Proximal row carpectomy is an operation to remove the three bones of the proximal carpal row (scaphoid, lunate, and triquetrum), allowing the capitate to articulate directly with the radius. It is a motion-preserving alternative to wrist fusion.
An incision is made on the back of the wrist. The scaphoid, lunate, and triquetrum bones are carefully removed. The capitate (the central bone of the distal row) drops into the radius socket, creating a new articulation. No implant or fusion is needed. The operation takes one to one and a half hours.
Proximal row carpectomy is suitable for certain patterns of wrist arthritis (SLAC or SNAC wrist stages I-II), failed scaphoid treatment, and Kienböck's disease (lunate AVN). It preserves wrist motion unlike total wrist fusion.
Splinting, injection, pain medication. Surgical alternatives include four-corner fusion, total wrist fusion, or wrist replacement.
X-rays to confirm preserved cartilage on the capitate head and lunate fossa of the radius — essential for a good result.
Preservation of approximately 60% of normal wrist motion and 80% of grip strength. Good pain relief. Avoids fusion.
Approximately 60% of normal range is preserved.
Approximately 80% of normal. Usually functionally adequate.
Some patients notice clicking in the new wrist joint.
The new capitate-radius joint may develop arthritis over time, potentially requiring later fusion.
The new joint may be unstable.
Dorsal sensory nerve branches.
Wound infection.
If the procedure fails, wrist fusion remains available.
General or regional anaesthesia.
Splint for two to four weeks. Active wrist exercises from two to four weeks. Grip strengthening from six weeks. Return to manual work at two to three months. Full recovery three to six months.
Reviews at two weeks, six weeks, and three months.
Proximal row carpectomy preserves wrist motion and is a simpler procedure than fusion. It is particularly good for younger patients who want to maintain mobility.