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Rieussec C, Caillard G, Helfter L, Girard P, Forli A, Corcella D. Comparison of proximal row carpectomy with RCPI® versus proximal row carpectomy with Eaton's capsular interposition in the management of advanced wrist osteoarthritis. Orthop Traumatol Surg Res 2024; 110:103783. [PMID: 38048904 DOI: 10.1016/j.otsr.2023.103783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 11/15/2023] [Accepted: 11/29/2023] [Indexed: 12/06/2023]
Abstract
INTRODUCTION Proximal row carpectomy (PRC) is one of the recommended techniques for managing wrist osteoarthritis, it implies the integrity of the lunate fossa of the radius and the proximal pole of the capitate. If PRC is not possible, it is suggested to consider combining it with a capsule interposition (such as Eaton's flap) or opting for intra- or radiocarpal arthrodesis. Another alternative is to combine capitate resurfacing with a pyrocarbon implant (RCPi®). The aims of this study was to assessed the results between proximal PRC+Eaton and those associated PRC+RCPi® for advanced wrist osteoarthritis. HYPOTHESIS We hypothesized that there would be no differences in clinical or functional outcome between proximal row carpectomy associated with RCPI® and those associated with Eaton capsular flap. MATERIAL AND METHODS It is a monocentric, retrospective, multi-operator study involving 83 wrists with osteoarthritis, included between January 2000 and December 2020 with a minimum follow-up period of 12 months. Thirty-nine patients underwent PRC+Eaton and 44 patients underwent RCPI® resurfacing. Data such as pain, flexion, extension and strength as well as functional scores (PRWE, Mayo and quick DASH) were collected from the patient files at the last check-up. RESULTS Results were comparable between the two groups in terms pain (VAS), mobility (flexion and extension), strength (GRASP) and functional scores (PRWE, Mayo and quick DASH). Carpal height was better preserved in the PRC+RCPI® group, with a Youm and McMurtry index evaluated at 0.3 in the PRC+Eaton group compared to 0.4 in the PRC+RCPI® group (p-value<0.001). Radiocarpal arthrodesis was required in 16% of the PRC+Eaton group and 6.8% of the PRC+RCPI® group, with a statistically significant difference (p-value=0.023). DISCUSSION This study reports clinical and functional results that suggest RCPI® is an interesting alternative and can be associated with proximal row carpectomy in advanced wrist osteoarthritis. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Clémentine Rieussec
- Service de chirurgie de la main, hôpital Nord de la Tronche, CHU de Grenoble-Alpes, Grenoble, France.
| | - Gauthier Caillard
- Service de chirurgie de la main, hôpital Nord de la Tronche, CHU de Grenoble-Alpes, Grenoble, France
| | - Laura Helfter
- Service de chirurgie de la main, hôpital Nord de la Tronche, CHU de Grenoble-Alpes, Grenoble, France
| | - Pierre Girard
- Service de chirurgie de la main, hôpital Nord de la Tronche, CHU de Grenoble-Alpes, Grenoble, France
| | - Alexandra Forli
- Service de chirurgie de la main, hôpital Nord de la Tronche, CHU de Grenoble-Alpes, Grenoble, France
| | - Denis Corcella
- Service de chirurgie de la main, hôpital Nord de la Tronche, CHU de Grenoble-Alpes, Grenoble, France
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Maris S, Apergis E, Apostolopoulos A, Melissaridou D, Koulouvaris P, Papagelopoulos PJ, Savvidou O. Scapholunate Advanced Collapse (SLAC) and Scaphoid Nonunion Advanced Collapse (SNAC): A Review of Treatment Options for Stage II. Cureus 2024; 16:e59014. [PMID: 38800268 PMCID: PMC11127752 DOI: 10.7759/cureus.59014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) represent clinical entities identified by a pattern of predictable degenerative changes. They are the most common causes of wrist arthritis. Both entities can remain asymptomatic for many years and may go undiagnosed. Diagnosis is usually confirmed through clinical examination, which reveals progressive wrist pain and instability. Radiographically, degenerative changes in the radiocarpal and midcarpal joints are present, as well as nonunion of the scaphoid fracture in SNAC. The management differs according to the stage. Particularly in this review article, we reviewed the treatment options for stage II SLAC and SNAC wrist. In addition to the well-described surgical techniques such as proximal row carpectomy and four-corner fusion, alternatives such as capitolunate arthrodesis, three-corner fusion, and soft tissue procedures like capsulodesis and tenodesis are available. Proximal row carpectomy and partial arthrodeses yield comparable results. Soft tissue procedures are viable alternatives and are preferred in younger patients to avoid early salvage operations.
