Progression of arthritis after four-corner fusion in patients with calcium pyrophosphate deposition disease: a case series of eleven patients

Abstract

Aim: The purpose of this study is to evaluate outcomes and radiographic progression of wrist arthritis after four-corner fusion (4CF) in patients with evidence of calcium pyrophosphate deposition disease (CPPD). The insights derived from this study are expected to improve the understanding of 4CF outcomes in the presence of CPPD, guiding clinical decisions, and management strategies. Methods: 11 patients with prior 4CF and evidence of CPPD were available for prospective follow-up and imaging, with a mean follow-up time of 5 years. Range of motion measurements, radiographs, and outcome data were collected at the follow-up visit and prior data and imaging were reviewed retrospectively. The chronological progression of arthritis was evaluated on standard three-view wrist radiographs using the Larsen scale. Results: All participants (11/11) deemed their wrist fusion a success, with an average satisfaction score of 8.8 out of 10.73% (8/11) patients were able to return to their original occupation after the procedure. The mean flexion of the affected wrist preoperatively was 43 degrees (SD: ±12 degrees) and 41 degrees (SD: ±7 degrees) at the final follow-up. The mean extension of the affected wrist was 35 degrees (SD: ±8 degrees) preoperatively and 40 degrees (SD: ±12 degrees) at the final follow-up. Radiographic analysis showed that 82% (9/11) of patients displayed progression of arthritis as per the Larsen scale by the final follow-up. All patients that showed radiographic progression had involvement of the radiolunate (RL) articulation, which is classically persevered in non-inflammatory wrist arthritis. Conclusions: Scaphoid excision with 4CF is a promising surgical option for managing CPPD-related wrist arthritis, offering significant functional improvements, motion preservation, and high patient satisfaction. However, it does not halt radiographic progression of arthritis for the majority of patients at a mean prospective long-term follow-up of 5 years.