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Proximal row carpectomy generates better mid- to long-term outcomes than four-corner arthrodesis for post-traumatic wrist arthritis: A meta-analysis.
Orthop Traumatol Surg Res. 2022 11; 108(7):103373.OT

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.

LEVEL OF EVIDENCE

III; systematic review and meta-analysis.

Authors+Show Affiliations

Hand and Upper Extremity Surgery Unit, Lapeyronie Hospital, Montpellier University Medical Center, Av. du Doyen Gaston Giraud 371, 34295 Montpellier, France; Collège des Jeunes Orthopédistes, Rue Boissonade 56, 75014 Paris, France. Electronic address: pe-chammas@chu-montpellier.fr.Department of Physical Medicine and Rehabilitation, Dijon-Bourgogne University Hospital, Boulevard du Maréchal de Lattre de Tassigny 2, 21000 Dijon, France; InterSyndicale Nationale des Internes, Rue du Fer À Moulin 17, 75005 Paris, France.Hand and Upper Extremity Surgery Unit, Lapeyronie Hospital, Montpellier University Medical Center, Av. du Doyen Gaston Giraud 371, 34295 Montpellier, France.ReSurg SA, Rue Saint Jean 22, 1260 Nyon, Switzerland.ReSurg SA, Rue Saint Jean 22, 1260 Nyon, Switzerland.ReSurg SA, Rue Saint Jean 22, 1260 Nyon, Switzerland.Elsan, Rue la Boétie 58, 75008 Paris, France.

Pub Type(s)

Meta-Analysis
Journal Article
Review
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

35940440

Citation

Chammas, Pierre-Emmanuel, et al. "Proximal Row Carpectomy Generates Better Mid- to Long-term Outcomes Than Four-corner Arthrodesis for Post-traumatic Wrist Arthritis: a Meta-analysis." Orthopaedics & Traumatology, Surgery & Research : OTSR, vol. 108, no. 7, 2022, p. 103373.
Chammas PE, Hadouiri N, Chammas M, et al. Proximal row carpectomy generates better mid- to long-term outcomes than four-corner arthrodesis for post-traumatic wrist arthritis: A meta-analysis. Orthop Traumatol Surg Res. 2022;108(7):103373.
Chammas, P. E., Hadouiri, N., Chammas, M., Ramos-Pascual, S., Stirling, P., Nover, L., & Klouche, S. (2022). Proximal row carpectomy generates better mid- to long-term outcomes than four-corner arthrodesis for post-traumatic wrist arthritis: A meta-analysis. Orthopaedics & Traumatology, Surgery & Research : OTSR, 108(7), 103373. https://doi.org/10.1016/j.otsr.2022.103373
Chammas PE, et al. Proximal Row Carpectomy Generates Better Mid- to Long-term Outcomes Than Four-corner Arthrodesis for Post-traumatic Wrist Arthritis: a Meta-analysis. Orthop Traumatol Surg Res. 2022;108(7):103373. PubMed PMID: 35940440.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Proximal row carpectomy generates better mid- to long-term outcomes than four-corner arthrodesis for post-traumatic wrist arthritis: A meta-analysis. AU - Chammas,Pierre-Emmanuel, AU - Hadouiri,Nawale, AU - Chammas,Michel, AU - Ramos-Pascual,Sonia, AU - Stirling,Patrick, AU - Nover,Luca, AU - Klouche,Shahnaz, Y1 - 2022/08/05/ PY - 2022/01/09/received PY - 2022/04/04/revised PY - 2022/04/25/accepted PY - 2022/8/9/pubmed PY - 2022/11/2/medline PY - 2022/8/8/entrez KW - Long-term effects KW - Osteoarthritis KW - Palliative treatment KW - Post traumatic KW - Wrist SP - 103373 EP - 103373 JF - Orthopaedics & traumatology, surgery & research : OTSR JO - Orthop Traumatol Surg Res VL - 108 IS - 7 N2 - 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. LEVEL OF EVIDENCE: III; systematic review and meta-analysis. SN - 1877-0568 UR - https://www.unboundmedicine.com/medline/citation/35940440/Proximal_row_carpectomy_generates_better_mid__to_long_term_outcomes_than_four_corner_arthrodesis_for_post_traumatic_wrist_arthritis:_A_meta_analysis_ DB - PRIME DP - Unbound Medicine ER -