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Risk of Total Wrist Arthrodesis or Reoperation Following 4-Corner Arthrodesis or Proximal Row Carpectomy for Stage-II SLAC/SNAC Arthritis: A Propensity Score Analysis of 502 Wrists.
J Bone Joint Surg Am. 2020 Jun 17; 102(12):1050-1058.JB

Abstract

BACKGROUND

For stage-II scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) patterns of wrist arthritis, the optimal method of surgical treatment remains unclear. Previous literature has demonstrated similar clinical outcomes between proximal row carpectomy (PRC) and 4-corner arthrodesis (FCA), making the risk of reoperation a focus of particular interest. In the present study, the primary null hypothesis was that there would be no difference in the rate of conversion to total wrist arthrodesis between PRC and FCA. Additionally, we hypothesized that the rate of secondary surgical procedures would be similar between the 2 procedures.

METHODS

The national Veterans Health Administration Corporate Data Warehouse was utilized to identify 2,449 patients who underwent either PRC or FCA between 1992 and 2016. With use of operative reports to identify the arthritis pattern, only cases of stage-II SLAC/SNAC were included. All complications and subsequent surgical procedures were confirmed by manual chart review. Propensity score analyses with matching weights were utilized to balance the PRC and FCA cohorts. The rates of conversion to wrist arthrodesis and secondary surgical procedures were calculated.

RESULTS

Of the 1,168 patients with stage-II SLAC/SNAC arthritis, 933 wrists underwent PRC and 257 wrists underwent FCA. Ten-year survival free of total wrist arthrodesis in the matching PRC (251 procedures) and FCA (251 procedures) cohorts was 94.3% (95% confidence interval [CI], 92.3% to 96.3%) and 94.1% (95% CI, 90.8% to 97.4%), respectively. Survival free of a secondary surgical procedure other than wrist arthrodesis was 99.7% (95% CI, 99.3% to 100.0%) for PRC and 83.5% (95% CI, 78.2% to 88.8%) for FCA.

CONCLUSIONS

PRC and FCA demonstrated similarly low rates of conversion to total wrist arthrodesis. In contrast, the rate of secondary surgical procedures following FCA was significantly higher compared with PRC. Given the historically similar clinical outcomes between PRC and FCA, the results of the present study show that PRC may be a preferable treatment for stage-II SLAC/SNAC wrist arthritis.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Garcia BN
Department of Orthopaedic Surgery, University of Utah Hospital, Salt Lake City, Utah.
Lu CC
HSR&D IDEAS Center, Salt Lake City George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah. Team VERITAS, Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah.
Stephens AR
Department of Orthopaedic Surgery, University of Utah Hospital, Salt Lake City, Utah.
Kazmers NH
Department of Orthopaedic Surgery, University of Utah Hospital, Salt Lake City, Utah.
Chen W
HSR&D IDEAS Center, Salt Lake City George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah. Team VERITAS, Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah.
Leng J
HSR&D IDEAS Center, Salt Lake City George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah. Team VERITAS, Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah.
Li L
Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas.
Sauer BC
HSR&D IDEAS Center, Salt Lake City George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah. Team VERITAS, Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah.
Tyser AR
Department of Orthopaedic Surgery, University of Utah Hospital, Salt Lake City, Utah.

MeSH

AdultArthrodesisCarpal BonesFemaleFollow-Up StudiesHumansMaleMiddle AgedOsteoarthritisPropensity ScoreReoperationTreatment OutcomeWrist Joint

