before the surgery to 11 (median) after the surgery ( p = 0.0004). The postoperative ROM of 62/37 degrees (mean) were recorded for total dorsovolar/radioulnar flexions, respectively. Three patients were converted to total wrist fusion and one to total wrist arthroplasty. One had a rearthrodesis to two-column fusion, which united. Conclusion One- and two-column fusion showed significant improvement in pain and function, with minimal impairment of the grip strength on the short- to mid-term follow-up. A union rate of 95% and an acceptable complication rate were achieved, without fusing all carpals. Level of Evidence Prospective, cohort study, level III.
Collapse
Affiliation(s)
- Lars Solgård
- Department of Hand Surgery, Herlev/Gentofte University Hospital of Copenhagen, Hellerup, Denmark
| | - Robert Gvozdenovic
- Department of Hand Surgery, Herlev/Gentofte University Hospital of Copenhagen, Hellerup, Denmark
- Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
| |
Collapse
|
8
|
Kopriva JM, Karzon AL, Cooke HL, Suh N, Gottschalk MB, Wagner ER. A Changing Landscape in the Surgical Management of Wrist Arthritis: An Analysis of National Trends From 2009 to 2019. J Hand Surg Am 2024; 49:83-90. [PMID: 38085190 DOI: 10.1016/j.jhsa.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE The purpose of this study was to analyze the trends in the annual volume and incidence of proximal row carpectomy (PRC), four-corner fusion (4CF), total wrist arthrodesis (TWF), and total wrist arthroplasty (TWA) from 2009 to 2019 in the United States. METHODS The IBM Watson Health MarketScan databases were queried to identify annual case volumes for PRC, 4CF, TWF, and TWA from 2009 to 2019. The annual incidence of these procedures was then calculated based on the population estimates from the US Census Bureau. Trends in annual volume and incidence over the study period were evaluated using regression line analysis. Further subgroup analysis was conducted based on age and region. RESULTS From 2009 to 2019, the total case volumes for the four procedures increased by 3.4%, but the incidence decreased by 2.8%. However, PRC case volume and incidence trends significantly increased (38.2% and 29.7%, respectively), whereas 4CF remained constant. Conversely, the case volume and incidence of TWA significantly decreased (-52.2% and -54.5%, respectively), whereas TWF remained constant. When stratified by age, all four procedures decreased in the <45-year-old cohort (combined -35.1%) significantly for 4CF, TWF, and TWA. TWA decreased significantly in the <45-year-old and 45- to 65-year-old cohorts (53.6% and 63.2%, respectively). For age >65 years, the total case incidence increased by 98.9%, including a significant positive trend in TWF (175%). CONCLUSIONS Surgical management of wrist arthritis remains a controversial issue. However, PRC has gained recent support in the literature, and our results reflect this shift, even for the <45-year-old cohort. Furthermore, TWA declined, despite reports of positive early outcomes for fourth-generation implants. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
Collapse
Affiliation(s)
- John M Kopriva
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA
| | - Anthony L Karzon
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA
| | - Hayden L Cooke
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA
| | - Nina Suh
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA
| | | | - Eric R Wagner
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA.
| |
Collapse
|
9
|
Gvozdenovic R, Schioedt MA, Solgaard L, Vadstrup LS, Soee NH. Limited intercarpal fusion versus proximal row carpectomy in the treatment of SLAC or SNAC wrist, results after 3.5 years. J Orthop Surg Res 2023; 18:681. [PMID: 37705034 PMCID: PMC10498579 DOI: 10.1186/s13018-023-04177-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/09/2023] [Indexed: 09/15/2023] Open
Abstract
The present study compares the postoperative clinical, radiological, and patient-reported functional results between the surgical procedures Proximal Row Carpectomy and Limited Carpal Fusion, in the treatment of SLAC and SNAC conditions of the wrist. 15 Proximal Row Carpectomy patients and 45 Limited Carpal Fusion patients were included in the study. Postoperative outcomes were assessed and compared for pain at load, range of motion, grip strength, Quick-DASH, and satisfaction. A radiological assessment was performed at the follow-up. The Proximal Row Carpectomy patients had a mean age of 60 years (range 31-77) and a mean follow-up of 42 months. The Limited Carpal Fusion patients had a mean age of 58 years (range 35-76) and a mean follow-up of 41 months. The patients treated with Limited Carpal Fusion performed significantly better regarding pain, radial-ulnar motion, and the Quick-DASH (p = 0.002, p = 0.003, and p = 0.002), respectively. The grip strength difference between the treatment groups was stratified for gender and was found significantly better for men in the LCF-treated patients, but not different for women (p = 0.03, p = 0.26), respectively. Differences in flexion-extension between the groups were insignificant (p = 0.525). A higher conversion rate to total wrist fusion was observed in the patients treated with the Proximal Row Carpectomy. All the Proximal Row Carpectomy patients had osteoarthritis at follow-up, whereas it was seen in 19% of the Limited Carpal Fusion patients. The patient-reported satisfaction was substantially better for the Limited Carpal Fusion patients. In conclusion, among patients treated for SNAC and SLAC wrist conditions, besides the findings of flexion-extension, and grip strength which were found without difference for women the findings are in favour of Limited Carpal Fusion compared to Proximal Row Carpectomy. Further, preferably prospective studies are needed to confirm or reject our findings.Level of evidence: Retrospective, comparative cohort study, level III.
Collapse
Affiliation(s)
- Robert Gvozdenovic
- Department of Hand Surgery, Herlev/Gentofte University Hospital of Copenhagen, Hospitalsvej 1, 2900, Hellerup, Denmark.
- Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.
| | - Martina Agerskov Schioedt
- Department of Hand Surgery, Herlev/Gentofte University Hospital of Copenhagen, Hospitalsvej 1, 2900, Hellerup, Denmark
| | - Lars Solgaard
- Department of Hand Surgery, Herlev/Gentofte University Hospital of Copenhagen, Hospitalsvej 1, 2900, Hellerup, Denmark
| | - Lars Soelberg Vadstrup
- Department of Hand Surgery, Herlev/Gentofte University Hospital of Copenhagen, Hospitalsvej 1, 2900, Hellerup, Denmark
| | - Niels Henrik Soee
- Department of Hand Surgery, Herlev/Gentofte University Hospital of Copenhagen, Hospitalsvej 1, 2900, Hellerup, Denmark
| |
Collapse
|
10
|
Schäfer RC, Nusche A, Einzmann A, Illg C, Daigeler A, Rachunek K. The corticocancellous press fit iliac crest bone dowel for recalcitrant scaphoid nonunion: analysis of union rate and clinical outcome. Arch Orthop Trauma Surg 2023; 143:6001-6010. [PMID: 37012506 PMCID: PMC10449721 DOI: 10.1007/s00402-023-04846-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/12/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Scaphoid nonunion after failed primary treatment remains challenging particularly when entailed by bone loss, avascular necrosis or deformity. We describe a scaphoid augmentation and fixation technique for cases of recalcitrant nonunion after screw placement by autologous press fit corticocancellous dowel. This study aims to provide reliable data on clinical and radiological outcomes and to contextualize in the face of other treatment options. MATERIAL AND METHODS The study included 16 patients with recalcitrant nonunion of the scaphoid. All patients received screw removal and scaphoid reconstruction by a dowel shaped non-vascularized corticocancellous bone graft from the iliac crest facilitating packing of the screw channel. Bone union, the scapholunate, radiolunate and intrascaphoidal angles were evaluated on X-ray and CT images, range of motion noted. Additionally grip strength, DASH and Green O'Brien scores were obtained from eight patients. RESULTS A union rate of 73% was noted after mean follow-up of 54 months. After revisional reconstruction of the scaphoid an extension-flexion rate of 84% of the healthy side was noted while pronation-supination reached 101%. DASH score averaged at 2.9, rest pain on a numeric rating scale was 0.43 with 99% peak grip force of the healthy side. CONCLUSION In complex cases of revisional scaphoid nonunion after screw placement, the corticocancellous iliac crest pressfit dowel is an option for augmentation and stabilization of the scaphoid by preserving the articular surface. LEVEL OF EVIDENCE IV, retrospective case series.
Collapse
Affiliation(s)
- Ruth Christine Schäfer
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany.
| | - Andreas Nusche
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany
| | - Anna Einzmann
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany
| | - Claudius Illg
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany
| | - Adrien Daigeler
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany
| | - Katarzyna Rachunek
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany
| |
Collapse
|
11
|
Alanen M, Stjernberg-Salmela S, Waris E, Karjalainen T, Miettunen J, Ryhänen J, Aspinen S. Proximal ROw carpectOmy versus four-corner Fusion (PROOF-trial) for osteoarthritis of the wrist: study protocol for multi-institutional double-blinded randomized controlled trial. Trials 2023; 24:499. [PMID: 37550711 PMCID: PMC10405450 DOI: 10.1186/s13063-023-07544-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 07/25/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Scapholunate advanced collapse (SLAC) and scaphoid non-union advanced collapse (SNAC) are common types of wrist osteoarthritis (OA). Non-operative treatment consists of pain medication, splinting, and avoiding activities that induce pain. However, in case a course of conservative treatment is unsuccessful, operative treatment is needed. The two most conventional operative approaches for SLAC/SNAC OA are four-corner arthrodesis (FCA) and proximal row carpectomy (PRC). Although FCA is the gold-standard operative technique and may lead to superior grip strength, the evident benefit of PRC is that it obviates any need for hardware removal and controlling for bony union. To date, no high-quality randomized controlled trial comparing FCA and PRC exists. As clinical outcomes seem comparable, a trial that assesses patient-reported outcomes, adverse events, and secondary operations may guide clinical decision making between these two procedures. Thus, the aim of this multi-institutional double-blind randomized controlled trial is to study whether PRC is non-inferior to FCA in treating SLAC/SNAC OA. We hypothesize that PRC is non-inferior to FCA with lower economic expanses. METHODS The trial is designed as a randomized, controlled, patient- and outcome-assessor blinded multicenter, two-armed 1:1 non-inferiority trial. Patients with SLAC/SNAC-induced wrist pain meeting trial inclusion criteria will undergo wrist arthroscopy to further assess eligibility. Each patient eligible for the trial will be randomly assigned to undergo either FCA or PRC. The primary endpoint of this study is the Patient Rated Wrist Evaluation (PRWE) at 1-year after FCA versus PRC. Secondary outcomes include Quick-Disabilities of the Arm, Shoulder and Hand, EQ-5D-5L, pain, grip strength, wrist active range of motion, radiographic evaluation, and adverse events. Trial design, methods, and statistical analysis plan will be presented here. DISCUSSION We present an RCT design comparing FCA vs PRC for SLAC/SNAC-induced OA. The results of this trial will assist in decision making when planning surgery for SLAC/SNAC. TRIAL REGISTRATION ClinicalTrials.gov NCT04260165 . Registered February 7, 2020.
