Once considered a salvage operation, proximal row carpectomy now occupies a more prominent role in treating radioscaphoid arthrosis. When compared to arthrodesis, it offers the advantage of maintaining range of motion. While prior studies have assessed clinical and functional outcomes for this procedure, they suffer from relatively small sample sizes. We comprehensively examined the outcomes for a relatively large cohort of patients having undergone proximal row carpectomy.

The records of 72 patients undergoing 73 procedures were reviewed. Mean age at time of surgery was 51.3 years with the dominant hand treated in 53% of the cases. Fifty-eight percent were laborers and 47% were worker’s compensation cases. Scapholunate advanced collapse was the predominant diagnosis (37%). Patients were followed for a mean of 12.6 months (range 1.3 to 92.8) after surgery. Outcome measures included pre- and postoperative range of motion (ROM), grip (JAMAR) and pinch strengths, pain, complications, and return to work status. Repeat measures ANOVA was used to assess the significance of changes to the clinical assessments (alpha=.05).

Clinical function remained essentially unchanged following surgery (p>0.325). ROM decreased from 68 +/- 29.2 degrees to 67 +/- 23.3 degrees representing 58-63% of the untreated hand. Grip strength was unaffected by the procedure, with an overall mean force value of 41.3 +/- 21.7 lbs preoperatively and 42.0 +/- 20.8 lbs postoperatively. For those with completed records, 85% (46/54) of the patients returned to work at a mean of 6.3 +/- 8.3 months after surgery with 50% (23/46) assuming light duty functions. The majority of patients 62% (41/66) were pain-free following treatment. The complication rate was 15% (11/73) mostly being superficial infections (4/11).

The data support that proximal row carpectomy relieves pain while maintaining function and enables most to resume work duty albeit often at a light duty status. In comparison to other published results, this study represents the largest series comprised of the oldest age group of patients. Despite this, ROM, grip strengths, and pain relief were comparable to these predecessor studies.