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Midterm Clinical Outcomes of a Resurfacing Capitate Pyrocarbon Implant: A Case Series
Steve A Andrews1, Andrew Mayo1, Ben Hope1,2
1Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Queensland, Australia.
Purpose:
Scaphoid nonunion advanced collapse (SNAC), scapholunate advanced collapse (SLAC), and Kienbock's disease are some of the most common pathologies to result in arthritis of the wrist in patients with a relatively high functional demand. An option for treatment where there are not two cartilage surfaces suitable for articulation to allow either a proximal row carpectomy (PRC) or partial fusion is to perform a PRC combined with resurfacing of the capitate using a pyrocarbon implant (RCPI). The purpose of this study was to examine the medium-term survivorship, clinical-, and patient-reported outcomes of the RCPI in a case series of patients.
Materials And Methods:
Survivorship was assessed in 46 patients at approximately 21 months or greater (range = 21-144, median follow-up = 67). Of these, 36 patients completed patient-reported outcome measures (Visual Analogue Scales, Disabilities of the Arm, Shoulder and Hand-short form, Patient-Rated Wrist Evaluation, Global Rating of Change) at 21 months or greater. Patient population was 42% ( n = 16) female, average age was 59 (range = 25-79), and majority had the operation on their right hand (78%, n = 35).
Results:
Implant survival can be confirmed until most recent follow-up at a median of 60 months (range = 21-144), with Kaplan-Meier analysis indicating an 83% survival probability at 10 years. Complications at 21 months or greater were observed in 11 patients (24%), with 9 (20%) patients receiving further surgery (7 wrist fusions, 1 ulnar nerve decompression, and 1 distal radioulnar joint replacement [RCPI in situ]). Time to revision was a mean of 20 months (range = 4-39). Comparison between passive range of motion at 21 months to 4 years and >5 years showed no significance ( p > 0.5), suggesting 2- to 4-year outcomes are maintained midterm.
Conclusions:
The RCPI extends the indications for PRC where there is unsatisfactory cartilage on the proximal capitate, the lunate facet of the radius, or both. It provides a safe and effective treatment for pain relief and improved functional use of the hand for SLAC and SNAC arthritis without the increased morbidity of more complex arthroplasty or total wrist arthrodesis.
Level Of Evidence:
IV, case series.