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Affiliation(s)
- Spyridon Maris
- Department of Orthopaedics and Traumatology, General Hospital Hellenic Red Cross Korgialenio Benakio, Athens, GRC
| | - Emmanouil Apergis
- Department of Orthopaedics, General Hospital Hellenic Red Cross Korgialenio Benakio, Athens, GRC
| | - Alexandros Apostolopoulos
- Department of Orthopaedics, East Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, Redhill, GBR
| | - Dimitra Melissaridou
- First Department of Orthopaedic Surgery, Attikon University General Hospital, Athens, GRC
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Panagiotis Koulouvaris
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Panayiotis J Papagelopoulos
- First Department of Orthopaedic Surgery, Attikon University General Hospital, Athens, GRC
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Olga Savvidou
- First Department of Orthopaedic Surgery, Attikon University General Hospital, Athens, GRC
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
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Lee DH, Seo JB, Jung JU, Yoo JS. Proximal row carpectomy with interposition arthroplasty using both capsular flap and acellular human dermal matrix. BMC Musculoskelet Disord 2024; 25:199. [PMID: 38443851 PMCID: PMC10913256 DOI: 10.1186/s12891-024-07305-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 02/22/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND In cases of wrist arthritis, proximal row carpectomy (PRC) has been widely utilized and shown favorable long-term outcomes. However, its applicability is limited in cases where arthritis extends to the lunate fossa or capitate. Recently, surgical approaches combining various methods of interposition arthroplasty have been introduced to overcome these drawbacks. The purpose of this study was to perform PRC and interposition arthroplasty with dorsal capsule and acellular dermal matrix(ADM),and analyze the clinical outcomes of these procedures. METHODS Fourteen cases who underwent PRC and interposition arthroplasty using both dorsal capsular flap and ADM were retrospectively recruited. The researchers assessed the patients' Visual Analog Scale (VAS) pain score, Disabilities of the Arm, Shoulder and Hand (DASH) scores, range of motion (ROM), retear, and radiocarpal distance (RCD). RESULTS One year post-surgery, both the VAS pain scores, DASH scores, and ROM showed statistically significant improvement compared to before the surgery. Upon reviewing the radiological results, the postoperative mean RCD was 4.8 ± 0.8 mm and one year follow up mean RCD was 3.6 ± 0.5 mm at one year post-surgery. Moreover, in the one year follow-up, there was no observed failure of the allodermis graft in any of the cases. CONCLUSION The PRC and interposition arthroplasty with ADM demonstrated significantly improved clinical outcomes after surgery, showing a maintain of RCD without graft failure effectively.
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Affiliation(s)
- Dae-Hee Lee
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Manghyangro 201, Dongnam-gu, Cheonan, 330-715, Chungnam, Korea
| | - Joong-Bae Seo
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Manghyangro 201, Dongnam-gu, Cheonan, 330-715, Chungnam, Korea
| | - Jae-Uk Jung
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Manghyangro 201, Dongnam-gu, Cheonan, 330-715, Chungnam, Korea
| | - Jae-Sung Yoo
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Manghyangro 201, Dongnam-gu, Cheonan, 330-715, Chungnam, Korea.
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Oh S, Park HW, Kang S, Lim D, Park I. Coexisting Kienböck's and Preiser's Disease of the Wrist: Experience with Proximal Row Carpectomy with Dorsal Capsular Interposition Technique. Orthop Surg 2023; 15:2477-2481. [PMID: 37345451 PMCID: PMC10475650 DOI: 10.1111/os.13776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Idiopathic avascular necrosis of the lunate is known as Kienböck's disease and that of the scaphoid is known as Preiser's disease. Because the prevalence of coexisting Kienböck's and Preiser's diseases is very low, standardized stages of disease and treatments are not established. CASE PRESENTATION We report coexisting avascular necrosis of the scaphoid and lunate in a 68-year-old woman with no history of steroids or other risk factors. We treated her with proximal row carpectomy with capsular interposition technique. A distal-based dorsal capsular flap was prepared and repaired the palmar capsule. At the last follow-up, she had no pain and had gained improved range of wrist motion. There was no arthritic change at the newly formed radiocapitate joint. CONCLUSIONS In the case of collapsed lunate and scaphoid with avascular necrosis, the proximal row carpectomy procedure has an advantage. Proximal row carpectomy with dorsal capsular interposition can be performed when the lunate or scaphoid cannot be saved. Arthritic changes of the capitate head and distal radius lunate facet can be covered with the dorsal capsule.