Collapse
Affiliation(s)
- Mikko Alanen
- Department of Hand Surgery, Helsinki University Hospital, Helsinki, Finland.
| | | | - Eero Waris
- Department of Hand Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Teemu Karjalainen
- Department of Hand Surgery, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Jouko Miettunen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Jorma Ryhänen
- Department of Hand Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Samuli Aspinen
- Department of Hand Surgery, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
12
|
LoGiudice A, Awan H. Wrist Arthritis and Arthrodesis: Preserving Function, Minimizing Problems. Hand Clin 2023; 39:353-365. [PMID: 37453763 DOI: 10.1016/j.hcl.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Wrist arthritis is a common condition with numerous causes and presentations. Several management options exist, and treatment should be individualized based on patient age, comorbidities, occupation, duration of symptoms, and failed treatment modalities. Arthroscopy and denervation are appealing because of shorter recovery time and preservation of motion, but duration of effectiveness varies between patients. Patients who fail these smaller procedures or those with pancarpal arthrosis are treated effectively with total wrist arthrodesis or total wrist arthroplasty in lower-demand patients. This article reviews causes and patterns of wrist arthritis and discusses treatment strategies aimed at preserving function and minimizing complications.
Collapse
Affiliation(s)
- Anthony LoGiudice
- Department of Orthopaedic Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Hisham Awan
- Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Road, Suite 3200, Columbus, OH 43212, USA.
| |
Collapse
|
13
|
Mirza A, Mirza JB, Zappia LC, Thomas TL, Corabi J, Dusckas Z, Lubahn JD. Clinical Outcomes of Lunocapitate Arthrodesis: A Retrograde Single-Screw Approach. Hand (N Y) 2023:15589447231174041. [PMID: 37243476 DOI: 10.1177/15589447231174041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND A single-site retrospective study was designed to evaluate the clinical outcomes of single-screw lunocapitate arthrodesis (LCA) using a retrograde approach for the treatment of scapholunate advanced collapse (SLAC) wrist. METHODS We retrospectively identified 31 patients (33 cases) between September 2010 and December 2019 with SLAC wrist changes who were treated with single-screw LCA. Objective outcomes included time to fusion, union rate, range of motion, and grip and pinch strength recovery. Subjective outcomes included Disabilities of the Arm, Shoulder, and Hand (DASH) scores. RESULTS We report on 33 cases (7 female), mean age 58.4 years (range: 41-85), with SLAC wrist who underwent LCA. Our cohort reported a 94% union rate and a 90-day mean time to fusion. Final active wrist range of motion was 38° dorsiflexion, 35° volarflexion, 17° radial deviation, 17° ulnar deviation, 82° pronation, and 83° supination (mean: 450.8 days). Final grip and pinch strengths recovered was 75% gross grip, 84% lateral pinch, and 75% precision pinch (mean: 379.0 days) compared with the contralateral side. The mean postoperative DASH score was 27 (mean: 1203.9 days). Two nonunions were observed. Two hardware complications occurred: one symptomatic screw and one screw fatigue fracture. CONCLUSIONS We found retrograde single-screw LCA to be an effective salvage procedure for SLAC wrist. LCA is a less-taxing procedure, requires shorter operating time, and produces range of motion and grip and pinch strength recovery comparable to those of 4-corner arthrodesis. Furthermore, the viability of single-screw fixation may reduce hardware-related operative costs without compromising union rates.
Collapse
Affiliation(s)
- Ather Mirza
- North Shore Surgi-Center, Smithtown, NY, USA
- Mirza Orthopedics, Smithtown, NY, USA
| | - Justin B Mirza
- North Shore Surgi-Center, Smithtown, NY, USA
- Mirza Orthopedics, Smithtown, NY, USA
| | - Luke C Zappia
- Mirza Orthopedics, Smithtown, NY, USA
- New York Institute of Technology, Old Westbury, USA
| | | | | | - Zachary Dusckas
- University of Pittsburgh Medical Center Hamot, Erie, PA, USA
| | - John D Lubahn
- University of Pittsburgh Medical Center Hamot, Erie, PA, USA
- Hand, Microsurgery & Reconstructive Orthopaedics, LLP, Erie, PA, USA
| |
Collapse
|
14
|
Schindelar LE, Wang ML, Bednar JM, Miller AJ. Lunatocapitate and Triquetrohamate Arthrodeses for Degenerative Arthritis of the Wrist: A Midterm Follow-Up. Hand (N Y) 2023; 18:96S-101S. [PMID: 35088610 PMCID: PMC10052620 DOI: 10.1177/15589447211066351] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Degenerative arthritis of the wrist is a common condition often treated with 4 corner arthrodesis (FCA) or a partial wrist fusion. A number of limited intercarpal arthrodeses have been proposed for treatment of this condition. One technique, described by Wang and Bednar in 2012, involves fusion of the lunatocapitate and triquetrohamate joints. This study presents midterm follow-up of outcomes following this 2 column arthrodesis. METHODS From 2000 to present, patients who underwent lunatocapitate and triquetrohamate arthrodesis were evaluated. The original cohort from the 2012 study was reviewed, as well as any additional patients who since underwent this procedure. Only patients who had greater than 5 years of follow-up data were included. Outcomes included demographics, wrist range of motion, grip strength, complications, and radiographic evidence of union. RESULTS Twenty-one cases were included in the final analysis. Mean follow-up was 8.75 years. Wrist extension and flexion were 58% and 90% of the unaffected side, respectively. Grip strength was 92% of the unaffected side. Osseous union was achieved in 95.2% of cases. Two cases underwent revision surgery, one for nonunion and one following a fall. CONCLUSIONS Lunatocapitate and triquetrohamate arthrodesis offers a treatment for wrist arthritis that yields good clinical outcomes, low nonunion rates, and no conversions to total wrist arthrodesis, as shown by 5-year follow-up data. Limited intercarpal arthrodesis is an alternative to FCA, with the advantage of a smaller surgical footprint and simpler technique, while still providing excellent mid- to long-term outcomes.
Collapse
Affiliation(s)
| | - Mark L. Wang
- Thomas Jefferson University, Philadelphia, PA, USA
- The Rothman Institute, Philadelphia, PA, USA
| | - John M. Bednar
- Thomas Jefferson University, Philadelphia, PA, USA
- Philadelphia Hand to Shoulder Center, PA, USA
| | - Andrew J. Miller
- Thomas Jefferson University, Philadelphia, PA, USA
- Philadelphia Hand to Shoulder Center, PA, USA
| |
Collapse
|
15
|
Risk of Total Wrist Arthrodesis Following Proximal Row Carpectomy: An Analysis of 1,070 Patients. J Hand Surg Am 2023; 48:195.e1-195.e10. [PMID: 34857405 DOI: 10.1016/j.jhsa.2021.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 07/23/2021] [Accepted: 09/22/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Proximal row carpectomy (PRC) is a motion-sparing procedure with good patient-reported and clinical outcomes. Although some studies have investigated the risk of conversion to total wrist arthrodesis (TWA) after PRC, additional larger studies evaluating the specific risk factors that lead to failure are required. This study aimed to investigate the patient and procedure factors that are associated with increased risk for conversion to TWA in a large cohort of patients who underwent PRC. METHODS The current procedural technology codes identified patients in a National Veteran's Health database undergoing a PRC over a 26-year period. Risk factors of interest comprised age, posterior interosseous nerve neurectomy, wrist arthritis pattern, bilateral surgery, smoking, comorbidities, and preoperative opioid use. The primary outcome was the rate of conversion to TWA. Cox proportional hazard regression was used to create hazard ratios of selected factors for reoperation. RESULTS There were 1,070 PRCs performed, with a mean follow-up of 79.8 ± 59.6 months. A total of 5.3% (57/1,070) wrists underwent conversion to TWA. Younger age at the time of PRC (<50 years) significantly increased the risk of TWA (hazard ratio, 3.8; 95% confidence interval, 2.2-6.6). With every 1-year increase in age, there was a reduction of 4% (hazard ratio, 0.96; 95% confidence interval: 0.94-0.98) in the hazard of conversion to TWA. No other factors, including concomitant posterior interosseous nerve neurectomy or bilateral PRC, increased the risk of conversion to TWA. CONCLUSIONS Proximal row carpectomy is a motion-preserving salvage procedure with a low rate of conversion to wrist arthrodesis. Younger patient age increases the risk of conversion to arthrodesis, whereas posterior interosseous nerve neurectomy, bilateral PRCs, and comorbidity status do not appear to have an impact on the risk of arthrodesis. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
Collapse
|
16
|
Perry AC, Wilkes C, Curran MWT, Ball BJ, Morhart MJ. Proximal Row Carpectomy Modifications for Capitate Arthritis: A Systematic Review. J Wrist Surg 2023; 12:86-94. [PMID: 36644731 PMCID: PMC9836777 DOI: 10.1055/s-0042-1751013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 05/12/2022] [Indexed: 01/18/2023]
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.
Collapse
Affiliation(s)
- Alexander C. Perry
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Courtney Wilkes
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew W. T. Curran
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Brandon J. Ball
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Michael J. Morhart
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
17
|
Garcia BN, Lu CC, Chen W, Stephens AR, Kazmers NH, Sauer BC, Tyser A. Factors Associated With Unplanned Reoperation After 4-Corner Arthrodesis: A Study of 478 Wrists. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 5:1-5. [PMID: 36704368 PMCID: PMC9870791 DOI: 10.1016/j.jhsg.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/24/2022] [Indexed: 11/27/2022] Open
Abstract
Purpose The 4-corner arthrodesis (FCA) is a reliable, motion-sparing technique used to treat scapholunate advanced collapse and scaphoid nonunion advanced collapse arthritis, particularly in stage III wrists in which the capitolunate articulation is compromised. Surgical technique and patient-level variables may influence complications following FCA. We sought to evaluate the rate of complications in a large, combined database and manual chart review study. Methods Current Procedural Terminology codes were used to search the United States Veteran's Health Administration corporate database to identify wrists treated with FCA over a 24-year period. A retrospective chart review was completed to collect data regarding scapholunate advanced collapse/scaphoid nonunion advanced collapse stage, implant used, the use of a bone graft, smoking status, and comorbidities for all patients undergoing an FCA. A multivariable cox proportional hazards regression was used to assess hazard ratios for reoperation. Incidence rates and the standard error of the mean for reoperation and conversion to total wrist fusion were calculated after grouping patients by 10-year age categories. Results A total of 478 wrists underwent FCA during the study period, with a mean follow-up of 63 months. Seventy-three (16%) wrists required reoperation. The most frequent secondary procedures included unplanned implant removal (8.2%), total wrist arthrodesis (4.6%), and revision FCA (1.7%). Positive smoking history increased the risk of reoperation, whereas posterior interosseous nerve neurectomy, arthritis stage, and fixation type did not have a statistically significant association with reoperation. Younger age demonstrated an increased incidence of overall reoperation and wrist fusion. Conclusions The most common reason for reoperation after FCA was implant removal. Smoking history is associated with increased rates of reoperation and wrist arthrodesis. Knowledge of these factors may assist with accurately counseling and indicating patients for FCA. Type of study/level of evidence Therapeutic III.
