Arthroscopic Proximal Row Carpectomy

• Published in: The Journal of hand surgery (American ed.) Vol. 36; no. 4; pp. 577 - 582
• Main Authors: Weiss, Noah D., MD, Molina, Ricardo A., MD, Gwin, Stephanie, BS
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier 01-04-2011
• Subjects: Adult; Aged; Arthritis - diagnostic imaging; Arthritis - physiopathology; Arthroscopy; Arthroscopy - methods; Biological and medical sciences; Carpal Bones - physiopathology; Carpal Bones - surgery; Diseases of the osteoarticular system; Endoscopy; Female; Follow-Up Studies; Hand Strength; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Malformations and congenital and or hereditary diseases involving bones. Joint deformations; Medical sciences; Middle Aged; Minimally Invasive Surgical Procedures - methods; Miscellaneous. Osteoarticular involvement in other diseases; Orthopedic Procedures - methods; Orthopedics; Postoperative Care - methods; Radiography; Range of Motion, Articular - physiology; Recovery of Function; Sampling Studies; Treatment Outcome; Wrist Joint - diagnostic imaging; Wrist Joint - physiopathology; wrist arthritis; proximal row carpectomy; Arthroscopy; case series; scapholunate advanced collapse wrist; Carpus (bone); Proximal; Scapholunate advanced collapse; Diseases of the osteoarticular system; Surgical resection; Arthritis; Wrist; Treatment; Surgery; Orthopedics; Endoscopy
• ISSN: 0363-5023; 1531-6564
• DOI: 10.1016/j.jhsa.2011.01.009

Purpose Proximal row carpectomy is an effective procedure for treating a variety of wrist pathologies. To date, all outcome studies have reported on the results of an open procedure, with a dorsal capsulotomy. We present our technique and early results of arthroscopic proximal row carpectomy. Methods A total of 17 consecutive patients (10 men and 7 women) underwent arthroscopic proximal row carpectomy. After routine arthroscopy, the proximal carpal row was removed with an arthroscopic bur, with care being taken to protect the articular cartilage of the head of the capitate and the lunate fossa. The average time of the procedure was 70 minutes (range, 34–110 min). Range of motion exercise was initiated 2 days postoperatively. We assessed clinical follow-up objectively by evaluating range of motion and grip strength. We assessed subjective outcomes with the Disabilities of the Arm, Shoulder, and Hand questionnaire and with a patient-centered questionnaire assessing satisfaction, return to prior employment, and pain. Results A total of 16 patients were available, with an average follow-up of 24 months (range, 12–48 mo). There were no complications, no revisions were required, and no arthroscopic procedure was converted to open technique. At final follow-up, the average wrist flexion-extension arc was 80% of the contralateral side, and grip strength averaged 81% of the contralateral side. The mean Disabilities of the Arm, Shoulder, and Hand score was 21. All 16 patients rated themselves as satisfied or very satisfied with the procedure. Eleven patients had no work restrictions and 13 were able to return to previous employment. Ten patients rated themselves as having mild or no pain. Conclusions Arthroscopic proximal row carpectomy appears to be a safe, effective, and reliable procedure for a variety of wrist conditions, and it allows for rapid mobilization of the wrist compared with the open procedure. Range of motion and grip strength compare favorably with existing values in the literature for the open technique. Type of study/level of evidence Therapeutic IV.