Proximal row carpectomy generates better mid- to long-term outcomes than four-corner arthrodesis for post-traumatic wrist arthritis: A meta-analysis - 26/10/22

Doi : 10.1016/j.otsr.2022.103373

Pierre-Emmanuel Chammas ^a,^b,^⁎ , Nawale Hadouiri ^c,^d, Michel Chammas ^a, Sonia Ramos-Pascual ^e, Patrick Stirling ^e, Luca Nover ^e, Shahnaz Klouche ^f
^a Hand and Upper Extremity Surgery Unit, Lapeyronie Hospital, Montpellier University Medical Center, Av. du Doyen Gaston Giraud 371, 34295 Montpellier, France
^b Collège des Jeunes Orthopédistes, Rue Boissonade 56, 75014 Paris, France
^c Department of Physical Medicine and Rehabilitation, Dijon-Bourgogne University Hospital, Boulevard du Maréchal de Lattre de Tassigny 2, 21000 Dijon, France
^d InterSyndicale Nationale des Internes, Rue du Fer À Moulin 17, 75005 Paris, France
^e ReSurg SA, Rue Saint Jean 22, 1260 Nyon, Switzerland
^f Elsan, Rue la Boétie 58, 75008 Paris, France

^⁎Corresponding author. Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques, Département de chirurgie orthopédique, CHU de Lapeyronie, 191, avenue du Doyen Gaston-Giraud, 34090 Montpellier, France.Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques, Département de chirurgie orthopédique, CHU de Lapeyronie191, avenue du Doyen Gaston-GiraudMontpellier34090France

connectez-vous ou créez un compte

Bienvenue sur EM-consulte, la référence des professionnels de santé.
Article gratuit.

Connectez-vous pour en bénéficier!

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.