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Resurfacing Capitate Pyrocarbon Implant versus Proximal Row Carpectomy Alone: A Comparative Study to Evaluate the Role of Capitate Prosthetic Resurfacing in Advanced Carpal Collapse.
Resurfacing Capitate Pyrocarbon Implant versus Proximal Row Carpectomy Alone: A Comparative Study to Evaluate the Role of Capitate Prosthetic Resurfacing in Advanced Carpal Collapse.
- Source :
-
Plastic and reconstructive surgery [Plast Reconstr Surg] 2017 Nov; Vol. 140 (5), pp. 962-970. - Publication Year :
- 2017
-
Abstract
- Background: The Resurfacing Capitate Pyrocarbon Implant associated with proximal row carpectomy has been used to treat symptomatic advanced carpal collapse, widening the indications of proximal row carpectomy to patients with capitate head arthritis. The authors retrospectively compared their case series of implant versus carpectomy alone, analyzing whether prosthetic implant outcomes could be similar to those of proximal row carpectomy even with a higher stage of osteoarthritis.<br />Methods: Fifty-seven patients who underwent surgery for wrist osteoarthritis (minimum follow-up, 2 years) were selected retrospectively. Twenty-five patients (scapholunate advanced collapse/scaphoid nonunion advanced collapse stage III to IV and Kienböck disease stage IV) underwent proximal row carpectomy plus Resurfacing Capitate Pyrocarbon Implant (group A); 32 patients (scapholunate advanced collapse/scaphoid nonunion advanced collapse stage I to II and Kienböck disease stage III) underwent carpectomy alone (group B). Mean follow-up was 33 months. Patients were evaluated clinically and radiographically. Patient-Rated Wrist Evaluation and Disabilities of the Arm, Shoulder, and Hand questionnaire scores were assessed.<br />Results: Group A showed consistent pain relief (visual analogue scale score of 2), while preserving wrist mobility (flexion, 27 degrees; extension, 33 degrees) and grip strength (54 percent compared with the contralateral side). Average Disabilities of the Arm, Shoulder, and Hand questionnaire score was 20, and average Patient-Rated Wrist Evaluation score was 28. No statistically significant difference was observed between groups for all outcomes, except for better extension (p < 0.05) in group B.<br />Conclusions: Even starting from a higher grade of osteoarthritis, Resurfacing Capitate Pyrocarbon Implant plus proximal row carpectomy showed satisfying results, compared with those obtained with just carpectomy. Data show that indications for proximal row carpectomy can be widened by using the implant, without worsening outcomes. The implant could be a useful alternative to more aggressive salvage procedures in case of capitate head and lunate fossa osteoarthritis involvement.<br />Clinical Question/level of Evidence: Therapeutic, III.
- Subjects :
- Adult
Aged
Aged, 80 and over
Arthroplasty, Replacement instrumentation
Carpal Bones diagnostic imaging
Carpal Bones pathology
Female
Follow-Up Studies
Humans
Male
Middle Aged
Osteoarthritis diagnostic imaging
Osteoarthritis pathology
Radiography
Retrospective Studies
Arthroplasty, Replacement methods
Carbon
Carpal Bones surgery
Joint Prosthesis
Osteoarthritis surgery
Wrist Joint surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1529-4242
- Volume :
- 140
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Plastic and reconstructive surgery
- Publication Type :
- Academic Journal
- Accession number :
- 29068934
- Full Text :
- https://doi.org/10.1097/PRS.0000000000003759