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32187124

Citation

Garcia, Brittany N., et al. "Risk of Total Wrist Arthrodesis or Reoperation Following 4-Corner Arthrodesis or Proximal Row Carpectomy for Stage-II SLAC/SNAC Arthritis: a Propensity Score Analysis of 502 Wrists." The Journal of Bone and Joint Surgery. American Volume, vol. 102, no. 12, 2020, pp. 1050-1058.
Garcia BN, Lu CC, Stephens AR, et al. Risk of Total Wrist Arthrodesis or Reoperation Following 4-Corner Arthrodesis or Proximal Row Carpectomy for Stage-II SLAC/SNAC Arthritis: A Propensity Score Analysis of 502 Wrists. J Bone Joint Surg Am. 2020;102(12):1050-1058.
Garcia, B. N., Lu, C. C., Stephens, A. R., Kazmers, N. H., Chen, W., Leng, J., Li, L., Sauer, B. C., & Tyser, A. R. (2020). Risk of Total Wrist Arthrodesis or Reoperation Following 4-Corner Arthrodesis or Proximal Row Carpectomy for Stage-II SLAC/SNAC Arthritis: A Propensity Score Analysis of 502 Wrists. The Journal of Bone and Joint Surgery. American Volume, 102(12), 1050-1058. https://doi.org/10.2106/JBJS.19.00965
Garcia BN, et al. Risk of Total Wrist Arthrodesis or Reoperation Following 4-Corner Arthrodesis or Proximal Row Carpectomy for Stage-II SLAC/SNAC Arthritis: a Propensity Score Analysis of 502 Wrists. J Bone Joint Surg Am. 2020 Jun 17;102(12):1050-1058. PubMed PMID: 32187124.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk of Total Wrist Arthrodesis or Reoperation Following 4-Corner Arthrodesis or Proximal Row Carpectomy for Stage-II SLAC/SNAC Arthritis: A Propensity Score Analysis of 502 Wrists. AU - Garcia,Brittany N, AU - Lu,Chao-Chin, AU - Stephens,Andrew R, AU - Kazmers,Nikolas H, AU - Chen,Wei, AU - Leng,Jianwei, AU - Li,Liang, AU - Sauer,Brian C, AU - Tyser,Andrew R, PY - 2020/3/19/pubmed PY - 2021/1/21/medline PY - 2020/3/19/entrez SP - 1050 EP - 1058 JF - The Journal of bone and joint surgery. American volume JO - J Bone Joint Surg Am VL - 102 IS - 12 N2 - BACKGROUND: For stage-II scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) patterns of wrist arthritis, the optimal method of surgical treatment remains unclear. Previous literature has demonstrated similar clinical outcomes between proximal row carpectomy (PRC) and 4-corner arthrodesis (FCA), making the risk of reoperation a focus of particular interest. In the present study, the primary null hypothesis was that there would be no difference in the rate of conversion to total wrist arthrodesis between PRC and FCA. Additionally, we hypothesized that the rate of secondary surgical procedures would be similar between the 2 procedures. METHODS: The national Veterans Health Administration Corporate Data Warehouse was utilized to identify 2,449 patients who underwent either PRC or FCA between 1992 and 2016. With use of operative reports to identify the arthritis pattern, only cases of stage-II SLAC/SNAC were included. All complications and subsequent surgical procedures were confirmed by manual chart review. Propensity score analyses with matching weights were utilized to balance the PRC and FCA cohorts. The rates of conversion to wrist arthrodesis and secondary surgical procedures were calculated. RESULTS: Of the 1,168 patients with stage-II SLAC/SNAC arthritis, 933 wrists underwent PRC and 257 wrists underwent FCA. Ten-year survival free of total wrist arthrodesis in the matching PRC (251 procedures) and FCA (251 procedures) cohorts was 94.3% (95% confidence interval [CI], 92.3% to 96.3%) and 94.1% (95% CI, 90.8% to 97.4%), respectively. Survival free of a secondary surgical procedure other than wrist arthrodesis was 99.7% (95% CI, 99.3% to 100.0%) for PRC and 83.5% (95% CI, 78.2% to 88.8%) for FCA. CONCLUSIONS: PRC and FCA demonstrated similarly low rates of conversion to total wrist arthrodesis. In contrast, the rate of secondary surgical procedures following FCA was significantly higher compared with PRC. Given the historically similar clinical outcomes between PRC and FCA, the results of the present study show that PRC may be a preferable treatment for stage-II SLAC/SNAC wrist arthritis. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. SN - 1535-1386 UR - https://www.unboundmedicine.com/medline/citation/32187124/Risk_of_Total_Wrist_Arthrodesis_or_Reoperation_Following_4_Corner_Arthrodesis_or_Proximal_Row_Carpectomy_for_Stage_II_SLAC/SNAC_Arthritis:_A_Propensity_Score_Analysis_of_502_Wrists_ DB - PRIME DP - Unbound Medicine ER -