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

Abstract 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). 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. 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%). 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. III B.