Artikel
Outcome of Proximal Row Carpectomy in a cohort study with 12 months follow up
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Autoren
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Freek Lötters
- Hand en Pols Revalidatie Nederland, Goes, Netherlands
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Ton Schreuders
- Hand en Pols Revalidatie Nederland, Erasmus University Rotterdam, Goes, Netherlands
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Hans Pieter Van Not
- Hand en Pols Revalidatie Nederland, Admiraal de Ruyter Ziekenhuis, Goes, Netherlands
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: Proximal Row Carpectomy (PRC) is a surgical salvage procedure for treatment of severe pain in e.g. a SLAC or SNAC wrist. After the PRC procedure patients were submitted to a standardized rehabilitation protocol. The objective of this study was to monitor functional outcomes of PRC and the subsequent rehabilitation in a 12 months follow up period.
Methods: Fifty patients (30 male, 20 female) underwent a PRC. The mean age was 56±12.1 years, and the side of operation was right (56%) and left (44%). The SLAC/SNAC wrists were due to primary radio-carpal osteoarthritis (46%), trauma in the past (18%), wrist fracture (16%), scaphoid fracture (14%) and other (6%).
The primary outcome of the study was pain (NRS 0-10), secondary outcomes were wrist mobility (goniometry), grip strength (JAMAR), disability in daily live (DASH/PRWHE 0-100) and patient satisfaction with the operation (0-24;the higher the better). Differences over time were analysed with a Paired T-test (pre-operative-12 months follow up). We applied an intention-to-treat analysis. Effect sizes (EF) and the corresponding confidence intervals (CI) were calculated using Cohen-d.
Results and Conclusions: The primary outcome showed a strong statistically significant (p<=0.001) decline in pain intensity at 12 months of 4 points (62%) in comparison with the initial pre-surgery measurement (EF(d)=2.3, CI=-2.9-2.4). On the disability/participation scales patients showed a statistically significant (p<=0.001) improvement of 42.9 points (75%) (EF(d)=3.5, CI= 0.1-6.9) with the initial pre-surgery measurement. Both the improvement on pain and disability/participation can be considered clinically important.
For mobility (EF(d)=0.6, CI=-4.4-5.6) and gripstrength (EF(d)=-0.3, CI=-2.9-2.4) no statistical significant differences with pre-surgery status were detectable after 12 months follow up.
The mean post-operative rehabilitation time was 8.1±3.1 hours, and patient satisfaction with operation after 6 months was very high (20.6±4.0). Re-operation was needed in 4 patients, with one arthrodesis and 3 carpal tunnel releases within 12 months follow up.
PRC surgery and the subsequent rehabilitation resulted in a strong decline in pain in patients with a SLAC or SNAC wrist. Additionally, patients clearly perceived less disability problems in daily life after 12 months follow up. Gradually improvement and relief of symptoms occurred during the first 6 months follow up period, and stabilized or slightly further improved in the subsequent 6 months.
