Accelerated Progression of Arthritis after Four-Corner Fusion in Patients with Calcium Pyrophosphate Deposition Disease

Abstract

Background

This study aims to evaluate outcomes and radiographic progression of arthritis following four-corner fusion (4CF) in patients with and without calcium pyrophosphate deposition disease (CPPD).

Materials and Methods

A retrospective cohort study with prospective follow-up was conducted involving 21 patients who underwent 4CF for wrist arthritis with a mean follow-up period of 4.6± 2.8 years. Eleven patients with confirmed CPPD and 10 patients without CPPD were included. Demographic data, range of motion, return to work and recreational function, subjective outcomes, and radiographic progression of arthritis as per the Larsen scale were assessed and compared between groups.

Results

Both groups showed a comparable range of motion at final follow-up. All patients rated their surgery as successful, and both groups reported high levels of satisfaction. The CPPD group demonstrated a significantly lower recovery of work function, averaging 39.2% of full work function compared with 88.1% in the control group. About 81.8% of patients in the CPPD group showed significant progression of arthritis on radiographs, compared with only 10% in the control group. The CPPD group experienced significantly higher rates of perceived deterioration in wrist motion (36.4%) versus the control group (0%).

Conclusion

4CF provides satisfactory outcomes in patients with and without CPPD, although higher rates of radiographic progression of arthritis were observed in patients with evidence of CPPD. CPPD may lead to more rapid structural changes, however, the symptomatic benefits of 4CF remain considerable.

Level of Evidence

III B.

Keywords

arthritis - calcium pyrophosphate deposition disease - CPPD - four-corner fusion - wrist arthritis

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Ethical Approval

Rush University Medical Center Institutional Review Board approval obtained. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and the Helsinki Declaration of 1975, as revised in 2008 (5).

Patients' Consent

Written informed consent was obtained from the patient(s) for their anonymized information to be published in this article.

Publication History

Received: 09 January 2025

Accepted: 30 April 2025

Article published online:
20 May 2025

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