A carpectomy is a surgical procedure involving the removal of one or more of the eight small carpal bones located in the wrist. These bones are arranged in two rows, the proximal and the distal, providing the wrist with mobility and stability. The most frequently performed version is the Proximal Row Carpectomy (PRC), which removes the three bones closest to the forearm. This procedure is typically performed to alleviate chronic wrist pain and improve limited function when non-surgical treatments have failed, creating a new, less painful joint surface.
Medical Reasons for the Procedure
The need for a carpectomy most often arises from advanced wrist arthritis, where the protective cartilage on the carpal bones has worn away, causing painful bone-on-bone friction. Common indications for the Proximal Row Carpectomy include Scapholunate Advanced Collapse (SLAC) wrist, which develops after a chronic injury to the scapholunate ligament. Another frequent diagnosis is Scaphoid Nonunion Advanced Collapse (SNAC) wrist, occurring when an unhealed scaphoid fracture leads to progressive degenerative changes. These conditions cause instability and collapse of the carpal architecture, leading to persistent pain and loss of motion.
A carpectomy is also considered for late-stage Kienböck’s disease, characterized by avascular necrosis (death) of the lunate bone due to loss of blood supply. The procedure offers a solution when the proximal carpal row is severely damaged but the joint surfaces of the radius and the capitate bone remain healthy. The success of a Proximal Row Carpectomy depends on preserving the cartilage on the lunate fossa of the radius and the head of the capitate, which will form the new joint. If arthritis has progressed to involve these surfaces, the surgeon may need to consider a complete wrist fusion instead.
Removing the arthritic bones eliminates the painful joint surfaces and allows the distal carpal row, primarily the capitate, to move directly against the smooth, concave surface of the forearm’s radius bone. This rearrangement converts the complex, multi-joint articulation of the wrist into a simpler, more stable hinge-like joint. While the goal is pain relief, the procedure is also chosen over total wrist fusion because it preserves a functional arc of wrist motion.
The Surgical Process
The carpectomy operation typically begins with general anesthesia or a regional nerve block to numb the arm. The patient’s arm is positioned on a surgical table, and a tourniquet is often inflated on the upper arm to minimize bleeding. A longitudinal incision is then made on the dorsal (back) aspect of the wrist to gain access to the joint.
The surgeon retracts the extensor tendons and opens the wrist joint capsule to expose the carpal bones. In a Proximal Row Carpectomy, the three bones of the proximal row—the scaphoid, lunate, and triquetrum—are meticulously removed. Specialized instruments are used to dissect the surrounding soft tissue attachments and ligaments, ensuring the bones are excised entirely.
Once the three bones are removed, the operating field is inspected to confirm that the lunate fossa of the radius and the proximal surface of the capitate are smooth and undamaged. The remaining capitate bone is then positioned to articulate with the radius, forming the new radiocapitate joint. The wrist capsule is often tightened with sutures to help stabilize the new joint configuration. Finally, the incision is closed, and the wrist is immobilized in a bulky dressing or a splint to protect the surgical site.
Recovery Timeline and Rehabilitation
The initial phase of recovery involves immobilizing the wrist in a cast or splint for approximately four to six weeks to allow soft tissues and the joint capsule to stabilize. Pain management is a focus during this period. Patients are encouraged to keep the hand elevated to minimize swelling and perform gentle range-of-motion exercises for the fingers. Sutures are typically removed around the two-week mark, and a new cast or splint may be applied.
Physical therapy, often administered by a certified hand therapist, begins once the initial immobilization period is complete, usually between four and six weeks post-surgery. The primary goals of rehabilitation are to restore a functional range of motion, increase grip strength, and reduce residual stiffness. Early exercises focus on active wrist movement, progressing to light strengthening activities with resistance bands or putty around six to eight weeks.
Patients with sedentary jobs, such as office work, can often return to professional duties within six to eight weeks, though lifting and forceful gripping remain restricted. Returning to full strength and heavy activity, including manual labor or demanding sports, typically requires four to six months. Full recovery and maximum improvement in grip strength can take up to a year. Patients can expect to regain approximately 50% of their wrist’s normal range of motion and 50% to 80% of their pre-injury grip strength.