What is a PRC Surgery? Understanding Proximal Row Carpectomy

September 21, 2025 •

4 min read

Affecting millions, wrist arthritis can significantly impair function and cause chronic pain. For those with advanced cases, a surgical procedure known as Proximal Row Carpectomy (PRC) offers a proven method for pain relief while preserving motion. This article will delve into what this operation entails and its potential benefits.

Quick Summary

A PRC surgery, or Proximal Row Carpectomy, is an orthopedic procedure involving the removal of the three carpal bones in the proximal row of the wrist to relieve pain and improve function in patients with severe wrist arthritis or degenerative conditions. The remaining bones are repositioned to form a new, functional joint.

Key Points

Surgical Procedure: A PRC surgery removes the proximal row of three carpal bones (scaphoid, lunate, and triquetrum) from the wrist to create a new, less painful joint.
Purpose: The procedure is primarily used to treat severe wrist arthritis and degenerative changes caused by conditions like SLAC wrist, SNAC wrist, or post-traumatic injury.
Motion-Sparing: Unlike a total wrist fusion, PRC is considered a motion-sparing surgery, preserving partial wrist movement while providing significant pain relief.
Recovery: Recovery involves an initial period of immobilization (4-6 weeks) followed by an extensive physical therapy program to restore motion and strength.
Comparison with 4CF: When compared to four-corner arthrodesis (4CF), PRC offers better wrist motion and has lower complication rates, though 4CF may provide better grip strength and long-term stability.
Long-term Outlook: While effective for pain relief, PRC can carry a risk of developing new arthritis over time at the new joint surface, which may eventually require further intervention.

What Exactly is a Proximal Row Carpectomy (PRC)?

A proximal row carpectomy (PRC) is a surgical technique designed to address painful, arthritic conditions in the wrist. The wrist is composed of eight small carpal bones, arranged in two rows: a proximal row closer to the forearm and a distal row closer to the hand. During a PRC procedure, the three bones of the proximal row—the scaphoid, lunate, and triquetrum—are surgically removed. This creates a new joint surface where the capitate bone (from the distal row) now articulates directly with the radius bone of the forearm. This simple hinge-like joint can reduce bone-on-bone friction and alleviate chronic wrist pain.

Indications for PRC Surgery

PRC is typically recommended for patients with specific degenerative conditions that have not responded to conservative treatments like splints, anti-inflammatory medication, or injections. The ideal candidate for PRC usually meets several criteria, including relatively advanced arthritis localized to certain joints, and a well-preserved surface on the capitate and lunate fossa of the radius, which will form the new joint. The most common conditions necessitating a PRC include:

Scapholunate Advanced Collapse (SLAC) Wrist: This progressive instability results from a ligament tear between the scaphoid and lunate bones, leading to arthritis.
Scaphoid Nonunion Advanced Collapse (SNAC) Wrist: This occurs when a scaphoid bone fracture fails to heal properly, causing collapse and arthritis.
Kienböck's Disease: Avascular necrosis (death of bone tissue due to lack of blood supply) of the lunate bone can also be treated with PRC.
Post-traumatic Wrist Arthritis: Following a significant wrist injury, arthritis may develop and become severe enough to warrant a PRC.

The PRC Surgical Procedure: What to Expect

The PRC surgery is a relatively straightforward procedure, usually lasting one to two hours, and is often performed on an outpatient basis.

Anesthesia: The patient is placed under general or regional anesthesia.
Incision: A surgeon makes a small incision, typically on the back (dorsal side) of the wrist.
Exposure: The extensor tendons are moved aside to allow access to the wrist joint capsule.
Excision: The surgeon removes the scaphoid, lunate, and triquetrum bones with precision.
Preparation: The surgeon smooths the remaining carpal bones to ensure a clean articulation with the radius.
Closure: The joint capsule and skin are carefully closed, and a dressing and splint are applied to immobilize the wrist.