Collapse
Affiliation(s)
- Brittany N. Garcia
- Department of Orthopaedic Surgery, University of Utah Hospital, Salt Lake City, UT,Corresponding author: Brittany N. Garcia, MD, Department of Orthopaedic Surgery, University of Utah Hospital, 590 Wakara Way, Salt Lake City, UT 84108.
| | - Chao-Chin Lu
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City Veterans Affairs IDEAS Center, Salt Lake City, UT,Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Wei Chen
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City Veterans Affairs IDEAS Center, Salt Lake City, UT,Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Andrew R. Stephens
- Department of Physical Medicine and Rehabilitation, University of Rochester, Rochester, NY
| | - Nikolas H. Kazmers
- Department of Orthopaedic Surgery, University of Utah Hospital, Salt Lake City, UT
| | - Brian C. Sauer
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City Veterans Affairs IDEAS Center, Salt Lake City, UT,Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Andrew Tyser
- Department of Orthopaedic Surgery, University of Utah Hospital, Salt Lake City, UT
| |
Collapse
|
18
|
Teunissen JS, Duraku LS, Feitz R, Zuidam JM, Selles RW, Wouters RM. Routinely-Collected Outcomes of Proximal Row Carpectomy. J Hand Surg Am 2022:S0363-5023(22)00539-1. [PMID: 36372595 DOI: 10.1016/j.jhsa.2022.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 08/11/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE To describe patient-reported pain and function 12 months after proximal row carpectomy (PRC). Secondary outcomes included return to work, grip strength, range of wrist motion, satisfaction with treatment results, and complications. METHODS This cohort study was part of the British Society for Surgery of the Hand Studyathon 2021, using ongoing routinely-collected data of 304 eligible patients who underwent PRC (73% scapholunate advanced collapse, 11% scaphoid nonunion advanced collapse wrist; 11% Kienböck, 5% other indications) from Xpert Clinics, the Netherlands between 2012-2020. The primary outcome was the Patient Rated Wrist/Hand Evaluation total score (range, 0-100, lower scores indicate better performance). RESULTS Of the 304 patients, the primary outcome was available in 217 patients. The total Patient Rated Wrist/Hand Evaluation score improved from 60 (95% confidence interval [CI], 57-63) to 38 (95% CI, 35-41) at 3 months, and 26 (95% CI, 23-29) at 12 months. The pain and function subscales improved by 18 (95% CI, 17-20) and 16 (95% CI, 14-18) points, respectively. At 12 months, 82% had returned to work at a median time of 12 (95% CI, 9-14) weeks following PRC. Grip strength did not improve. Wrist flexion and extension demonstrated a clinically irrelevant decrease. Satisfaction with treatment result was excellent in 27% of patients, good in 42%, fair in 20%, moderate in 6%, and poor in 5%. Complications occurred in 11% of patients, and conversion to wrist arthroplasty occurred in 2 patients. CONCLUSION A clinically relevant improvement in patient-reported pain and function was observed at 3 months after PRC, with continued improvement to 12 months. These data can be used for shared-decision making and expectation management. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Joris S Teunissen
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands; Hand and Wrist Center, Xpert Clinics, Amsterdam, The Netherlands.
| | - Liron S Duraku
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Reinier Feitz
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands; Hand and Wrist Center, Xpert Clinics, Amsterdam, The Netherlands
| | - J Michiel Zuidam
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robbert M Wouters
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
19
|
Llopis E, Cerezal L, Auban R, Aguilella L, Piñal FD. Postoperative Imaging of the Wrist and Hand. Magn Reson Imaging Clin N Am 2022; 30:645-671. [DOI: 10.1016/j.mric.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
20
|
Chammas PE, Hadouiri N, Chammas M, Ramos-Pascual S, Stirling P, Nover L, Klouche S. Proximal row carpectomy generates better mid- to long-term outcomes than four-corner arthrodesis for post-traumatic wrist arthritis: A meta-analysis. Orthop Traumatol Surg Res 2022; 108:103373. [PMID: 35940440 DOI: 10.1016/j.otsr.2022.103373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/04/2022] [Accepted: 04/25/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION In posttraumatic wrist arthritis of intermediate severity, two main palliative procedures are used to preserve some mobility in the wrist: proximal row carpectomy (PRC) and scaphoid excision followed by four corner arthrodesis (4CA). Despite satisfactory overall results, the debate continues about which one provides the best results and long-term outcomes, particularly prevention of arthritis progression. Recent comparative studies now provide us with information about mid- and long-term results. The aim of this study was to compare the clinical results, complications, conversion rate to total wrist arthrodesis and progression to osteoarthritis of PRC versus 4CA in the medium and long term. HYPOTHESIS The null hypothesis was that there is no significant difference between PRC and 4CA in the clinical results, complications, conversion to total wrist arthrodesis and arthritis progression. MATERIALS AND METHODS A systematic literature review was carried out by following the PRISMA guidelines. Included were studies comparing 4CA and PRC for the treatment of post-traumatic wrist arthritis secondary to scapholunate dissociation (SLAC) and scaphoid nonunion (SNAC) with a mean follow-up of 5 years. A search was performed of the MEDLINE, EMBASE and Cochrane databases that identified 831 articles. After removing 230 duplicates and excluding 595 articles based on their title and/or abstract, and then adding 1 article manually, 7 articles were included in our analysis. Parameters analyzed were range of motion (ROM), pain, grip strength, functional scores, complications, conversion to total wrist arthrodesis, and arthritis progression. RESULTS In the 7 articles, 1059 wrists - 582 PRC and 477 4CA - were analyzed with follow-up ranging from 5.2 to 18 years. PRC produced significantly better ROM in flexion (weighted mean difference [WMD]=10.0°; p<0.01) and in ulnar deviation (WMD=8.7°; p<0.01) along with significantly lower complication rates (OR=0.3; p<0.01) and reoperation rates (OR=0.1; p<0.01). There was no significant difference in the conversion rate, grip strength, extension, radial deviation, pain, DASH and PRWE scores. The progression of osteoarthritis could not be analyzed due to lack of data. DISCUSSION This meta-analysis was the first to include recently published mid- and long-term studies comparing PRC and 4CA. The main finding is that PRC is superior overall with better ROM and a lower complication rate. Another important finding was the absence of differences in grip strength and the conversion rate to total wrist arthrodesis. Unfortunately, the lack of systematic studies on arthritis progression leaves this question unanswered. Our findings must be interpreted cautiously because it was impossible to stratify the cases by etiology and osteoarthritis stage. LEVEL OF EVIDENCE III; systematic review and meta-analysis.
Collapse
Affiliation(s)
- Pierre-Emmanuel Chammas
- Hand and Upper Extremity Surgery Unit, Lapeyronie Hospital, Montpellier University Medical Center, Av. du Doyen Gaston Giraud 371, 34295 Montpellier, France; Collège des Jeunes Orthopédistes, Rue Boissonade 56, 75014 Paris, France.
| | - Nawale Hadouiri
- Department of Physical Medicine and Rehabilitation, Dijon-Bourgogne University Hospital, Boulevard du Maréchal de Lattre de Tassigny 2, 21000 Dijon, France; InterSyndicale Nationale des Internes, Rue du Fer À Moulin 17, 75005 Paris, France
| | - Michel Chammas
- Hand and Upper Extremity Surgery Unit, Lapeyronie Hospital, Montpellier University Medical Center, Av. du Doyen Gaston Giraud 371, 34295 Montpellier, France
| | | | | | - Luca Nover
- ReSurg SA, Rue Saint Jean 22, 1260 Nyon, Switzerland
| | | |
Collapse
|
21
|
van Rijt WG, Delnoy RE, Bonhof-Jansen EEDJ, de Jong TR. The role of routine radial styloidectomy in proximal row carpectomy: a retrospective review of 120 patients. J Hand Surg Eur Vol 2022; 47:705-710. [PMID: 35331038 DOI: 10.1177/17531934221087588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Impingement between the radial styloid and the trapezium can occur after a proximal row carpectomy (PRC). We hypothesized that a PRC with primary radial styloidectomy reduces the risk of radial impingement, without affecting clinical or functional outcomes. In this retrospective cohort study, 120 patients were divided into two groups: PRC with or without primary radial styloidectomy. Patient-related outcome, strength and range of motion after proximal row carpectomy were measured in a subgroup. The occurrence of radial impingement was significantly lower in the group with primary radial styloidectomy versus those without (p = 0.002). Five patients in the latter group were subsequently treated by a secondary radial styloidectomy, as compared with one patient who underwent primary radial styloidectomy (p = 0.034). There were no significant differences in range of motion or patient-related outcome observed between the two groups. From our study, a radial styloidectomy is recommended as a routine part of the PRC procedure to prevent radial impingement without negatively impacting on function.Level of evidence: IV.
