Long-term Outcome of Proximal Row Carpectomy. Influence of the Shape of the Capitate

In cases of severe arthritis of the wrist, surgical removal of the scaphoid, lunate and triquetrum bones or proximal row carpectomy (PRC) is a well-known procedure. This procedure converts the wrist in a simple hinged joint but allows us to preserve a certain range of motion in the wrist. One of the main disadvantages of PRC is the risk of developing arthritis between the head of the capitate and the lunate fossa. The long-term follow-up of this procedure has always been a reason for concern. The investigators set up this retrospective study to evaluate the long-term results of the procedure in the investigators institution.

Also, the shape of the head of the capitate may play a role in the development of arthritis. A more round shape could distribute the forces more equally and thus prevent the progression of cartilage damage

The study hypothesis is:

• PRC preserves range of motion and force in the long term (more than 10 years postoperatively).
• A more round head of the capitate is associated with an increased risk of developing arthritis in the new joint.

Study Overview

• Status: Unknown
• Conditions: Wrist Arthritis
• Intervention / Treatment: Procedure: Proximal row carpectomy

Detailed Description

We invite all patients who underwent a PRC at our institution with a follow-up of more than 10 years for review.

Questions

• VAS pain in rest and during activity

  • Pain is quantified as none, minimal (pain with strenuous activity), moderate (pain with daily activity), or severe (pain at rest).
  • If pain, use of analgetics, splint, …
• quick DASH
• patient related wrist evaluation (PRWE) score. form-36 (SF-36) general health status outcome ?
• Satisfaction, do it again?
• Complications? Re-operations?
• Return to work after operation, which job (manual labor?) changed job due to wrist problems? Worker's compensation claims?

Clinical review

• grip force + other side to compare (Jamar Dynamometer)
• pinch grip + other side to compare

• range of motion measurement:

  • absolute and compared to other side
  • flexion-extension, ulnar-radial deviation and prosupination

Radiography:

• Standard anterioposterior and lateral wrist radiography performed to evaluate the onset or degree of arthritis.

  o Radiocapitate arthrosis grading:

  • None
  • Minimal (joint space narrowing alone),
  • Moderate (joint space narrowing with adjacent subchondral sclerosis)
  • severe (bone collapse, erosion, or subchondral cyst formation)
• Oldest radiography of each patient was retrieved and the shape of the capitate evaluated.
• If available, a pre-operative MRI scan could also be interpreted. (Probably no MRI's available, but MRI gives a better indication of the shape of the capitate than plain X-ray).
• Review: documentation of intra-operative findings concerning capitate and lunate fossa.

Statistical analysis

• Student's t-test on the numerical data
• Wilcoxon signed- rank test on the visual analog scales
• Differences significant at p < .05. Two-tailed tests in all cases.
• Subgroups according to initial diagnosis
• Compare results with the initial follow-up to evaluate the prospective value of this follow-up moment.

• Study Type: Observational
• Enrollment (Anticipated): 60

Contacts and Locations

Study Locations

• Belgium
  • Vlaams-Brabant
    • Leuven, Vlaams-Brabant, Belgium, 3000
      • University Hospitals Leuven

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

All patients who underwent a Proximal row carpectomy in our institution more than 10 year ago will be contacted for review

Description

Inclusion Criteria:

• All patients who underwent a Proximal row carpectomy

Exclusion Criteria:

• Bilateral procedure

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Retrospective

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Proximal row carpectomy	Procedure: Proximal row carpectomy

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
quick DASH score	The Disability of Arm, Shoulder and Hand score is a standardised outcome measure for upper limb evaluation.	more than 10 year after operation

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Arthritis between capitate and lunate fossa	radiographic evaluation of arthritis in the wrist: None; Minimal (joint space narrowing alone),; Moderate (joint space narrowing with adjacent subchondral sclerosis); Severe (bone collapse, erosion, or subchondral cyst formation)	10 years after operation

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Range of movement	clinical measurement with a goniometer of the flexion, extension, ulnar and radial deviation and pronation and supination + comparison to the other, uninvolved wrist	10 years after operation

Collaborators and Investigators

• Sponsor: University Hospital Pellenberg
• Investigators: Principal Investigator: Maarten Van Nuffel, M.D., Universitaire Ziekenhuizen KU Leuven

Study record dates

Study Major Dates

• Study Start: March 1, 2014
• Primary Completion (Anticipated): June 1, 2014
• Study Completion (Anticipated): July 1, 2014

Study Registration Dates

• First Submitted: March 4, 2014
• First Submitted That Met QC Criteria: March 5, 2014
• First Posted (Estimate): March 6, 2014

Study Record Updates

• Last Update Posted (Estimate): March 7, 2014
• Last Update Submitted That Met QC Criteria: March 6, 2014
• Last Verified: March 1, 2014

More Information

Terms related to this study

• Keywords: carpectomy, proximal row, long-term, wrist, arthritis
• Additional Relevant MeSH Terms: Joint Diseases; Musculoskeletal Diseases; Arthritis
• Other Study ID Numbers: PRC Van Nuffel De Smet