A Comparative Analysis of Resource Utilization Between Proximal Row Carpectomy and Partial Wrist Fusion: A Population Study.

PURPOSE: We conducted a population-level analysis comparing proximal row carpectomy (PRC) and partial wrist arthrodesis (PWA) for treatment of chronic wrist arthritis to (1) characterize national practice patterns, (2) determine the rate of conversion to total wrist arthrodesis (TWA), and (3) calculate the associated direct cost of care.

METHODS: Using the Truven MarketScan databases from 2009 to 2015, we identified patients 18 years or older with a diagnosis of wrist osteoarthritis who had a PRC or PWA and were followed for 18 months. We used Chi-square analysis and multivariable logistic regression to examine patient characteristics associated with conversion to a TWA. Rates of repeat PWA were also obtained, including the total number of procedures until completion and direct treatment cost.

RESULTS: Of a total of 3,388 eligible patients, 1,305 had a PRC (39%) and 2,083 had a PWA (61%). In patients 54 years of age or younger, PWA was more commonly performed than PRC (49% vs 38%). The TWA rates were significantly higher for patients of all ages who underwent PWA (19.2%) versus PRC (4.9%). Those undergoing PWA required more total procedures than patients who received a PRC (average, 1.7 vs 1.1) resulting in a greater average direct cost per patient ($10,842 vs $7,171).

CONCLUSIONS: Conversion rates to a TWA are significantly higher with a PWA (19.2%) than with a PRC (4.9%) and have a greater associated direct cost. This includes younger patients, who in the past were considered better candidates for PWA. Our findings suggest that surgeons may need to reevaluate their indications for PWA and that there may need to be a paradigm shift in the current practice patterns for salvage treatment of wrist arthrosis, more often considering PRC for all age groups.

TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.