Recovery and Rehabilitation After PRC

Postoperative care and rehabilitation are crucial for a successful outcome after PRC. The typical recovery involves several stages:

Initial Immobilization (4–6 weeks): A cast or splint is worn to protect the wrist and allow soft tissues to heal. Patients are advised to keep the hand elevated to minimize swelling and perform gentle finger movements to prevent stiffness.
Early Motion (After immobilization): Once the cast is removed, a structured hand or physical therapy program begins. The therapist guides the patient through range-of-motion exercises to restore mobility.
Strengthening (8–12 weeks): Progressive strengthening exercises are introduced to rebuild grip and wrist strength. Patients are restricted from lifting heavy objects for several months.
Long-term Recovery (4–6+ months): Most patients can return to daily activities and sedentary jobs within three months. For heavy manual labor, recovery may take up to six months or longer. Full strength can take up to a year to recover.

PRC vs. Four-Corner Arthrodesis: A Comparison

For patients with advanced wrist arthritis, PRC is often compared to another common procedure, four-corner arthrodesis (4CF). Each has distinct advantages and disadvantages, and the best choice depends on the specific condition and patient's lifestyle needs.


Feature	Proximal Row Carpectomy (PRC)	Four-Corner Arthrodesis (4CF)
Surgical Complexity	Less technically demanding, shorter surgical time	More technically challenging, longer surgical time
Preservation of Motion	Preserves some wrist motion (approx. 50% normal)	Significantly restricts motion; wrist is fused into a fixed position
Grip Strength	Can result in some loss of grip strength; averages 50-80% of normal side	Better potential for preserving grip strength due to greater stability
Complications	Lower complication rate; risk of future radiocapitate arthritis	Higher complication rate due to nonunion or hardware issues; less risk of future arthritis if fusion is successful
Hardware	No implants or hardware required	Involves permanent implants, such as plates, screws, or pins
Rehabilitation	Often a shorter rehabilitation period	Can involve a longer period of immobilization while bones fuse

Potential Risks and Complications

As with any surgery, a PRC has potential risks and complications that should be discussed with a surgeon. While generally considered a safe procedure with a lower complication rate compared to other wrist surgeries, potential issues include:

Persistent wrist pain
Reduced range of wrist motion or grip strength
Development of arthritis at the new joint over time
Nerve injury, causing numbness or tingling
Infection or delayed wound healing
Chronic stiffness or swelling
The need for further surgery, such as a complete wrist fusion

Is PRC the Right Choice for You?

Deciding whether a PRC is the right treatment depends on several factors, including the severity and stage of the wrist condition, a patient's age, and their functional demands. It's often favored for those with moderate activity needs, as it provides a good balance between pain relief and motion preservation. For younger patients or those with high-demand occupations, surgeons may discuss alternative options to ensure the best long-term outcome. Open and honest dialogue with a qualified orthopedic or hand surgeon is essential to weigh the potential benefits against the risks and choose the most suitable path forward.

For further information on various orthopedic procedures, consider reviewing medical journals such as the Journal of Hand Surgery.

Frequently Asked Questions

Recovery from a PRC surgery typically involves wearing a cast or splint for 4 to 6 weeks, followed by several months of physical therapy to regain strength and motion. Full recovery, including regaining maximum grip strength, can take up to a year.

A PRC surgery removes bones to create a new, movable joint, preserving some wrist motion. In contrast, a wrist fusion permanently locks the wrist bones together to eliminate motion, which provides greater stability and often better grip strength but no movement.

Patients who undergo PRC can expect significant relief from chronic wrist pain. They typically regain about 50% of their wrist's normal range of motion and 50-80% of their grip strength compared to their non-operated side.

After the three proximal carpal bones are removed, the capitate bone from the distal row takes their place. It articulates with the radius bone to form a new joint, which provides a functional, hinge-like movement.

Pain is expected after any surgery, but patients are managed with pain medication prescribed by their doctor. The goal of the procedure is to relieve the chronic pain caused by arthritis, so long-term pain is typically reduced.

PRC surgery is most often used to treat advanced cases of wrist arthritis resulting from conditions like Scapholunate Advanced Collapse (SLAC), Scaphoid Nonunion Advanced Collapse (SNAC), or Kienböck's disease.

Alternatives to PRC include conservative treatments like splinting and injections, as well as other surgeries. For more advanced cases, options may include four-corner arthrodesis (4CF) or a total wrist arthrodesis (fusion).