Wrist Arthritis Clinical Trial
Official title:
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.
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:
- 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.
;
Observational Model: Cohort, Time Perspective: Retrospective
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