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Affiliation(s)
- Seungbae Oh
- Department of Orthopaedic Surgery, St. Vincent's HospitalCollege of Medicine, The Catholic University of KoreaSeoulRepublic of Korea
| | - Hyun Woo Park
- Department of Orthopaedic Surgery, St. Vincent's HospitalCollege of Medicine, The Catholic University of KoreaSeoulRepublic of Korea
| | - Soo‐Hwan Kang
- Department of Orthopaedic Surgery, St. Vincent's HospitalCollege of Medicine, The Catholic University of KoreaSeoulRepublic of Korea
| | - Dohyung Lim
- Department of Mechanical EngineeringSejong UniversitySeoulRepublic of Korea
| | - Il‐Jung Park
- Department of Orthopaedic Surgery, Bucheon St. Mary's HospitalCollege of Medicine, The Catholic University of KoreaSeoulRepublic of Korea
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Cavadas PC, Padial B. Radiocarpal Joint Reconstruction with a Double Free Metatarsophalangeal Joint Transfer. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5284. [PMID: 38152704 PMCID: PMC10752467 DOI: 10.1097/gox.0000000000005284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/25/2023] [Indexed: 12/29/2023]
Abstract
Background Destruction of the radiocarpal and midcarpal joints causes loss of wrist motion, pain, and reduced grip strength. A novel technique for radiocarpal reconstruction is presented. Methods Two patients who had radiocarpal and midcarpal destruction and osteoarthritis underwent reconstruction using simultaneous bilateral microvascular second metatarsophalangeal joint transfer. The insetting was performed, inverting the distal-proximal orientation of both metatarsophalangeal joints and fixing them with two 2.0 screws in proximal and Kirschner wires in distal. Results Radiocarpal extension and flexion without pain were preserved after a minimum of 4 years follow-up. Both patients could return to recreational activities. No secondary procedures were needed. Conclusions This technique could be an alternative for radiocarpal reconstruction, although longer follow-up and more cases are needed.
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Affiliation(s)
- Pedro C. Cavadas
- From Reconstructive Surgery, Clinica Cavadas, Valencia, Spain
- Departamento de Cirugía, Facultad de Ciencias de la Salud, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | - Beatriz Padial
- From Reconstructive Surgery, Clinica Cavadas, Valencia, Spain
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Proximal row carpectomy of the wrist in the setting of midcarpal arthritis: Survivorship and associated complications in soft tissue interposition versus capitate resurfacing. CURRENT ORTHOPAEDIC PRACTICE 2023. [DOI: 10.1097/bco.0000000000001202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Risk of Total Wrist Arthrodesis Following Proximal Row Carpectomy: An Analysis of 1,070 Patients. J Hand Surg Am 2023; 48:195.e1-195.e10. [PMID: 34857405 DOI: 10.1016/j.jhsa.2021.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 07/23/2021] [Accepted: 09/22/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Proximal row carpectomy (PRC) is a motion-sparing procedure with good patient-reported and clinical outcomes. Although some studies have investigated the risk of conversion to total wrist arthrodesis (TWA) after PRC, additional larger studies evaluating the specific risk factors that lead to failure are required. This study aimed to investigate the patient and procedure factors that are associated with increased risk for conversion to TWA in a large cohort of patients who underwent PRC. METHODS The current procedural technology codes identified patients in a National Veteran's Health database undergoing a PRC over a 26-year period. Risk factors of interest comprised age, posterior interosseous nerve neurectomy, wrist arthritis pattern, bilateral surgery, smoking, comorbidities, and preoperative opioid use. The primary outcome was the rate of conversion to TWA. Cox proportional hazard regression was used to create hazard ratios of selected factors for reoperation. RESULTS There were 1,070 PRCs performed, with a mean follow-up of 79.8 ± 59.6 months. A total of 5.3% (57/1,070) wrists underwent conversion to TWA. Younger age at the time of PRC (<50 years) significantly increased the risk of TWA (hazard ratio, 3.8; 95% confidence interval, 2.2-6.6). With every 1-year increase in age, there was a reduction of 4% (hazard ratio, 0.96; 95% confidence interval: 0.94-0.98) in the hazard of conversion to TWA. No other factors, including concomitant posterior interosseous nerve neurectomy or bilateral PRC, increased the risk of conversion to TWA. CONCLUSIONS Proximal row carpectomy is a motion-preserving salvage procedure with a low rate of conversion to wrist arthrodesis. Younger patient age increases the risk of conversion to arthrodesis, whereas posterior interosseous nerve neurectomy, bilateral PRCs, and comorbidity status do not appear to have an impact on the risk of arthrodesis. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Perry AC, Wilkes C, Curran MWT, Ball BJ, Morhart MJ. Proximal Row Carpectomy Modifications for Capitate Arthritis: A Systematic Review. J Wrist Surg 2023; 12:86-94. [PMID: 36644731 PMCID: PMC9836777 DOI: 10.1055/s-0042-1751013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 05/12/2022] [Indexed: 01/18/2023]
Abstract
