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[A adaptive proximal scaphoid implant].

J P Pequignot1, B Lussiez, Y Allieu

  • 1Hôpital Lapeyronie, 34059 Montpellier, France.

Chirurgie De La Main
|January 9, 2001
PubMed
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This study introduces the adaptive pyrocarbon implant (APSI) for treating wrist arthritis, showing promising results in pain reduction and functional recovery for SNAC wrist conditions. While effective for scaphoid pseudoarthritis, its benefit for SLAC wrist with severe ligament damage requires further investigation.

Area of Science:

  • Orthopedic surgery
  • Biomaterials science
  • Hand and wrist biomechanics

Background:

  • Carpal instability and arthritis, specifically SNAC (scaphoid non-union advanced collapse) and SLAC (scapholunate advanced collapse) wrists, significantly impair hand function.
  • Current treatments aim to restore carpal height and mobility, but often face limitations in preventing further deterioration.
  • The proximal scaphoid implant (APSI) offers a novel approach to address these issues by restoring carpal anatomy and allowing adaptive mobility.

Purpose of the Study:

  • To evaluate the safety and efficacy of the adaptive pyrocarbon implant (APSI) in treating SNAC and SLAC wrists.
  • To assess the implant's impact on pain, functional recovery, and radiographic outcomes.
  • To determine the implant's suitability for different types of carpal collapse and ligamentous instability.

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Main Methods:

  • A retrospective analysis of 25 patients who underwent APSI implantation.
  • Patients were evaluated an average of six years post-surgery (range: 3-10 years) by an independent observer.
  • Data collected included pain levels, functional outcomes (grip and pinch strength), radiographic measurements (carpal height, radio-lunate angle), and implant integrity.

Main Results:

  • 88% of patients reported satisfaction, with 60% experiencing complete pain resolution and 28% with pain only during exertion.
  • Digitopalmar grip and pinch strength increased compared to the contralateral hand.
  • Radiological assessment confirmed maintained carpal height and no implant dislocations; dynamic X-rays demonstrated adaptive mobility. Two cases with severe preoperative ligamentous lesions had poor outcomes.

Conclusions:

  • The APSI implant shows promising preliminary results for treating SNAC wrists, effectively preventing further deterioration and carpal collapse.
  • The implant restores carpal height and allows adaptive mobility, leading to significant pain relief and functional improvement.
  • For SLAC wrists with severe ligamentous instability, the APSI implant may not fully address the underlying destabilization, necessitating further treatment considerations.