Proximal row carpectomy of the wrist in the setting of midcarpal arthritis: Survivorship and associated complications in soft tissue interposition versus capitate resurfacing

Background: Proximal row carpectomy (PRC) has been shown to be an effective treatment option for early stages of wrist arthritis. In the presence of midcarpal arthritis however, PRC has generally been contraindicated due to a high conversion rate to total wrist arthrodesis. Variations to PRC, including radio-capitate soft tissue interposition and capitate resurfacing, have been introduced to delay conversion and have demonstrated similar outcomes compared to standard PRC. Comparative outcomes between these technical variations have not been investigated however. Methods: Retrospective chart review was conducted for patients who underwent PRC with interposition or capitate resurfacing from 2009-2019. Patient demographics, pre- and post-operative range of motion, operative time, cost, and post-operative complications were collected. Descriptive statistics were expressed as means and standard deviations. Survivability was plotted on a Kaplan-Meier survival curve. Results: Final cohorts included ten patients who underwent PRC with interposition and six who underwent PRC with resurfacing. Resurfacing had longer average operative duration (51.3±18.3 vs. 79.0±16.5 min, P=0.009) and higher cost ($29,116±10,036 vs. $15,290±3,743, P=0.028). There was no significant difference in wrist ROM. Two of the six patients who underwent resurfacing experience complications requiring conversion to total wrist arthrodesis, however there was no significant difference in overall survivorship. Conclusions: In this observational comparative study, PRC with capitate resurfacing trended towards longer operative time, increased cost, and higher complication and conversion rate. Future larger and more standardized analyses are needed in order to evaluate the long-term outcomes of these procedures. Level of Evidence: Level IV – Case Series.