The Rate and Timing of Revision Carpal Tunnel Release with Long-Term Follow-Up.

PURPOSE: Although carpal tunnel release (CTR) is the most common upper-extremity orthopedic procedure in the United States, revision surgery can be indicated when symptoms of carpal tunnel syndrome persist, recur, or worsen after primary surgery. Understanding the revision surgery profile after CTR is important for preoperative counseling and treatment decision-making, yet published rates of revision surgery vary widely. In our study, we aimed to establish the rate of revision CTR and describe temporal patterns of revisions after primary surgery for patients with long-term follow-up at our institution.

METHODS

We performed a retrospective chart review of 1,328 primary CTR procedures performed from July 2008-June 2013 with a minimum follow-up period of 10 years at our center and at least one documented encounter within our integrated health network within the last 3 years (2021-present). Of the 1,328 cases originally reviewed, 783 (59%) met our inclusion criteria. We conducted bivariate analyses to assess for risk factors associated with revision CTR.

RESULTS

Of the 783 patients included in our study, 20 (2.6%) underwent revision CTR at a median of 5.2 years (interquartile range [IQR], 0.48-8.2 years) after primary surgery. Of the revision CTRs, 80% were performed for recurrent symptoms and 20% for persistent symptoms. Median follow-up after primary surgery with the surgeon was 3.6 years (IQR, 0.4-9.6 years) and median follow-up within the integrated health system was 12.8 years (IQR, 11.9-14.4 years). The rate of revision surgery for recurrent carpal tunnel syndrome remained constant and linear throughout the follow-up period, whereas for persistent carpal tunnel syndrome, all revisions were performed within 2 years of the primary surgery.

CONCLUSIONS

The rate of revision CTR with long-term follow-up is low. Our finding expands upon the existing literature to further characterize the revision surgery rate of this common hand procedure, helping to inform preoperative counseling.

TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.