Collapse
Affiliation(s)
| | - Robin E Delnoy
- Department of Plastic Surgery, Isala, Zwolle, The Netherlands
| | | | | |
Collapse
|
22
|
Two-Corner Fusion or Four-Corner Fusion of the Wrist for Midcarpal Osteoarthritis? A Multicenter Prospective Comparative Cohort Study. Plast Reconstr Surg 2022; 149:1130e-1139e. [PMID: 35404339 DOI: 10.1097/prs.0000000000009116] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Midcarpal osteoarthritis is a debilitating wrist pain, and a mainstay treatment is midcarpal fusion. The accepted standard for midcarpal fusion is four-corner fusion, but lately, two-corner fusion (i.e., capitolunate fusion) has gained popularity. This is the first prospective, multicenter, cohort study comparing capitolunate fusion with four-corner fusion for midcarpal osteoarthritis. METHODS Patients with scaphoid nonunion advanced collapse or scapholunate advanced collapse wrist of grade 2 to 3 undergoing capitolunate fusion or four-corner fusion between 2013 and 2019 were included. Sixty-three patients (34 with capitolunate fusion, 29 with four-corner fusion) were included. Patient demographics were similar between groups. Patient-Rated Wrist Hand Evaluation questionnaire score, visual analog scale pain score, grip strength, range of motion, and complications were measured at baseline and 3 months and 12 months postoperatively. Complications (i.e., nonunion, hardware migration, conversion to wrist arthrodesis, or arthroplasty) were determined. RESULTS A significant difference in Patient-Rated Wrist Hand Evaluation or visual analog scale pain score at 3 and 12 months postoperatively between the capitolunate fusion and four-corner fusion groups was not found. There were no differences in grip strength between patient groups preoperatively or 12 months postoperatively. At 12 months postoperatively, capitolunate fusion patients had better flexion compared with that in the four-corner fusion group (p = 0.002); there were no differences in complications and reoperation rates between groups. CONCLUSIONS Capitolunate fusion and four-corner fusion were comparable in terms of functional scores (i.e., Patient-Rated Wrist Hand Evaluation and visual analog scale pain scores) and complication scores. Capitolunate fusion showed favorable wrist mobility compared with four-corner fusion in treatment of midcarpal osteoarthritis. Capitolunate fusion advantages include use of less material, less need for bone-graft harvesting, and easier reduction of the lunate during fixation. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
Collapse
|
23
|
Stephens AR, Garcia BN, Rogers MJ, Zhang C, Himbert C, McFarland MM, Presson AP, Kazmers NH, Tyser AR. Scaphotrapeziotrapezoid Arthrodesis: Systematic Review. J Hand Surg Am 2022; 47:218-227.e2. [PMID: 35033404 DOI: 10.1016/j.jhsa.2021.09.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 05/10/2021] [Accepted: 09/21/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Scaphotrapeziotrapezoid (STT) arthrodesis surgery is used for various types of wrist pathologies. The objective of our study was to perform a systematic review of complications and outcomes after STT arthrodesis. METHODS Several major databases were used to perform a systematic literature review in order to obtain articles reporting complications and outcomes following STT arthrodesis. The primary purpose was to identify rates of nonunion and conversion to total wrist arthrodesis. Secondary outcomes included wrist range of motion, grip strength, and Disabilities of the Arm Shoulder and Hand scores. A multivariable analysis was performed to evaluate factors associated with the primary and secondary outcomes of interest. RESULTS Out of the 854 records identified in the primary literature search, 30 studies were included in the analysis. A total of 1,429 procedures were performed for 1,404 patients. The pooled nonunion rate was 6.3% (95% CI, 3.5-9.9) and the rate of conversion to total wrist arthrodesis following the index STT was 4.2% (95% CI, 2.2-6.7). The mean pooled wrist flexion was 40.7° (95% CI, 30.8-50.5) and extension was 49.7° (95% CI, 43.5-55.8). At final follow-up, the mean pooled grip strength was 75.9% (95% CI, 69.3-82.5) of the nonsurgical contralateral hand. Compared with all other known indications, Kienbock disease had a statistically significant lower nonunion rate (14.1% vs 3.3%, respectively). Mixed-effects linear regression using patient-level data revealed that increasing age was significantly associated with complications, independent of occupation and diagnosis. CONCLUSIONS Our study demonstrated a low failure rate and conversion to total wrist arthrodesis after STT arthrodesis and acceptable postoperative wrist range of motion and strength when compared to the contralateral hand. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
| | | | - Miranda J Rogers
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
| | - Chong Zhang
- Division of Public Health, University of Utah, Salt Lake City, UT
| | | | - Mary M McFarland
- Eccles Health Sciences Library, University of Utah, Salt Lake City, UT
| | | | | | - Andrew R Tyser
- Department of Orthopaedics, University of Utah, Salt Lake City, UT.
| |
Collapse
|
24
|
Moran TE, Akinleye SD, Demers AJ, Forster GL, DeGeorge BR. Opioid Prescribing for Proximal Row Carpectomy versus Four-Corner Arthrodesis. J Wrist Surg 2022; 11:54-61. [PMID: 35127265 PMCID: PMC8807101 DOI: 10.1055/s-0041-1731821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/01/2021] [Indexed: 10/20/2022]
Abstract
Background Proximal row carpectomy (PRC) and four-corner arthrodesis (4-CA) represent motion-sparing procedures for addressing degenerative wrist pathologies. While both procedures demonstrate comparable functional outcomes, postoperative pain presents a surgical challenge that often necessitates the use of opioids. Objectives The aim of this study was to (1) compare opioid prescribing patterns surrounding PRC and 4-CA, (2) identify risk factors predisposing patients to increased perioperative and prolonged postoperative opioids, and (3) examine the association between opioids and perioperative health care utilization. Patients and Methods PearlDiver Patients Records Database was used to retrospectively identify patients undergoing primary PRC and 4-CA between 2010 and 2018. Patient demographics, comorbidities, prescription drug usage, and perioperative health care utilization were evaluated. Perioperative opioid prescriptions and post-operative opioid prescriptions were recorded. Logistic regression analysis evaluated the association of patient risk factors. Results There was no significant difference in perioperative (PRC [odds ratio {OR}: 0.84, p = 0.788]; 4-CA [OR: 0.75, p = 0.658]) or prolonged postoperative opioid prescriptions (PRC [OR: 0.95, p = 0.927]; 4-CA [OR: 0.99, p = 0.990]) between PRC and 4-CA. Chronic back pain and use of benzodiazepines or anticonvulsants were associated with increased risks of prolonged postoperative opioids. Prolonged postoperative opioids presented increased risks of emergency department visits (OR: 2.09, p = 0.019) and hospital readmissions (OR: 10.2, p = 0.003). Conclusion No significant differences exist in the prescription of opioids for PRC versus 4-CA. Both procedures have high amounts of prolonged postoperative opioid use, which is associated with increased risks of emergency department visits and hospital readmissions. Level of Evidence This is a level III, retrospective comparative study.
Collapse
Affiliation(s)
- Thomas E. Moran
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Sheriff D. Akinleye
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Alex J. Demers
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Grace L. Forster
- Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia
| | - Brent R. DeGeorge
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
- Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia
| |
Collapse
|
25
|
Andronic O, Nagy L, Burkhard MD, Casari FA, Karczewski D, Kriechling P, Schweizer A, Jud L. Long-term outcomes of the four-corner fusion of the wrist: A systematic review. World J Orthop 2022; 13:112-121. [PMID: 35096541 PMCID: PMC8771412 DOI: 10.5312/wjo.v13.i1.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 10/26/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Four-corner fusion (4CF) is a motion sparing salvage procedure that is used to treat osteoarthritis secondary to advanced scapholunate collapse or longstanding scaphoid nonunion advanced collapse. Little is known about the long-term survivorship and outcomes of 4CF.
AIM To report on clinical and functional long-term outcomes as well as conversion rates to total wrist fusion or arthroplasty.
METHODS The systematic review protocol was registered in the international prospective register of systematic reviews (PROSPERO) and followed the PRISMA guidelines. Original articles were screened using four different databases. Studies with a minimum Level IV of evidence that reported on long-term outcome after 4CF with a minimum follow-up of 5 years were included. Quality assessment was performed using the Methodological Index for Non-Randomized Studies criteria.
RESULTS A total of 11 studies including 436 wrists with a mean follow-up of 11 ± 4 years (range: 6-18 years) was included. Quality assessment according to Methodological Index for Non-Randomized Studies criteria tool averaged 69% ± 11% (range: 50%-87%). Fusion rate could be extracted from 9/11 studies and averaged 91%. Patient-reported outcomes were extracted at last follow-up from 8 studies with an average visual analog scale of 1 ± 1 (range: 0-2) and across 9 studies with an average Disabilities of the Arm, Shoulder and Hand score of 21 ± 8 (range: 8-37). At last follow-up, the cumulative conversion rate to total wrist fusion averaged 6%. There were no conversions to total wrist arthroplasty.
CONCLUSION The 4CF of the wrist is a reliable surgical technique, capable of achieving a good long-term patient satisfaction and survivorship with low rates of conversion to total wrist fusion.
Collapse
Affiliation(s)
- Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Switzerland, Zürich 8008, Switzerland
| | - Ladislav Nagy
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Switzerland, Zürich 8008, Switzerland
| | - Marco D Burkhard
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Switzerland, Zürich 8008, Switzerland
| | - Fabio A Casari
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Switzerland, Zürich 8008, Switzerland
| | - Daniel Karczewski
- Department of Trauma and Orthopaedics, Charitè University Medicine Berlin, Center for Musculoskeletal Surgery, Berlin 10117, Germany
| | - Philipp Kriechling
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Switzerland, Zürich 8008, Switzerland
| | - Andreas Schweizer
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Switzerland, Zürich 8008, Switzerland
| | - Lukas Jud
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Switzerland, Zürich 8008, Switzerland
| |
Collapse
|
26
|
Saiz A, Delman CM, Haffner M, Wann K, McNary S, Szabo RM, Bayne CO. The Biomechanical Effects of Simulated Radioscapholunate Fusion With Distal Scaphoidectomy, 4-Corner Fusion With Complete Scaphoidectomy, and Proximal Row Carpectomy Compared to the Native Wrist. J Hand Surg Am 2021; 46:1125.e1-1125.e8. [PMID: 33934922 DOI: 10.1016/j.jhsa.2021.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 12/12/2020] [Accepted: 02/24/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the effect of simulated radioscapholunate fusion with distal scaphoid excision (RSLF+DSE), 4-corner fusion with scaphoidectomy (4-CF), and proximal row carpectomy (PRC) on the wrist's range of motion (ROM), contact pressure, and contact force in a cadaveric model. METHODS Ten freshly frozen cadaveric wrists were tested under 4 sequential conditions: native wrist, RSLF+DSE, 4-CF, and PRC. The simulated fusions were performed using two 1.6-mm Kirschner wires. The ROM in the flexion-extension and radioulnar deviation planes was evaluated. Contact area, contact pressure, and contact force were measured at the scaphocapitolunate joint for the RSLF+DSE simulation and radiocarpal joint for the 4-CF and PRC simulations. Mechanical testing was performed using a 35-N uniaxial load and pressure-sensitive film. RESULTS The RSLF+DSE and 4-CF groups had a decreased wrist arc ROM compared with the native wrist. The PRC group had a greater wrist arc ROM compared with the RSLF+DSE and 4-CF groups, but compared to the native wrist, it demonstrated a mildly decreased wrist arc ROM. The carpal pressure and contact force were significantly increased in the RSLF+DSE, 4-CF, and PRC groups compared with those in the native wrist. The RSLF+DSE group had the smallest increase in the carpal pressure and contact force, whereas the PRC group had the greatest increase. CONCLUSIONS Our study validates previous findings that PRC is motion-conserving but has the greatest contact force, whereas RSLF-DSE and 4-CF may cause a decrease in the ROM but have lower contact forces. CLINICAL RELEVANCE Understanding the underlying native wrist biomechanics and alterations following different surgical treatments may assist hand surgeons in their clinical decision making for the treatment of stage II scapholunate advanced collapse.