Introduction Proximal row carpectomy (PRC) is a motion-sparing procedure for radiocarpal arthritis with reliable results. Traditionally, proximal capitate arthritis is a contraindication to PRC; however, PRC with modifications are proposed to circumvent this contraindication. PRC modifications can be broadly grouped into capitate resurfacing (CR) and capsular interposition (CI) procedures which could expand PRC indications. Our primary question was to characterize the outcomes achievable with various PRC modifications. Our secondary question was to determine which PRC modification was the optimal procedure when capitate arthritis was present. Methods A systematic review was conducted to examine the outcomes of modified PRC procedures. Independent reviewers appraised multiple databases for PRC studies with modifications for capitate arthritis in adult patients (age >18 years) with a minimum of three cases and extractable outcomes. Modified PRC procedures included capsular/allograft interposition, resurfacing capitate pyrocarbon implants, and osteochondral grafting. Pertinent outcomes included patient demographics, range-of-motion, grip strength, patient-reported outcomes, and complications, including salvage rates. Results Overall, 18 studies met the inclusion criteria-10 studies ( n = 147) on CI and 8 studies on CR ( n = 136). PRC with CI had the greatest flexion-extension arc and grip strength. Complications were marginally higher in the CR group (4%), while the CI group had a higher conversion to total wrist arthrodesis (10%). Conclusion Techniques to address capitate arthritis center around resurfacing or soft tissue interposition. PRC modifications with CI produces better range-of-motion and grip strength but higher conversion to total wrist arthrodesis. Higher conversion rates may be attributable to longer follow-up periods in studies examining CI compared with CR. Level of Evidence This is a Level III study.
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Affiliation(s)
- Alexander C. Perry
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Courtney Wilkes
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew W. T. Curran
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Brandon J. Ball
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Michael J. Morhart
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
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Abstract
Background: Current recommendations for osteoarthritis of the metacarpophalangeal joint (MCPJ) are confined to implant arthroplasty to preserve joint motion and provide pain relief. This study documents the median 2-year results of a novel soft tissue arthroplasty technique that interposes the dorsal capsule. Methods: A retrospective review of 10 MCPJ dorsal capsule interposition arthroplasties in 8 patients was conducted. Physical evaluation assessed MCPJ range of motion (ROM), grip strength, and pain. Outcome tests used were the Michigan Hand Outcome Score, Visual Analog Scale (VAS), and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH). Kellgren and Lawrence Classification assessed severity of MCPJ osteoarthritis on preoperative radiographs. Results: The mean follow-up was 29 months from surgery. Average VAS was 2/10 postoperatively and average postoperative ROM improved 7 degrees. Average postoperative grip strength of the surgical hand was 30 kg. The QuickDASH average score was 24. Average Michigan Hand Questionnaire final score was 70. Patients with Kellgren Grades 2 or 3 osteoarthritis had the best QuickDASH and Michigan Hand Outcome scores. All patients working before surgery returned to work. No patient required a second surgery. Conclusion: This technique of dorsal capsule interposition arthroplasty provides a viable surgical option for isolated degenerative or traumatic arthritis of the MCPJ at an average follow-up of 2 years. Pain relief was most reliably provided in patients with less severe radiograph findings. The advantages of this procedure include preservation of bony anatomy, collateral ligaments, and volar plate to not preclude later implant arthroplasty.
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Affiliation(s)
| | | | - Jeffrey A. Marchessault
- East Tennessee State University, Kingsport, USA
- Associated Orthopaedics of Kingsport, TN, USA
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Lee SJ, Rabinovich RV, Kim A. Proximal Row Carpectomy Using Decellularized Dermal Allograft: Preliminary Results. J Wrist Surg 2021; 10:116-122. [PMID: 33815946 PMCID: PMC8012091 DOI: 10.1055/s-0040-1718912] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
Objective The purpose of this study was to evaluate the short-term outcomes of patients undergoing proximal row carpectomy (PRC) with interposition arthroplasty using a decellularized dermal allograft. Methods Patients with a minimum of 1-year follow-up after undergoing a PRC using decellularized dermal allograft were contacted for clinical evaluation, radiographs, and postoperative outcome questionnaires, including the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire as well as the modified Likert scale for patient satisfaction. Nine of ten (90%) consecutive patients who were treated using this surgical technique were available for follow-up. Results At a mean follow-up of 18 months, a total of nine patients achieved a mean flexion-extension arc of 113 degrees, pronosupination of 170.5 degrees, grip strength of 68 Ibs and pinch strength of 17 Ibs. Relative to the contralateral side, these values were 95, 100, 84 and 82%, respectively. There was significant improvement in the mean DASH score from 63.5 preoperatively to 23.8 postoperatively. Patient satisfaction postoperatively achieved a mean modified Likert score of 1.5. There was no evidence of radiocarpal joint space degeneration or dislocation in any of the patients. No patient suffered wound-related issues, foreign-body reaction to the graft, or other complications. Conclusion PRC with interposition arthroplasty using a decellularized dermal allograft in patients with degenerative changes at the lunate fossa or capitate demonstrates short-term outcomes comparable to what has been reported for routine PRC in patients without degenerative changes affecting the radiocapitate joint. This method of interposition arthroplasty expands the indications for PRC and may help avoid salvage, motion-sacrificing procedures in select patients with late-stage wrist arthritis. Level of Evidence This is a level IV, therapeutic study.
