Arthroscopic Proximal Row Carpectomy Using the Volar Central Portal

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.

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The Use of Contact Biomechanics to Study the Intact, Proximal Row Carpectomy and Scaphoid Excision, Four Bone Fusion Wrist

Current Rheumatology Reviews ◽

10.2174/1573397116666200530221114 ◽

2020 ◽

Vol 16 (3) ◽

pp. 189-193

Author(s):

David H. Wei ◽

Peter Tang

Keyword(s):

Proximal Row Carpectomy ◽

Scapholunate Ligament ◽

Bone Fusion ◽

Pressure Sensitive ◽

Sensitive Film ◽

Radiocarpal Joint ◽

Pressure Sensitive Film ◽

Number Of Authors

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.

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The effect of four-corner fusion and proximal row carpectomy on uniplanar and multiplanar wrist motion: A biomechanical study

Journal of Orthopaedics ◽

10.1016/j.jor.2021.02.032 ◽

2021 ◽

Vol 24 ◽

pp. 102-110

Author(s):

Stacy Fan ◽

Clare Padmore ◽

Assaf Kadar ◽

Spencer Chambers ◽

G. Daniel G. Langohr ◽

...

Keyword(s):

Biomechanical Study ◽

Proximal Row Carpectomy ◽

Wrist Motion

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Prosthetic Replacement of the Scaphoid Proximal Pole: Should It Be the Future?

Hand ◽

10.1177/1558944720974120 ◽

2020 ◽

pp. 155894472097412

Author(s):

Matteo Ferrero ◽

Enrico Carità ◽

Francesco Giacalone ◽

Julien Teodori ◽

Alberto Donadelli ◽

...

Keyword(s):

Avascular Necrosis ◽

Early Mobilization ◽

Functional Results ◽

Good Alternative ◽

Proximal Row Carpectomy ◽

Proximal Pole ◽

Subjective Outcomes ◽

Clinical Worsening ◽

Pyrocarbon Implant ◽

Over Time

Background Scaphoid proximal pole fractures with avascular necrosis represent a complex surgical problem. Many reconstruction techniques are based on osteosynthesis with a vascularized or nonvascularized bone graft. These procedures do not allow early mobilization and therefore sometimes lead to unsatisfying functional results. In some cases, it is possible to perform a scaphoid hemiarthroplasty using a pyrocarbon implant (adaptive proximal scaphoid implant [APSI]) in place of the necrotic proximal pole, allowing an early mobilization and delaying palliative treatments such as 4-corner arthrodesis or proximal row carpectomy. Methods In this study, we reviewed all patients who had undergone a scaphoid hemiarthroplasty using APSI in our institutions from 1999 to 2017; the F.U. was performed through radiographic, clinical, and subjective (Disabilities of the Arm, Shoulder, and Hand) analysis. Results The performances of scaphoid proximal pole implants are encouraging; radiographic, clinical, and subjective outcomes were good, and the functional recovery proved to be fast and reliable over time. Conclusions This study reports our experience in the use of APSI implants, which proved to be a good alternative to traditional techniques for treating avascular necrosis of the proximal pole, still allowing further surgical steps in case of clinical worsening over time (wrist osteoarthritis). These patients are usually young and present high functional demands. Our experience is promising, but we believe that further evaluation over time will be needed.

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Proximal Row Carpectomy with Total Scapoidectomy vs. Conventional Carpal Resection for ReMotion Total Wrist Arthroplasty

Journal of Clinical Medicine ◽

10.3390/jcm10091865 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1865

Author(s):

Stefan M. Froschauer ◽

Matthias Holzbauer ◽

Dietmar Hager ◽

Oskar Kwasny ◽

Dominik Duscher

Keyword(s):

Grip Strength ◽

Clinical Assessment ◽

Complication Rates ◽

Proximal Row Carpectomy ◽

Prosthesis Implantation ◽

Total Wrist Arthroplasty ◽

Significant Difference ◽

Flexion Extension ◽

Wrist Arthroplasty

High complication rates in total wrist arthroplasty (TWA) still lead to controversy in the medical literature, and novel methods for complication reduction are warranted. In the present retrospective cohort study, we compare the outcomes of the proximal row carpectomy (PRC) method including total scaphoidectomy (n = 22) to the manufacturer’s conventional carpal resection (CCR) technique, which retains the distal pole of the scaphoid (n = 25), for ReMotion prosthesis implantation in non-rheumatoid patients. Mean follow-up was 65.8 ± 19.8 and 80.0 ± 28.7 months, respectively. Pre- and postoperative clinical assessment included wrist flexion-extension and radial-ulnar deviation; Disability of Arm, Shoulder, and Hand scores; and pain via visual analogue scale. At final follow-up, grip strength and satisfaction were evaluated. All complications, re-operations, and revision surgeries were noted. Clinical complications were significantly lower in the PRC group (p = 0.010). Radial impaction was detected as the most frequent complication in the CCR group (n = 10), while no PRC patients suffered from this complication (p = 0.0008). Clinical assessment, grip strength measurements, and the log rank test evaluating the re-operation as well as revision function showed no significant difference. All functional parameters significantly improved compared to preoperative values in both cohorts. In conclusion, we strongly recommend PRC for ReMotion prosthesis implantation.

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Osteochondral Autograft Transplantation for Proximal Lunate Articular Defects

Journal of Wrist Surgery ◽

10.1055/s-0037-1599215 ◽

2017 ◽

Vol 06 (04) ◽

pp. 329-333 ◽

Cited By ~ 2

Author(s):

Sidney Jacoby ◽

Paul Marchetto ◽

Peter DeLuca ◽

Randall Culp ◽

Michael Gaspar

Keyword(s):

Positive Outcomes ◽

Osteochondral Defects ◽

Proximal Row Carpectomy ◽

Osteochondral Autograft ◽

Chondral Defects ◽

Transplantation Surgery ◽

Osteochondral Autograft Transplantation ◽

And Function ◽

Active Patients

Abstract Background No consensus treatment option for focal osteochondral defects of the proximal lunate exist in the literature. Surgical management has thus far been limited to salvage procedures such as proximal row carpectomy and partial arthrodesis. Case Description We report our experience using the osteochondral autograft transplantation surgery (OATS) procedure in two young, active patients with focal osteochondral defects of the proximal lunate. At mean follow-up of 6 years, sustained improvements in pain, motion, and function were observed. Both patients reported high levels of satisfaction and neither experienced any complications. Literature Review To our knowledge, this is the first report describing the use of OATS to treat proximal lunate defects. Clinical Relevance OATS is a valuable surgical option for treating focal chondral defects of the proximal lunate, with positive outcomes at greater than 5 years postoperatively. This may be an especially useful technique for younger, active patients, and those wishing to maintain maximum functionality.

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