Collapse
Affiliation(s)
- Augustine Saiz
- Department of Orthopaedic Surgery, University of California, Davis Medical Center, Sacramento, CA
| | - Connor M Delman
- Department of Orthopaedic Surgery, University of California, Davis Medical Center, Sacramento, CA.
| | - Max Haffner
- Department of Orthopaedic Surgery, University of California, Davis Medical Center, Sacramento, CA
| | - Kathy Wann
- Department of Orthopaedic Surgery, University of California, Davis Medical Center, Sacramento, CA
| | - Sean McNary
- Department of Orthopaedic Surgery, University of California, Davis Medical Center, Sacramento, CA
| | - Robert M Szabo
- Department of Orthopaedic Surgery, University of California, Davis Medical Center, Sacramento, CA
| | - Christopher O Bayne
- Department of Orthopaedic Surgery, University of California, Davis Medical Center, Sacramento, CA
| |
Collapse
|
27
|
The never-ending battle between proximal row carpectomy and four corner arthrodesis: A systematic review and meta-analysis for the final verdict. J Plast Reconstr Aesthet Surg 2021; 75:711-721. [PMID: 34802951 DOI: 10.1016/j.bjps.2021.09.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 07/04/2021] [Accepted: 09/27/2021] [Indexed: 12/16/2022]
Abstract
While scaphoid excision combined with Four Corner Arthrodesis (FCA) or Proximal Row Carpectomy (PRC) is a commonly-used salvage procedures to treat type two and type three Scapholunate Advanced Collapse (SLAC) and Scaphoid Nonunion Advanced Collapse (SNAC)-induced degenerative arthritis, controversy remains over which treatment intervention provides superior outcomes. We searched for articles comparing a range of motion, grip strength, complications requiring reoperation, conversion to wrist arthrodesis, pain, and disability of shoulder and arm scores between FCA and PRC-treated patients. The risk of bias was assessed using the National Institutes of Health (NIH) quality assessment tool. We performed a meta-analysis using Random-Effects Models. Fifteen articles (10 retrospective, 2 cross-sectional, 1 prospective, and 2 randomized trials) were included. There was no significant difference between PRC and FCA in any of the different outcome measures. The risk of bias was found consistently high across all studies. Despite the lack of high-quality evidence, based on existing literature, we recommend PRC as the preferred choice of treatment because of the simplicity of the surgical procedure, lack of hardware-related complications, and comparable long-term outcomes. Level of evidence: III - Therapeutic.
Collapse
|
28
|
Wallace DD, Karmali RN, Kim C, White AM, Stange KC, Lich KH. Identifying Patient Strengths Instruments and Examining Their Relevance for Chronic Disease Management: A Systematic Review. Prev Chronic Dis 2021; 18:E41. [PMID: 33914678 PMCID: PMC8091945 DOI: 10.5888/pcd18.200323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Most health care focuses on patients' deficits to encourage behavior change. A strengths-based approach, which relies on identifying patient strengths, has great potential to facilitate behavior change for chronic disease management. Little is known about instruments used to assess patient strengths. We conducted a systematic review to identify validated instruments that assess personal strengths by using a theory elaboration approach. METHODS We searched 8 databases including Web of Science, Cumulative Index of Nursing and Allied Health (CINAHL), and PsycINFO (through July 2019) to identify peer reviewed, English-language studies that described strength-based instruments. Thereafter, we evaluated the validity and reliability of the instruments according to 18 Scientific Advisory Committee of the Medical Outcome Trust (SACMOT) criteria, and used an inductive, iterative editing process to identify constructs measured by the instruments. RESULTS We identified 26 instruments that met our inclusion criteria. The instruments were validated in various clinical and nonclinical populations. Only 4 instruments met most of the SACMOT criteria for validation. We extracted 91 unique constructs that fell into 3 domains: inner strengths (49), external strengths (13), and personality constructs (29). CONCLUSION A limited number of reliable and valid instruments are available to assess strengths for the adult population, particularly for clinical populations. Internal strengths can be leveraged to improve patient health; however, the development and validation of additional instruments to capture personal strengths is necessary to examine the multilevel influence of external strengths on individual behaviors and well-being.
Collapse
Affiliation(s)
- Deshira D Wallace
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Health Behavior, University of North Carolina at Chapel Hill, 302 Rosenau Hall, 135 Dauer Dr, CB7440, Chapel Hill, NC 27599.
| | - Ruchir N Karmali
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Northern California Kaiser Permanente Division of Research, Oakland, California
| | - Christine Kim
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ann Marie White
- University of Rochester Medical Center, Rochester, New York.,Children's Institute, Rochester, New York
| | - Kurt C Stange
- Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio
| | - Kristen Hassmiller Lich
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
29
|
Wagner ER, Spencer CC, Dawes AM, Gottschalk MB, Daly CA. Management of Proximal Pole Scaphoid Nonunions: A Critical Analysis Review. JBJS Rev 2021; 9:01874474-202104000-00001. [PMID: 33819205 DOI: 10.2106/jbjs.rvw.19.00181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Optimal management of nonunions of the proximal pole of the scaphoid is controversial and dependent on many patient and pathophysiologic considerations. » If the proximal pole subchondral bone support is sufficient, options include open reduction and internal fixation, either alone or in combination with autologous nonvascularized or vascularized bone graft. » If the proximal pole is not salvageable, replacement with osteochondral autografts or osteochondral flaps is the only option for reconstruction of the native anatomy.
Collapse
Affiliation(s)
- Eric R Wagner
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | | |
Collapse
|
30
|
Campbell CC, Neustein TM, Daly CA, Wagner ER. Surgical Treatment of Wrist Arthritis in Young Patients. JBJS Rev 2021; 8:e0078. [PMID: 32149931 DOI: 10.2106/jbjs.rvw.19.00078] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Surgical treatment of wrist arthritis in the younger patient population remains a challenging issue, and various surgical options need to be carefully considered for each patient. Proximal row carpectomy and 4-corner arthrodesis have proven to be reliable options for reducing pain and restoring adequate function in most young high-demand patients if the lunate facet is spared. Selective neurectomy has proven to be a promising stand-alone or complementary procedure for the treatment of pain that is associated with wrist arthritis in patients of all ages, with spared motion and the opportunity to perform additional procedures if pain continues. Alternative procedures, including capitolunate arthrodesis, total wrist arthrodesis, radial styloidectomy, total wrist arthroplasty, and wrist hemiarthroplasty, have considerable strengths and weaknesses and need to be studied further in younger patients.
Collapse
|
31
|
Reigstad O, Holm-Glad T, Dovland P, Korslund J, Grimsgaard C, Thorkildsen RD, Røkkum M. Progressing arthrosis and a high conversion rate 11 (4-19) years after four corner fusion. J Plast Surg Hand Surg 2021; 55:354-360. [PMID: 33733991 DOI: 10.1080/2000656x.2021.1898970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Four corner fusion (4CF) is a limited wrist arthrodesis offered to patients with painful wrists due to scaphoid non-union advanced collapse (SNAC) or scapho-lunate advanced collapse (SLAC). A retrospective study of 42 wrists (in 36 patients), operated with 4CF using K-wires and autologous bone graft followed up after 11 (4-19) years was performed, 25 were male and mean age at surgery was 51 (22-71) years. During the follow-up period, 13 wrists were converted to total wrist arthrodesis or wrist arthroplasty, and one is scheduled for conversion (14/42, 33%) due to non-union (3), DISI and progressing arthrosis (7) or progressing arthrosis (4). Non-union was seen in 3/42 (93%) wrists, all were later converted. At the final follow-up, the patients reported residual pain, VAS = 15 and 36 at rest and activity, respectively, and QDASH/PRWHE = 32 and 31, respectively. Active range of motion (AROM) was 38% and grip-strength was 76% compared to the uninjured side. Degenerative changes were seen in 88% on CT scans at follow-up. 4CF renders an acceptable pain reduction and function in the majority of patients, but increased degeneration and a high number of conversions after a longer follow-up time is concerning.
Collapse
Affiliation(s)
- Ole Reigstad
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trygve Holm-Glad
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Preben Dovland
- Department of Orthopedics, Østfold Hospital Trust, Graalum, Norway
| | - Johanne Korslund
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Rasmus D Thorkildsen
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magne Røkkum
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
32
|
Margulies IG, Xu H, Gopman JM, Freeman MD, Dayan E, Taub PJ, Melamed E. Narrative Review of Ligamentous Wrist Injuries. J Hand Microsurg 2021; 13:55-64. [PMID: 33867762 PMCID: PMC8041499 DOI: 10.1055/s-0041-1724224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Ligamentous wrist injuries are common occurrences that require complex anatomical mastery and extensive understanding of diagnostic and treatment modalities. The purpose of this educational review article is to delve into the most clinically relevant wrist ligaments in an organized manner to provide the reader with an overview of relevant anatomy, function, clinical examination findings, imaging modalities, and options for management. Emphasis is placed on elucidating reported diagnostic accuracies and treatment outcomes to encourage evidence-based practice.
Collapse
Affiliation(s)
- Ilana G Margulies
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, United States
| | - Hope Xu
- Section of Plastic Surgery, University of Chicago, Chicago, Illinois, United States
| | - Jared M Gopman
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Matthew D Freeman
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Etan Dayan
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Peter J Taub
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Eitan Melamed
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| |
Collapse
|
33
|
Fan S, Padmore C, Kadar A, Chambers S, Langohr GDG, Suh N. The effect of four-corner fusion and proximal row carpectomy on uniplanar and multiplanar wrist motion: A biomechanical study. J Orthop 2021; 24:102-110. [PMID: 33679035 DOI: 10.1016/j.jor.2021.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/14/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose To compare changes in wrist kinematics after scaphoidectomy and four-corner fusion (4CF), and proximal row carpectomy (PRC). Methods Six cadaveric specimens underwent flexion-extension, radial-ulnar deviation and circumduction in an active motion wrist simulator. Native state, "anatomic 4CF", "radial 4CF", and PRC were compared. Results Radial 4CF reduced wrist extension, while PRC reduced radial deviation. Fusion groups had similar motion profiles. 44%, 41%, and 32% of native circumduction was maintained in PRC, anatomic, and radial 4CF. Conclusions Both fusion positions resulted in comparable motion outcomes. Anatomic 4CF was restricted in wrist extension compared to PRC but provided favourable radial deviation.
