Artikel
Factors Associated with Conversion to Wrist Fusion after Proximal Row Carpectomy or Four Corner Arthrodesis
Suche in Medline nach
Autoren
Veröffentlicht: | 6. Februar 2020 |
---|
Gliederung
Text
Objectives/Interrogation: This study aimed to investigate the rate of conversion to total wrist fusion (arthrodesis or arthroplasty) in patients that underwent either proximal row carpectomy (PRC) or four-corner arthrodesis (FCA). Additionally, we evaluated the factors associated with conversion to wrist fusion and progression of radiographic arthrosis for patients treated with PRC or FCA.
Methods: We retrospectively identified patients that underwent a PRC or FCA using ICD-9 procedure and CPT codes and verified these by chart review. We included all adult patients (n=266) that were treated at a single institutional system from 2002-2016. The median age was 54 (IQR:45-62) years, and the median follow up was 8.1 (IQR:5.1-11.7) years. Eighty patients underwent FCA, and 186 underwent a PRC. We performed a multivariable logistic regression to evaluate factors associated with wrist fusion, including all explanatory variables with a p<0.10 in bivariate analysis.
Results and Conclusions: There was an increased progression of lunate fossa osteoarthritis in the PRC cohort (20% vs. 2%, p=0.005). The median time to wrist fusion was 16 months (IQR:12.1-37.7) for PRC and 32 months (IQR:19-45) for FCA. Intraoperative posterior and anterior interosseous neurectomy was associated with a lower rate of conversion to wrist fusion (p=0.004) after PRC. Smoking was independently associated with a higher rate of conversion to wrist fusion (OR: 30.9, p=0.017) after FCA.
Although PRC and FCA appear to have similar rates of arthrodesis at mid-term follow-up; PRC appears to demonstrate more radiographic arthritis. A partial denervation of the wrist may delay conversion or lower the rates of conversion to arthrodesis after PRC (Table 1 [Tab. 1], Table 2 [Tab. 2]).