[Prevalence of Pisotriquetral Subluxation and Osteoarthritis in Carpal Collapse - Pisotriquetral osteoarthritis with carpal collapse].

Abstract

Carpal collapse (CC), the most common cause of wrist osteoarthritis (OA), results from dissociative carpal instability. The pisotriquetral (PT) joint is usually given little attention, although it can be affected by carpal malalignment, become symptomatic, and may require treatment. The correlation between PT OA and CC has only been investigated in a small case series. The aim of this retrospective data analysis was to investigate the occurrence and severity of PT subluxation and/or PT OA in patients with CC using cross-sectional imaging in a sufficiently large and validated cohort.CT and MRI scans of patients who underwent surgical intervention for pain relief due to CC between 2003 and 2017 were re-evaluated. Parameters for OA and PT joint subluxation were assessed and correlated with the type and severity of CC, classified as scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC), stage II or III.A total of 234 patients (195 men, 39 women) with a mean age of 50±11.6 years were included. Of these, 148 were assigned to the SLAC group (33 patients with stage II; 115 patients with stage III) and 86 to the SNAC group (12 patients with stage II; 74 patients with stage III). PT OA was diagnosed in 76% of all patients; 47% had severe OA. (SLAC stage II: 21%, III: 46%, SNAC stages II and III: 58%). Of 154 patients with PT subluxation, 79% had PT OA, whereas patients without PT subluxation had an OA rate of 69%. Conversely, 69% of patients with PT OA also had PT subluxation, compared with a PT subluxation rate of 55% in patients without PT OA.These results indicate a high co-incidence of PT OA and CC. Obviously, PT OA occurs more frequently and earlier in SNAC than in SLAC, but its prevalence is high in both groups, particularly at stage III CC. This PT pathology concomitant with CC should be considered in all treatment planning, whether conservative or surgical, as it is not readily apparent on standard radiographic imaging.