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Affiliation(s)
- Steven J. Lee
- Department of Orthopaedic Surgery, Nicholas Institute of Sports Medicine and Athletic Trauma (NISMAT), Lenox Hill Hospital, New York, New York
| | - Remy V. Rabinovich
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York
| | - Andrew Kim
- Department of Orthopaedic Surgery, Nicholas Institute of Sports Medicine and Athletic Trauma (NISMAT), Lenox Hill Hospital, New York, New York
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Zhang Y, Gillis JA, Moran SL. Management of scapholunate advanced collapse and scaphoid nonunion advanced collapse without proximal row carpectomy or four corner fusion. J Hand Surg Eur Vol 2021; 46:50-57. [PMID: 33202162 DOI: 10.1177/1753193420973322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Four corner arthrodesis and proximal row carpectomy are the most common techniques for the management of advanced radiocarpal arthritis due to longstanding scapholunate instability and scaphoid nonunion. The advantages and short comings of each technique have been well defined in the literature. Advancements in joint replacement and arthroscopic surgery have resulted in new operations to manage radiocarpal and midcarpal arthritis. Most of these new procedures are modifications of the two classical operations, but some use modern implants and newer materials. New individualized options, like osteochondral grafting in combination with proximal row carpectomy or (arthroscopic) distal resection of the scaphoid, allowed us to improve our treatment and offer patients less invasive but equally effective procedures. We consider that four corner arthrodesis and proximal row carpectomy should not always be standard management for advanced radiocarpal arthritis.
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Affiliation(s)
- Yiyang Zhang
- Division of Orthopedic Surgery, Roth
- McFarlane Hand and Upper Limb Centre, London, ON, Canada
| | - Joshua A Gillis
- Division of Plastic and Reconstructive Surgery, Roth
- McFarlane Hand and Upper Limb Centre, London, ON, Canada
| | - Steven L Moran
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA
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Montiel V, Payo-Ollero J, Amillo S. Proximal row carpectomy in patients older than 50 years: 3 to 16 years of follow-up. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Montiel V, Payo-Ollero J, Amillo S. Proximal row carpectomy in patients older than 50 years: 3 to 16 years of follow-up. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 63:295-299. [PMID: 30926416 DOI: 10.1016/j.recot.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/22/2019] [Accepted: 02/01/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To analyze the long-term results and the prognosis of patients who have undergone proximal row carpectomy (PRC) in our hospital. MATERIAL AND METHOD This is a retrospective study of 14 patients undergoing PRC with a follow-up of 3 to 16 years. The ability to perform daily activities, mobility and functional capacity after the surgery were assessed using the Patient-Rated Wrist Evaluation questionnaire (PRWE). RESULTS The range of movement was satisfactory. The mean score on the PRWE scale was 20.9±17.2 for the pain subscale and 39±35.5 for the functional capacity subscale. None of the patients required revision surgery or developed complications. Eighty percent of the patients were satisfied or very satisfied. Ninety percent of the patients would undergo surgery again. DISCUSSION The wrist's range of movement achieved with this technique is similar to that obtained with other mobility preservation techniques. Secondary arthritic changes in the radio-capitate joint do not necessarily produce pain. Some authors have described that the degree of satisfaction after PRC is equivalent to that of other procedures such as arthrodesis in 4 corners with circular plate arthrodesis or middle-carpal arthrodesis. CONCLUSION PRC achieved high satisfaction rates among the patients providing pain relief, good mobility and post-operative functionality of the wrist. In addition, it presented few complications.