Collapse
Affiliation(s)
- Stacy Fan
- Division of Plastic and Reconstructive Surgery, University of Western Ontario, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada
| | - Clare Padmore
- Bioengineering Research Laboratory, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care London, London, ON, Canada
| | - Assaf Kadar
- Division of Orthopaedic Surgery, University of Western Ontario, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada
- Department of Orthopaedic Surgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Spencer Chambers
- Division of Plastic and Reconstructive Surgery, University of Western Ontario, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada
| | - G Daniel G Langohr
- Bioengineering Research Laboratory, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care London, London, ON, Canada
| | - Nina Suh
- Division of Plastic and Reconstructive Surgery, University of Western Ontario, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada
- Bioengineering Research Laboratory, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care London, London, ON, Canada
- Division of Orthopaedic Surgery, University of Western Ontario, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada
| |
Collapse
|
34
|
Wagner ER, Barras LA, Harstad C, Elhassan BT, Moran SL. Proximal Row Carpectomy in Young Patients. JBJS Essent Surg Tech 2021; 11:ST-D-19-00054. [PMID: 34123554 DOI: 10.2106/jbjs.st.19.00054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background There continues to be controversy regarding the treatment of early-stage arthritis of the wrist, particularly in young patients, because of the large number of techniques, the poor long-term results for many of these techniques, and the overall paucity of high-level scientific data. Proximal row carpectomy (PRC) and 4-corner arthrodesis (4CA) have been established as the mainstay motion-sparing surgical treatment options in cases of early scapholunate advanced collapse and scaphoid nonunion advanced collapse arthritis. However, there is marked controversy surrounding the best treatment option for younger patients with greater physical demands because of the questionable outcomes associated with these motion-sparing options in such patients1-9. Traditionally, many surgeons prefer 4CA over PRC for young, high-demand patients, in part because studies have suggested that young age and work status as a laborer are important risk factors for worse outcomes following PRC1,8. However, the concern for symptomatic nonunion and potential for radiolunate arthritis in 4CA, as well as the lack of medium to long-term comparative studies in this subset, make this recommendation controversial10. Description The wrist is accessed via the dorsal approach, creating a retinacular flap and a radially based ligament-sparing capsulotomy. The scaphoid, lunate, and triquetrum are then excised en bloc. The radioscapholunate ligament is protected. The capsule and retinaculum and then repaired. Alternatives Alternatives to PRC include nonoperative treatment, 4CA, capitolunate arthrodesis, posterior and anterior interosseous neurectomies, total wrist arthroplasty, and total wrist arthrodesis. Rationale A recent study by Wagner et al. compared patients <45 years old who underwent either PRC or 4CA11. Overall, PRC and 4CA had similar complication rates, postoperative pain levels, wrist function, and long-term outcomes free of conversion to arthrodesis. Patients who underwent PRC had improved motion and fewer complications, whereas patients who underwent 4CA had slightly lower rates of radiocarpal arthritis. Therefore, in this technique article, we describe PRC for wrist arthritis in patients <45 years old.
Collapse
Affiliation(s)
- Eric R Wagner
- Department of Orthopedic Surgery, Emory University, Atlanta, Georgia
| | - Laurel A Barras
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Chelsea Harstad
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Steven L Moran
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
35
|
Pomares G. Trapeziometacarpal osteoarthritis and arthritis of the wrist. HAND SURGERY & REHABILITATION 2021; 40S:S135-S142. [PMID: 33482390 DOI: 10.1016/j.hansur.2020.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 12/21/2022]
Abstract
Although the simultaneous occurrence of arthritis of the wrist and the base of the thumb is rare, it is nonetheless imperative to carry out a preoperative clinical and radiological assessment of the wrist when managing trapeziometacarpal osteoarthritis. The presence of pre-arthritic lesions or established wrist arthritis, even if treated, must be taken into consideration when treating osteoarthritis at the base of the thumb. The coexistence of these lesions determines the entire surgical strategy. Failure to take them into account during the surgical treatment often results in a compromised postoperative course and it often adversely impacts the outcome of secondary surgeries.
Collapse
Affiliation(s)
- G Pomares
- European Hand Institute Luxembourg - Kirchberg Hospital, 9, Edward Steichen Street, 2540 Luxembourg, Luxembourg.
| |
Collapse
|
36
|
Rocchi L, Fulchignoni C, Marcuzzi A. Resurfacing Capitate Pyrocarbon Implant Without Capitate Pole Resection to Improve Clinical Results in the Treatment of Chronic Wrist Arthritis. Tech Hand Up Extrem Surg 2021; 25:213-218. [PMID: 33399388 DOI: 10.1097/bth.0000000000000335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Proximal row carpectomy (PRC) is a long-time, well-accepted, easy-to-reproduce procedure for the treatment of several painful degenerative conditions of the wrist, when capitate pole and radius lunate fossa are preserved. It has been reported to relieve pain and preserve a substantial wrist range of motion, although a partial loss of strength has to be expected because of the decreased length of the carpus. Since 2010, a new technique has been described in the literature using the resurfacing capitate pyrocarbon implant, combined with PRC. This implant has been designed to perform PRC even in the presence of degenerate joint surfaces, and thus resolves the limited indications of this procedure; however, if a resection of the capitate pole is performed to set up the implant, similar to PRC it may not positively influence the recovery of strength. The authors propose an resurfacing capitate pyrocarbon implant technique without any capitate bone resection, to preserve as much as possible the carpus length and so to improve the functional recovery. The surgical technique, is described in detail and preliminary results are discussed.
Collapse
Affiliation(s)
- Lorenzo Rocchi
- Hand Surgery and Orthopedics Unit, Department of Orthopaedics and Traumatology, University Hospital A. Gemelli IRCCS, Rome
| | - Camillo Fulchignoni
- Hand Surgery and Orthopedics Unit, Department of Orthopaedics and Traumatology, University Hospital A. Gemelli IRCCS, Rome
| | - Augusto Marcuzzi
- Department of Hand Surgery, Modena University Hospital, Modena, Italy
| |
Collapse
|
37
|
Zhang Y, Gillis JA, Moran SL. Management of scapholunate advanced collapse and scaphoid nonunion advanced collapse without proximal row carpectomy or four corner fusion. J Hand Surg Eur Vol 2021; 46:50-57. [PMID: 33202162 DOI: 10.1177/1753193420973322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Four corner arthrodesis and proximal row carpectomy are the most common techniques for the management of advanced radiocarpal arthritis due to longstanding scapholunate instability and scaphoid nonunion. The advantages and short comings of each technique have been well defined in the literature. Advancements in joint replacement and arthroscopic surgery have resulted in new operations to manage radiocarpal and midcarpal arthritis. Most of these new procedures are modifications of the two classical operations, but some use modern implants and newer materials. New individualized options, like osteochondral grafting in combination with proximal row carpectomy or (arthroscopic) distal resection of the scaphoid, allowed us to improve our treatment and offer patients less invasive but equally effective procedures. We consider that four corner arthrodesis and proximal row carpectomy should not always be standard management for advanced radiocarpal arthritis.
Collapse
Affiliation(s)
- Yiyang Zhang
- Division of Orthopedic Surgery, Roth
- McFarlane Hand and Upper Limb Centre, London, ON, Canada
| | - Joshua A Gillis
- Division of Plastic and Reconstructive Surgery, Roth
- McFarlane Hand and Upper Limb Centre, London, ON, Canada
| | - Steven L Moran
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
38
|
Long-term radiological changes and functional outcomes after proximal row carpectomy: Retrospective study with 3 years' minimum follow-up. Orthop Traumatol Surg Res 2020; 106:1589-1595. [PMID: 33289656 DOI: 10.1016/j.otsr.2020.03.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 03/10/2020] [Accepted: 03/27/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The aim of this study was to analyze the radiological changes and determine the clinical and functional outcomes of proximal row carpectomy (PRC) over the long term. HYPOTHESIS Radiological changes after PRC occur in every patient while the clinical and functional outcomes remain stable over time. METHODS This was a retrospective single-center study of patients who underwent PRC between January 2004 and December 2014. A clinical assessment (range of motion, grip strength), functional assessment (Mayo Wrist score and QuickDASH) and radiographic assessment (radiocapitate osteoarthritis, radiocapitate congruency) was done in every patient at the longest follow-up. RESULTS Thirty-one patients were reviewed with a mean follow-up of 97.9 months. The indications for PRC were SLAC (n=10), SNAC (n=5), Kienböck disease (n=9) and other conditions (n=7). The radiocapitate index, which is the radius of curvature of the tip of the capitate divided by the mean radius of curvature of the lunate fossa, went from 0.68 immediately postoperative to 0.74 at the final assessment (p=0.035). The mean flexion/extension arc was 93°. The mean grip strength was 25 kg. The mean QuickDASH was 29 and the mean Mayo Wrist score was 69. Fifteen patients had radiocapitate osteoarthritis. Seven patients (22%) required revision surgery for wrist fusion after a mean of 18.6 months. CONCLUSION Radiological adaptation in the radiocapitate joint after PRC was found in this study. PRC is a reliable solution and yields stable outcomes over time for treating radiocarpal osteoarthritis, except in young adults and manual laborers who had a notable early revision rate. LEVEL OF EVIDENCE IV - retrospective study.
Collapse
|
39
|
Cost-Effectiveness Analysis of Motion-Preserving Operations for Wrist Arthritis. Plast Reconstr Surg 2020; 146:588e-598e. [PMID: 33141535 DOI: 10.1097/prs.0000000000007260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The authors conducted a cost-effectiveness analysis to answer the question: Which motion-preserving surgical strategy, (1) four-corner fusion, (2) proximal row carpectomy, or (3) total wrist arthroplasty, used for the treatment of wrist osteoarthritis, is the most cost-effective? METHODS A simulation model was created to model a hypothetical cohort of wrist osteoarthritis patients (mean age, 45 years) presenting with painful wrist and having failed conservative management. Three initial surgical treatment strategies-(1) four-corner fusion, (2) proximal row carpectomy, or (3) total wrist arthroplasty-were compared from a hospital perspective. Outcomes included clinical outcomes and cost-effectiveness outcomes (quality-adjusted life-years and cost) over a lifetime. RESULTS The highest complication rates were seen in the four-corner fusion cohort: 27.1 percent compared to 20.9 percent for total wrist arthroplasty and 17.4 percent for proximal row carpectomy. Secondary surgery was common for all procedures: 87 percent for four-corner fusion, 57 percent for proximal row carpectomy, and 46 percent for total wrist arthroplasty. Proximal row carpectomy generated the highest quality-adjusted life-years (30.5) over the lifetime time horizon, compared to 30.3 quality-adjusted life-years for total wrist arthroplasty and 30.2 quality-adjusted life-years for four-corner fusion. Proximal row carpectomy was the least costly; the mean expected lifetime cost for patients starting with proximal row carpectomy was $6003, compared to $11,033 for total wrist arthroplasty and $13,632 for four-corner fusion. CONCLUSIONS The authors' analysis suggests that proximal row carpectomy was the most cost-effective strategy, regardless of patient and parameter level uncertainties. These are important findings for policy makers and clinicians working within a universal health care system.
