Proximal row carpectomy: Indications, surgical technique, and long-term results

Proximal row carpectomy (PRC) can be an effective procedure in the treatment of painful arthritis of the wrist. Many conditions—most commonly untreated scaphoid nonunions and chronic scapholunate dissociation—can result in scapholunate advanced collapse pattern of arthritis, whereby the radioscaphoid and midcarpal joint become degenerative. Typically, the radiolunate joint, which is the basis for motion-preserving reconstructive procedures such as proximal row carpectomy, is spared. PRC converts a complex link joint to a simple hinge joint by creating a radiocapitate articulation. The ideal candidate for PRC has radioscaphoid arthritis with preservation of the capitate articular surface and the lunate fossa of the radius. This paper describes preoperative evaluation, surgical technique of both standard PRC and PRC with capsular interposition, postoperative rehabilitation, and results. Proximal row carpectomy is effective in treating posttraumatic arthritis of the wrist, has a low failure rate, and leaves the patient with a functional arc of motion and acceptable grip strength. With long-term follow-up, many patients show radiographic evidence of progressive radiocapitate arthritis, but do not manifest a corresponding deterioration in clinical function.

proximal row carpectomy, scapholunate advanced collapse, arthritis, scaphoid nonunion, Kienböck's disease

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