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Affiliation(s)
- V Montiel
- Departamento Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, Navarra, España.
| | - J Payo-Ollero
- Departamento Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - S Amillo
- Departamento Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, Navarra, España
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Tahta M, Aydin Y, Erpala F, Yildiz M, Gunal I, Sener M. No Benefits of Combining Proximal Row Carpectomy With PIN Neurectomy for Wrist Disorders-A Comparative Study With Systematic Review of the Literature. Plast Surg (Oakv) 2019; 27:130-134. [PMID: 31106170 DOI: 10.1177/2292550319826099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Posterior interosseous nerve (PIN) resection in combination with proximal row carpectomy (PRC), is a preferred method in order to obtain rapid recovery. However, the contribution of such combination to results isn't known well. Objectives We performed a comparative study to evaluate the effects of PIN neurectomy for PRC and a systematic review of the literature was performed to identify whether such combination has an advantage. Methods Patients with wrist diseases who underwent PRC were evaluated retrospectively. Patients without PIN neurectomy (group 1, n = 7) and with PIN neurectomy (group 2, n = 8) were compared in respect of mean age, follow-up, gender, Q-DASH, VAS, MAYO wrist scores, flexion-extension/radial-ulnar deviation range of motion at final follow-up. The MEDLINE database was searched for studies published between 2005 and 2015, as the second part of the study. The following keywords were used: "proximal," "row," "carpectomy." Studies, which met the inclusion criteria, were evaluated in terms of such combination. Results There were no significant difference between the groups in regard with age (P = .463), follow-up period (P = .728), the ranges of flexion-extension (P = .431) and radio-ulnar deviation (P = .689), Q-DASH (P = .452), and MAYO scores (P = .728). In the second part of the study, 12 studies met the inclusion criteria and none of them was specifically evaluating such combination. Only one study had specific comments on PRC with PIN neurectomy. Conclusion According to our study (which, to our knowledge, was the first comparative study in the literature), we advocate not to combine PRC with PIN neurectomy for such an approach has no advantage.
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Affiliation(s)
- Mesut Tahta
- Department of Orthopaedics and Traumatology, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Yener Aydin
- Division of Hand Surgery, Department of Orthopaedics and Traumatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Firat Erpala
- Department of Orthopaedics and Traumatology, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Mehmet Yildiz
- Division of Hand Surgery, Department of Orthopaedics and Traumatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | | | - Muhittin Sener
- Department of Orthopaedics and Traumatology, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey
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Arianni M, Mathoulin C. Arthroscopic Interposition Tendon Arthroplasty for Stage 2 Scapholunate Advanced Collapse. Arthroscopy 2019; 35:392-402. [PMID: 30612763 DOI: 10.1016/j.arthro.2018.10.134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 10/28/2018] [Accepted: 10/28/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To report and analyze the functional outcomes of arthroscopic interposition tendon arthroplasty (AITA) in stage 2 scapholunate advanced collapse (SLAC). METHODS Sixteen patients with stage 2 SLAC who underwent AITA between 2009 and 2014 with a minimum of 24-month follow-up were retrospectively evaluated. Medical records were assessed for preoperative and postoperative range of motions, grip strength, visual analog scale, disabilities of the arm, shoulder, and hand (DASH) score, scapholunate angle, and scaphoid fossa-to-scaphoid space. RESULTS After exclusion of 2 patients, 14 patients were available for this study. At final follow-up, improvements were found for the following variables: extension (preoperative mean, 49.29°; VS postoperative mean, 61.07°; P = .025, 95% confidence interval [CI], 1.74-21.85), radial deviation (preoperative mean, 6.43°; postoperative mean, 17.14°; P < .001, 95% CI, 6.06-15.36), grip strength (preoperative mean, 18.93 kg; postoperative mean, 29.64 kg; P < .001; 95% CI, 6.81-14.61), visual analog scale (preoperative mean, 8.07; postoperative mean, 2.50; P < .001; 95% CI, -6.52 to -4.61), and DASH (preoperative mean, 60.39; postoperative mean, 10.28; P < .001, 95% CI, -43.04 to -57.28), scapholunate angle (preoperative median, 67.50°; postoperative median, 55.00°, P = .002, Z = -2.831), and scaphoid fossa-to-scaphoid space (preoperative median, 0.00 mm; postoperative median, 1.00 mm; P < .001, Z = -3.145). There was no improvement in flexion (preoperative mean, 40.00°; postoperative mean, 50.00°;P = .025; 95% CI, -4.45 to -24.45), ulnar deviation (preoperative median, 25.00°; postoperative median, 30.00°;P = .063, Z = -2.060), or flexion-extension arc (preoperative mean, 89.28°; postoperative mean, 111.07°; P = .067; 95% CI, -1.79 to -45.36) following AITA. Nine of 13 patients were satisfied with the procedure, 3 were moderately satisfied, and 1 was not satisfied. CONCLUSIONS Arthroscopic interposition tendon arthroplasty is an acceptable procedure for stage 2 SLAC. This procedure preserves motion, yields acceptable functional outcome, and reduces pain. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Margareta Arianni
