A carpectomy is a surgical procedure that removes some or all of the small bones in the wrist (called carpal bones) to relieve pain and restore function. The most common version, called a proximal row carpectomy, removes three specific bones: the scaphoid, lunate, and triquetrum. These sit in the row closest to your forearm. Once removed, the remaining wrist bones settle into the space left behind, creating a simpler but still functional joint.
How the Procedure Works
Your wrist contains eight small bones arranged in two rows. The row nearest your forearm is the “proximal row,” and it acts as a bridge between the forearm bones and the rest of the hand. In a proximal row carpectomy, the surgeon removes all three bones in that row. After removal, a rounded bone called the capitate (the largest carpal bone, sitting in the second row) drops into the cup-shaped socket on the end of the radius (your main forearm bone). This new pairing functions as a simplified wrist joint.
The surgery can be done by removing all three bones as a single block or by taking them out individually. Either way, the surgeon needs to protect key ligaments and the surface of the capitate during the process, since these structures become the foundation of your “new” wrist joint.
Why It’s Done
Proximal row carpectomy is typically recommended when arthritis or bone damage has made the wrist painful and stiff, but some healthy cartilage remains. The two most common reasons are conditions called scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC). Both involve a chain reaction of arthritis that spreads through the wrist after a ligament tear or a scaphoid fracture that never healed properly. The procedure is best suited for earlier stages of these conditions, before arthritis reaches the capitate head or the socket on the radius.
That cartilage requirement is the key factor surgeons check before recommending the procedure. If the capitate’s surface or the radius socket already shows significant arthritic damage, this surgery won’t work well because the new joint would be bone grinding on bone from day one. In those cases, a full wrist fusion is usually a better option.
Carpectomy vs. Four-Corner Fusion
The main alternative to proximal row carpectomy is a procedure called four-corner fusion, which removes only the scaphoid and then fuses four remaining carpal bones together. Both are used for the same conditions, and for years surgeons debated which was better. A systematic review and meta-analysis comparing the two found that proximal row carpectomy produced significantly better outcomes in several areas: greater wrist extension, more ulnar deviation (tilting the hand toward the pinky side), and lower pain scores. Grip strength showed no significant difference between the two procedures.
Proximal row carpectomy also carries a lower complication rate. Complication rates for carpectomy range from about 16% to 19%, compared with 29% to 34% for four-corner fusion. The fusion procedure carries an additional risk of the bones failing to heal together (nonunion), a problem that doesn’t exist when you’re simply removing bones rather than fusing them.
What Recovery Looks Like
Recovery follows a structured timeline over roughly two months. For the first 10 to 14 days, you’ll wear a postoperative splint and keep it clean and dry. During this phase, the focus is on moving your fingers and elbow through their full range to prevent stiffness, but the wrist itself stays immobilized.
Between weeks two and four, the initial splint is replaced with either a short arm cast or a custom wrist brace that you wear full time, removing it only for hygiene and skin care. Active wrist movement begins around week four to eight, when you’ll start gentle range-of-motion exercises in all four directions: bending, extending, and tilting side to side. The transition from cast to removable brace happens during this phase if it hasn’t already.
Range of Motion After Surgery
One of the main advantages of this procedure over a full wrist fusion is that it preserves meaningful wrist motion. A systematic review of long-term outcomes found that patients maintained an average flexion-extension arc of about 73.5 degrees and roughly 31.5 degrees of side-to-side deviation. To put that in context, a normal wrist can bend and extend through roughly 150 degrees total, so carpectomy preserves about half of normal motion. That’s enough for most daily tasks.
A smaller study tracking patients over two years found significant improvements from their pre-surgery baselines: active bending improved from about 16 degrees to 37 degrees, extension from 14 degrees to 29 degrees, and ulnar deviation from 12.5 degrees to 21 degrees. These gains matter because by the time someone needs this surgery, their wrist is usually already very stiff and painful, so the comparison that matters most is not “normal wrist vs. post-surgery wrist” but “damaged wrist vs. post-surgery wrist.”
Long-Term Durability
Proximal row carpectomy holds up well over time for most patients, but it doesn’t last forever in every case. Studies with at least 10 years of follow-up show that about 12% of patients eventually need a secondary surgery to fuse the wrist (called a radiocarpal arthrodesis). In one study following patients for a minimum of 20 years, 65% of wrists required no further surgery at all. Among those that did fail, the average time before conversion to a wrist fusion was 11 years, with a wide range from 8 months to 20 years.
The fact that wrist fusion remains available as a backup is actually one of the procedure’s selling points. If the new joint eventually wears out and becomes painful again, surgeons can still fuse the wrist as a salvage option. This makes proximal row carpectomy a reasonable first step, particularly for younger or more active patients who want to preserve motion for as long as possible.
Possible Complications
Overall complication rates sit in the 16% to 19% range. The most commonly reported issues from systematic reviews include progressive arthritis in the new joint (about 4% of cases), significant swelling and inflammation of the joint lining (about 3%), and the need for conversion to wrist fusion (about 4%). A small percentage of patients develop a chronic pain condition called reflex sympathetic dystrophy (about 1%), and surgical infection is rare at roughly 0.2%.
More immediate risks include temporary numbness or tingling in the hand, which can resemble carpal tunnel symptoms due to post-surgical swelling. There’s also a risk of tendon injury during the bone removal, and if the ligaments that stabilize the remaining carpal bones are damaged during the procedure, the wrist can become unstable. Careful surgical technique minimizes these risks, but they’re worth understanding before going in.