Abstract
Background Surgical procedure selection for carpal arthritis depends on which articular surfaces
are affected, but there is no consensus on how to preoperatively evaluate cartilage
surfaces. Despite advances in cross-sectional imaging, the utility of advanced imaging
for preoperative decision-making has not been well established.
Objectives Our objective was to assess if there is an added value to presurgical advanced imaging
or diagnostic procedures in planning for carpal arthrodesis or carpectomy and to determine
what imaging or diagnostic procedures influence surgical treatment options.
Methods A seven-question survey was sent to 2,400 hand surgeons. Questions assessed which
articular surfaces surgeons consider important for decision-making, which imaging
modalities surgeons employ, and how often surgeons utilize diagnostic arthroscopy
before performing carpectomy or arthrodesis procedures.
Results A total of 337 (14%) surveys were analyzed. The capitolunate articulation (alone
or in combination) was most frequently reported to impact surgical decision-making
(48.1%). Most surgeons (86.6%) reported that standard plain radiographs are usually
sufficient. Few surgeons reported always obtaining magnetic resonance imaging (MRI)
or computed tomography (CT), with 44.2% of surgeons believing that MRI is never useful
and 38.4% believing that CT is never useful. Most surgeons (68.2%) reported that they
never perform wrist arthroscopy as part of their decision-making process.
Conclusions This study provides information on the decision-making process in the surgical management
of carpal arthritis. Given advances in cross-sectional imaging, further studies are
needed to determine the utility of MRI and CT for the planning of surgical procedures
in the treatment of arthritis of the carpus.
Level of Evidence Level 4.
Keywords
carpal arthritis - arthrodesis - carpectomy - CT - MRI