- Orthopaedic Surgery, Department of Surgery, Pasar Minggu General Hospital, Jakarta, Indonesia; Hand Clinic/Orthopaedic Surgery, Ramsay Premier Bintaro Hospital, Tangerang, Indonesia
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16
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Kazmers NH, Stephens AR, Presson AP, Xu Y, Feller RJ, Tyser AR. Comparison of Direct Surgical Costs for Proximal Row Carpectomy and Four-Corner Arthrodesis. J Wrist Surg 2019; 8:66-71. [PMID: 30723605 PMCID: PMC6358450 DOI: 10.1055/s-0038-1675791] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 09/24/2018] [Indexed: 12/21/2022]
Abstract
Background Proximal row carpectomy (PRC) and four-corner arthrodesis (FCA) are common treatments for stage II scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrists, with similar functional and patient-reported outcomes reported in the peer-reviewed literature. Questions Study questions included (1) whether surgical encounter total direct costs (SETDCs) differ between PRC and FCA, and (2) whether SETDC differs by method of fixation for FCA. Patients and Methods Consecutive adult patients (≥ 18 years) undergoing PRC and FCA between July 2011 and May 2017 at a single tertiary care academic institution were identified. Patients undergoing additional simultaneous procedures were excluded. Using our institution's information technology value tools, we extracted prospectively collected cost data for each surgical encounter. SETDCs were compared between PRC and FCA, and between FCA subgroups (screws, plating, or staples). Results Of 42 included patients, mean age was similar between the 23 PRC and 19 FCA patients (51.2 vs. 54.5 years, respectively). SETDCs were significantly greater for FCA than PRC by 425%. FCA involved significantly greater facility costs (2.3-fold), supply costs (10-fold), and operative time (121 vs. 57 minutes). Implant costs were absent for PRC, which were responsible for 55% of the SETDC for FCA. Compared with compression screws, plating and staple fixation were significantly more costly (70% and 240% greater, respectively). Conclusion SETDCs were 425% greater for FCA than PRC. Implant costs for FCA alone were 130% greater than the entire surgical encounter for PRC. For FCA, SETDC varied depending on the method of fixation. Level of Evidence This is a level III, cost analysis study.
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Affiliation(s)
| | | | - Angela P. Presson
- Division of Public Health, University of Utah, Salt Lake City, Utah
- Department of Pediatric Research Enterprise, University of Utah, Salt Lake City, Utah
| | - Yizhe Xu
- Division of Public Health, University of Utah, Salt Lake City, Utah
- Department of Pediatric Research Enterprise, University of Utah, Salt Lake City, Utah
| | - Ross J. Feller
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Andrew R. Tyser
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
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17
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Rabinovich RV, Lee SJ. Proximal Row Carpectomy Using Decellularized Dermal Allograft. J Hand Surg Am 2018; 43:392.e1-392.e9. [PMID: 29618419 DOI: 10.1016/j.jhsa.2018.01.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/21/2018] [Indexed: 02/02/2023]
Abstract
Wrist arthritis is a common problem. When managed early, motion-sparing procedures can be performed with successful outcomes. Proximal row carpectomy (PRC) has demonstrated good functional results and high patient satisfaction with up to 20-year follow-up. The majority of patients with longer follow-up have, however, exhibited radiographic signs of progressive degeneration of the radiocapitate space. Although radiographic changes have not been shown to correlate with wrist pain and function, it remains a concern and questions the durability of the radiocapitate articulation with continued patient follow-up, especially those who underwent the original procedure at a younger age. Several modifications have been proposed and used to address this concern, including radiocapitate arthroplasty, with either distal radius hemiarthroplasty or tissue interposition grafts. Theoretical benefits to these adjuncts include minimizing wear and preserving the radiocapitate articulation as well as expanding the utility of a PRC even in the setting of a wrist with arthritis of the capitate head. We describe our surgical technique for managing radiocarpal arthritis with PRC and decellularized dermal allograft. Dermal matrix allografts have proved to be a safe adjunct in various orthopedic procedures, including those in the wrist and hand. This technique adds another surgical option for the treatment of radiocarpal arthritis and expands the indications for PRC to include select patients with degeneration of the capitate head.