Collapse
|
40
|
Bain C, Tham S, Powell C, Berger A, Withers A, McCombe D. Three-and-a-half to 18 year outcome data for costal osteochondral grafts for salvage of the proximal pole of the scaphoid. J Hand Surg Eur Vol 2020; 45:959-964. [PMID: 32990133 DOI: 10.1177/1753193420959945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Twelve patients who had undergone costal osteochondral graft reconstruction of the proximal pole of scaphoid were evaluated with clinical examination, patient-reported outcome scores and radiographs with an average follow-up of 10 years (range 3.5-18). The range of wrist motion was not significantly changed compared with the preoperative range of motion and functional outcomes scores were acceptable. The patients reported low pain scores despite the universal presence of radiographic changes of reduced carpal height and arthritis of the midcarpal and radiocarpal joints. Costal osteochondral graft reconstruction of the proximal pole of scaphoid offers good long-term pain relief and function.Level of evidence: IV.
Collapse
Affiliation(s)
- Charles Bain
- Victorian Hand Surgery Associates, Melbourne, Australia
| | - Stephen Tham
- Victorian Hand Surgery Associates, Melbourne, Australia.,Hand and Wrist Biomechanics Laboratory, St. Vincent's Hospital, Melbourne, Australia.,Plastic, Reconstructive and Hand Surgery Department, St. Vincent's Hospital, Melbourne, Australia
| | - Chris Powell
- Victorian Hand Surgery Associates, Melbourne, Australia
| | - Anthony Berger
- Victorian Hand Surgery Associates, Melbourne, Australia.,Hand and Wrist Biomechanics Laboratory, St. Vincent's Hospital, Melbourne, Australia
| | - Aaron Withers
- Victorian Hand Surgery Associates, Melbourne, Australia
| | - David McCombe
- Victorian Hand Surgery Associates, Melbourne, Australia.,Hand and Wrist Biomechanics Laboratory, St. Vincent's Hospital, Melbourne, Australia.,Plastic, Reconstructive and Hand Surgery Department, St. Vincent's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| |
Collapse
|
41
|
Shim JW, Kim JW, Park MJ. Comparative study between open and arthroscopic techniques for scaphoid excision and four-corner arthrodesis. J Hand Surg Eur Vol 2020; 45:952-958. [PMID: 32153240 DOI: 10.1177/1753193420908820] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study presents our technique of arthroscopic scaphoid excision and four-corner arthrodesis and compares the clinical and radiological outcomes with those achieved with the open method. Twenty-seven patients (14 in arthroscopy group and 13 in open group) were included. Bone union was achieved in 13 of 14 patients in the arthroscopy group and in all 13 patients in the open group. In the open group, severe stiffness (flexion-extension arc was 10°) occurred in one patient after surgery. The mean postoperative flexion-extension arc was 75° and 51° in the arthroscopy group and open group, respectively. The pain, clinical scores, and radiological indices were improved in both arthroscopy and open groups. Arthroscopic and open scaphoid excision and four-corner arthrodesis did not show significant differences in clinical outcomes and bone union rates. The arthroscopic method provided a superior range of motion.Level of evidence: III.
Collapse
Affiliation(s)
- Jae Woo Shim
- Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Whan Kim
- Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Jong Park
- Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
42
|
Deng AD, Innocenti M, Arora R, Gabl M, Tang JB. Vascularized Small-Bone Transfers for Fracture Nonunion and Bony Defects. Clin Plast Surg 2020; 47:501-520. [PMID: 32892797 DOI: 10.1016/j.cps.2020.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Vascularized small-bone grafting is an efficient and often necessary surgical approach for nonunion or necrosis of several bones in particular sites of the body, including scaphoid, lunate, distal ulna, and clavicle. The medial femoral condyle is an excellent graft source that can be used in treating scaphoid, ulna, clavicle, or lower-extremity bone defects, including nonunion. Vascularized bone grafting to the small bones, particularly involving reconstruction of damaged cartilage surfaces, should enhance subchondral vascular supply and help prevent cartilage regeneration. Vascularized osteoperiosteal and corticoperiosteal flaps are useful for treating nonunion of long bones.
Collapse
Affiliation(s)
- Ai Dong Deng
- Department of Hand Surgery, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong 226001, Jiangsu, China
| | - Marco Innocenti
- Plastic Surgery, University of Florence Careggi University Hospital, CTO, Largo Palagi 150139, Florence, Italy
| | - Rohit Arora
- Department of Trauma Surgery and Sports Medicine, Medical University Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Markus Gabl
- Department of Trauma Surgery and Sports Medicine, Medical University Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Jin Bo Tang
- Department of Hand Surgery, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong 226001, Jiangsu, China.
| |
Collapse
|
43
|
Gauci MO, Waitzenegger T, Chammas PE, Coulet B, Lazerges C, Chammas M. Comparison of clinical outcomes of three-corner arthrodesis and bicolumnar arthrodesis for advanced wrist osteoarthritis. J Hand Surg Eur Vol 2020; 45:679-686. [PMID: 32106758 DOI: 10.1177/1753193420905484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We retrospectively compared results of 27 wrists with bicolumnar arthrodesis with mean follow-up of 67 months to 28 wrists with three-corner arthrodesis adding triquetral excision with mean follow-up of 74 months in 54 patients (55 wrists). Minimal follow-up was 2 years for all patients. Capitolunate nonunion occurred in three wrists with bicolumnar arthrodesis and six wrists with three-corner arthrodesis, and radiolunate arthritis developed in four wrists with three-corner arthrodesis. Among patients with bicolumnar arthrodesis, hamatolunate arthritis occurred in seven wrists, all with a Viegas type II lunate; and pisotriquetral arthritis occurred in three wrists. At mean 5 years after surgery, 45 wrists had not needed revision surgery, and both groups had similar revision rates. The wrists with three-corner arthrodesis and bicolumnar arthrodesis had similar functional outcomes, and range of wrist motion was not significantly different between the two groups. We concluded that bicolumnar arthrodesis results in greater longevity than three-corner arthrodesis for a type I lunate. We do not recommend bicolumnar arthrodesis for type II lunate. We also concluded that three-corner arthrodesis has a greater incidence of radiolunate arthritis and capitolunate nonunion.Level of evidence: III.
Collapse
Affiliation(s)
- Marc Olivier Gauci
- Institut Universitaire Locomoteur et du Sport (iULS), CHU de Nice, Université Côte d'Azur, UR2CA, France
| | - Thomas Waitzenegger
- Division of Hand and Upper Extremity Surgery, Lapeyronie University Hospital, Montpellier, France
| | - Pierre-Emmanuel Chammas
- Division of Hand and Upper Extremity Surgery, Lapeyronie University Hospital, Montpellier, France
| | - Bertrand Coulet
- Division of Hand and Upper Extremity Surgery, Lapeyronie University Hospital, Montpellier, France
| | - Cyril Lazerges
- Division of Hand and Upper Extremity Surgery, Lapeyronie University Hospital, Montpellier, France
| | - Michel Chammas
- Division of Hand and Upper Extremity Surgery, Lapeyronie University Hospital, Montpellier, France
| |
Collapse
|
44
|
Ferrero M, di Summa PG, Giacalone F, Senesi L, Sapino G, Battiston B. Salvage of advanced carpal collapse: proximal row carpectomy with pyrocarbon resurfacing of the capitate versus four-corner arthrodesis. J Hand Surg Eur Vol 2020; 45:687-692. [PMID: 32787664 DOI: 10.1177/1753193420931416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In this retrospective study we report on two comparable groups of patients with advanced carpal arthritis treated with either proximal row carpectomy combined with a pyrocarbon resurfacing of the capitate (31 patients) or a four-corner arthrodesis and dorsal plating (26 patients). Follow-up time was 46 months (24-118). Except for a modestly higher radial wrist deviation in the patients treated with four-corner arthrodesis, there were no significant differences in outcomes between the groups. Asymptomatic progression of osteoarthritis in the lunate fossa was observed in four cases in both groups. Two cases were converted to a total wrist arthrodesis in the pyrocarbon group compared with one case in the four-corner arthrodesis group. Although four-corner arthrodesis remains the reference standard in the treatment of wrist osteoarthritis with involvement of the midcarpal joint, proximal row carpectomy combined with pyrocarbon resurfacing of the capitate is an alternative option. It can even be used in selected cases with erosion of the lunate fossa.Level of evidence: III.
Collapse
Affiliation(s)
- Matteo Ferrero
- Department of Hand Surgery and Microsurgery, Ospedale CTO - Città della Salute e della Scienza di Torino, Turin, Italy
| | - Pietro G di Summa
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Francesco Giacalone
- Department of Hand Surgery and Microsurgery, Ospedale CTO - Città della Salute e della Scienza di Torino, Turin, Italy
| | - Letizia Senesi
- Department of Hand Surgery and Microsurgery, Ospedale CTO - Città della Salute e della Scienza di Torino, Turin, Italy
| | - Gianluca Sapino
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,Department of Plastic and Reconstructive Surgery, University Hospital of Modena, Modena, Italy
| | - Bruno Battiston
- Department of Hand Surgery and Microsurgery, Ospedale CTO - Città della Salute e della Scienza di Torino, Turin, Italy
| |
Collapse
|
45
|
Li NY, Kuczmarski AS, Hresko AM, Goodman AD, Gil JA, Daniels AH. Four-Corner Arthrodesis versus Proximal Row Carpectomy: Risk Factors and Complications Associated with Prolonged Postoperative Opioid Use. J Hand Microsurg 2020; 14:163-169. [DOI: 10.1055/s-0040-1715426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract
Introduction This article compares opioid use patterns following four-corner arthrodesis (FCA) and proximal row carpectomy (PRC) and identifies risk factors and complications associated with prolonged opioid consumption.
Materials and Methods The PearlDiver Research Program was used to identify patients undergoing primary FCA (Current Procedural Terminology [CPT] codes 25820, 25825) or PRC (CPT 25215) from 2007 to 2017. Patient demographics, comorbidities, perioperative opioid use, and postoperative complications were assessed. Opioids were identified through generic drug codes while complications were defined by International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification codes. Multivariable logistic regressions were performed with p < 0.05 considered statistically significant.
Results A total of 888 patients underwent FCA and 835 underwent PRC. Three months postoperatively, more FCA patients (18.0%) continued to use opioids than PRC patients (14.7%) (p = 0.033). Preoperative opioid use was the strongest risk factor for prolonged opioid use for both FCA (odds ratio [OR]: 4.91; p < 0.001) and PRC (OR: 6.33; p < 0.001). Prolonged opioid use was associated with an increased risk of implant complications (OR: 4.96; p < 0.001) and conversion to total wrist arthrodesis (OR: 3.55; p < 0.001) following FCA.
Conclusion Prolonged postoperative opioid use is more frequent in patients undergoing FCA than PRC. Understanding the prevalence, risk factors, and complications associated with prolonged postoperative opioid use after these procedures may help physicians counsel patients and implement opioid minimization strategies preoperatively.
Collapse
Affiliation(s)
- Neill Y. Li
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Alexander S. Kuczmarski
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Andrew M. Hresko
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Avi D. Goodman
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Joseph A. Gil
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Alan H. Daniels
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, Rhode Island, United States
| |
Collapse
|
46
|
Kromka JJ, Maher P, Fowler JR. Volar Carpus Dislocation Following Proximal Row Carpectomy for Scapholunate Advanced Collapse: A Rare Complication. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2020; 2:260-265. [PMID: 35415498 PMCID: PMC8991635 DOI: 10.1016/j.jhsg.2020.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 04/16/2020] [Indexed: 10/26/2022] Open
|
47
|
Garcia BN, Lu CC, Stephens AR, Kazmers NH, Chen W, Leng J, Li L, Sauer BC, Tyser AR. Risk of Total Wrist Arthrodesis or Reoperation Following 4-Corner Arthrodesis or Proximal Row Carpectomy for Stage-II SLAC/SNAC Arthritis: A Propensity Score Analysis of 502 Wrists. J Bone Joint Surg Am 2020; 102:1050-1058. [PMID: 32187124 DOI: 10.2106/jbjs.19.00965] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND For stage-II scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) patterns of wrist arthritis, the optimal method of surgical treatment remains unclear. Previous literature has demonstrated similar clinical outcomes between proximal row carpectomy (PRC) and 4-corner arthrodesis (FCA), making the risk of reoperation a focus of particular interest. In the present study, the primary null hypothesis was that there would be no difference in the rate of conversion to total wrist arthrodesis between PRC and FCA. Additionally, we hypothesized that the rate of secondary surgical procedures would be similar between the 2 procedures. METHODS The national Veterans Health Administration Corporate Data Warehouse was utilized to identify 2,449 patients who underwent either PRC or FCA between 1992 and 2016. With use of operative reports to identify the arthritis pattern, only cases of stage-II SLAC/SNAC were included. All complications and subsequent surgical procedures were confirmed by manual chart review. Propensity score analyses with matching weights were utilized to balance the PRC and FCA cohorts. The rates of conversion to wrist arthrodesis and secondary surgical procedures were calculated. RESULTS Of the 1,168 patients with stage-II SLAC/SNAC arthritis, 933 wrists underwent PRC and 257 wrists underwent FCA. Ten-year survival free of total wrist arthrodesis in the matching PRC (251 procedures) and FCA (251 procedures) cohorts was 94.3% (95% confidence interval [CI], 92.3% to 96.3%) and 94.1% (95% CI, 90.8% to 97.4%), respectively. Survival free of a secondary surgical procedure other than wrist arthrodesis was 99.7% (95% CI, 99.3% to 100.0%) for PRC and 83.5% (95% CI, 78.2% to 88.8%) for FCA. CONCLUSIONS PRC and FCA demonstrated similarly low rates of conversion to total wrist arthrodesis. In contrast, the rate of secondary surgical procedures following FCA was significantly higher compared with PRC. Given the historically similar clinical outcomes between PRC and FCA, the results of the present study show that PRC may be a preferable treatment for stage-II SLAC/SNAC wrist arthritis. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Brittany N Garcia
- Department of Orthopaedic Surgery, University of Utah Hospital, Salt Lake City, Utah
| | - Chao-Chin Lu
- HSR&D IDEAS Center, Salt Lake City George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Team VERITAS, Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Andrew R Stephens
- Department of Orthopaedic Surgery, University of Utah Hospital, Salt Lake City, Utah
| | - Nikolas H Kazmers
- Department of Orthopaedic Surgery, University of Utah Hospital, Salt Lake City, Utah
| | - Wei Chen
- HSR&D IDEAS Center, Salt Lake City George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Team VERITAS, Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Jianwei Leng
- HSR&D IDEAS Center, Salt Lake City George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Team VERITAS, Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Liang Li
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brian C Sauer
- HSR&D IDEAS Center, Salt Lake City George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Team VERITAS, Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Andrew R Tyser
- Department of Orthopaedic Surgery, University of Utah Hospital, Salt Lake City, Utah
| |
Collapse
|
48
|
Yoo M, Nelson RE, Illing DA, Martin BI, Tyser AR, Kazmers NH. Cost-Effectiveness Analysis Comparing Proximal Row Carpectomy and Four-Corner Arthrodesis. JB JS Open Access 2020; 5:e0080. [PMID: 33123669 PMCID: PMC7418915 DOI: 10.2106/jbjs.oa.19.00080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: The optimal surgical treatment for scapholunate advanced collapse (SLAC) and
scaphoid nonunion advanced collapse (SNAC) remains unclear. To inform
clinical decision-makers, we conducted a cost-effectiveness analysis
comparing proximal row carpectomy (PRC) and four-corner arthrodesis
(FCA). Methods: A Markov microsimulation model was used to compare clinical outcomes, costs,
and health utilities between PRC and FCA. The model used a 10-year time
horizon and a 1-month cycle length, and it was evaluated from the societal
perspective. Utilities and clinical parameters including transition
probabilities for debridement for infection, removal of implants, conversion
to total wrist arthrodesis, revision FCA, and revision total wrist
arthrodesis were obtained from published literature. Timing of complications
was estimated from the literature. Direct medical costs were derived from
Medicare ambulatory surgical cost data, and indirect costs for missed work
due to surgical procedures and complications were included. The
effectiveness outcome was quality-adjusted life years (QALYs). Probabilistic
sensitivity analysis and 1-way threshold analysis for utilities were
performed. Results: In the base-case model, PRC dominated FCA (i.e., PRC had lower cost and
greater effectiveness). The mean (and standard deviation) for the total cost
and QALYs per patient were $30,970 ± $5,931 and 8.24 ± 1.28,
respectively, for PRC and $44,526 ± $11,205 and 8.23 ± 1.26,
respectively, for FCA. In the probabilistic sensitivity analysis, PRC
dominated FCA in 57% of the 1 million iterations. The cost-effectiveness
acceptability curve indicated that PRC is the most cost-effective strategy
regardless of the willingness-to-pay threshold up to $100,000/QALY. Conclusions: PRC dominated FCA in the base-case analysis and in the probabilistic
sensitivity analysis. These results suggest that PRC is the optimal strategy
for Stage-I or II SLAC and for SNAC in patients ≥55 years of age. Level of Evidence: Economic Level IV. See Instructions for Authors for a
complete description of levels of evidence.
Collapse
Affiliation(s)
- Minkyoung Yoo
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah
| | - Richard E Nelson
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah.,VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Damian A Illing
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah
| | - Brook I Martin
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah
| | - Andrew R Tyser
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah
| | - Nikolas H Kazmers
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah
| |
Collapse
|
49
|
Wei DH, Tang P. The Use of Contact Biomechanics to Study the Intact, Proximal Row Carpectomy and Scaphoid Excision, Four Bone Fusion Wrist. Curr Rheumatol Rev 2020; 16:189-193. [PMID: 32473001 DOI: 10.2174/1573397116666200530221114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 04/03/2019] [Accepted: 01/03/2020] [Indexed: 11/22/2022]
Abstract
The study of contact biomechanics of the wrist is a challenge. This is partly due to the relatively small size of the joint as well as the lack of space in the radiocarpal joint which makes the delivery of investigative materials such as pressure sensitive film without causing artifact, difficult. Fortunately, a number of authors have studied the intact wrist, the scapholunate ligament injured wrist, the proximal row carpectomy and the scaphoid excision, four bone fusion. Despite some contrasting findings, there are some general concepts that we understand about wrist mechanics.
Collapse
Affiliation(s)
- David H Wei
- Orthopaedic & Neurosurgical Specialists, Greenwich Hospital, Greenwich, CT, United States
| | - Peter Tang
- Department of Orthopaedic Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, United States
| |
Collapse
|
50
|
Four-Corner Arthrodesis Versus Proximal Row Carpectomy for Scapholunate Advanced Collapse: A Systematic Literature Review and Meta-analysis. Ann Plast Surg 2020; 85:699-703. [PMID: 32384352 DOI: 10.1097/sap.0000000000002398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Scapholunate advanced collapse (SLAC) of the wrist is one of the most common patterns of degenerative arthritis in the wrist. Surgical intervention is warranted for individuals with symptomatic SLAC and degenerative disease that affects the radioscaphoid joint. The most popular options for motion-preserving reconstruction and treatment of this disease include 4-corner arthrodesis and proximal row carpectomy. The purpose of this article was to conduct a systematic literature review and meta-analysis to identify any differences in the clinical outcomes of 4-corner arthrodesis and proximal row carpectomy for the treatment of SLAC. METHODS An electronic literature search of PubMed, Embase, OVID, and the Cochrane Library was conducted to identify studies evaluating the clinical outcomes of 4-corner arthrodesis versus proximal row carpectomy for the treatment of SLAC. Primary outcome measures included flexion/extension range of motion, grip strength, and level of pain. RESULTS Eight studies encompassing 311 patients met the inclusion criteria for the meta-analysis. Our meta-analysis indicated that when compared with 4-corner arthrodesis, patients who underwent proximal row carpectomy had statistically significantly increased flexion/extension range of motion by 6.2 degrees, significantly increased grip strength by 1.52%, and reduced level of pain by 0.3. CONCLUSIONS This study demonstrated that in comparative studies, there was a statistical difference favoring proximal row carpectomy to 4-corner arthrodesis for the treatment of SLAC. Although these differences were statistically significant, they remain very small and lack clinical relevance. This study further supports that both of these treatment options are equivalent for the treatment of this disease. Although not clinically significant, compared with 4-corner arthrodesis, patients treated with proximal row carpectomy had increased range of motion, increased grip strength, and decreased pain. Limitations to these findings are the small number of studies available and the increased heterogeneity between the studies. Further studies need to be conducted to confirm these findings.
Collapse
|