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Affiliation(s)
- Remy V Rabinovich
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY.
| | - Steven J Lee
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY
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18
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Gaspar MP, Pham PP, Pankiw CD, Jacoby SM, Shin EK, Osterman AL, Kane PM. Mid-term outcomes of routine proximal row carpectomy compared with proximal row carpectomy with dorsal capsular interposition arthroplasty for the treatment of late-stage arthropathy of the wrist. Bone Joint J 2018; 100-B:197-204. [PMID: 29437062 DOI: 10.1302/0301-620x.100b2.bjj-2017-0816.r2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIMS The aims of this study were to compare the mid-term outcomes of patients with late-stage arthritis of the wrist treated with proximal row carpectomy (PRC) and dorsal capsular interposition (DCI) arthroplasty with a matched cohort treated with routine PRC alone. PATIENTS AND METHODS A total of 25 arthritic wrists (24 patients) with pre-existing degenerative changes of the proximal capitate and/or the lunate fossa of the radius were treated with PRC + DCI over a ten-year period. This group of patients were matched 1:2 with a group of 50 wrists (48 patients) without degenerative changes in the capitate or lunate fossa that were treated with a routine PRC alone during the same period. The mean age of the patients at the time of surgery was 56.8 years (25 to 81), and the demographics and baseline range of movement of the wrist, grip strength, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, and Patient-Rated Wrist Evaluation (PRWE) score were similar in both groups. RESULTS At a mean follow-up of 5.9 years (1.8 to 11.8), significant improvements in mean grip strength, the flexion-extension arc of movement of the wrist, QuickDASH, and PRWE scores were seen in both groups. There was no diifference between the groups for any of the outcomes. One patient in the PRC + DCI group required additional surgery for a deep infection, while two in the PRC group had complications (one wound dehiscence requiring revision closure, one transient radial sensory neuritis). One patient in each group required total arthrodesis of the wrist for progressive degenerative radiocarpal changes. A total of 70 patients (93%) were satisfied with the outcomes. CONCLUSION PRC with DCI is an effective form of treatment for late-stage arthritis of the wrist involving the capitolunate joint, with mid-term outcomes that are similar to those in patients without degenerative changes affecting the capitate or lunate fossa who are treated with a routine PRC alone. Cite this article: Bone Joint J 2018;100-B:197-204.
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Affiliation(s)
- M P Gaspar
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University, 834 Chestnut Street, The Franklin Building, Suite G114, Philadelphia, PA 19107, USA and Darden School of Business, University of Virginia, 100 Darden Boulevard, Charlottesville, Virginia 22903, USA
| | - P P Pham
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University, 834 Chestnut Street, The Franklin Building, Suite G114, Philadelphia, PA 19107, USA
| | - C D Pankiw
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University, 834 Chestnut Street, The Franklin Building, Suite G114, Philadelphia, PA 19107, USA
| | - S M Jacoby
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University, 834 Chestnut Street, The Franklin Building, Suite G114, Philadelphia, PA 19107, USA
| | - E K Shin
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University, 834 Chestnut Street, The Franklin Building, Suite G114, Philadelphia, PA 19107, USA
| | - A L Osterman
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University, 834 Chestnut Street, The Franklin Building, Suite G114, Philadelphia, PA 19107, USA
| | - P M Kane
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University, 834 Chestnut Street, The Franklin Building, Suite G114, Philadelphia, PA 19107, USA
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Resurfacing Capitate Pyrocarbon Implant versus Proximal Row Carpectomy Alone. Plast Reconstr Surg 2017; 140:962-970. [DOI: 10.1097/prs.0000000000003759] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Update on the operative treatment of scapholunate instability for radiologists. II. Salvage procedures, total wrist arthrodesis, and total wrist arthroplasty. Skeletal Radiol 2017; 46:1031-1040. [PMID: 28547205 DOI: 10.1007/s00256-017-2671-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/25/2017] [Accepted: 05/02/2017] [Indexed: 02/02/2023]
Abstract
Scapholunate (SL) instability is the most common form of carpal instability. Imaging (especially radiography) plays an important role in the staging, management, and postoperative follow-up of SL instability. In the final stage of SL instability, known as scapholunate advanced collapse, progressive degenerative changes occur at the carpal level. The goals of this article are to review the surgical options available for addressing the different stages of scapholunate advanced collapse, along with an emphasis on normal postoperative imaging and complications associated with each surgical option.
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21
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Past and present of interposition arthroplasties for joint repair with special tribute to the contribution by Vittorio Putti. Knee Surg Sports Traumatol Arthrosc 2016; 24:4005-4011. [PMID: 25399344 DOI: 10.1007/s00167-014-3428-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 11/06/2014] [Indexed: 10/24/2022]
Abstract
Several techniques have been proposed to restore the compromised function of a joint. These include the arthroplasty by placing various tissues or materials between the articular surfaces. An important contribution to the diffusion of arthroplasty techniques was made by Vittorio Putti, head of the Rizzoli Orthopedic Institute in Bologna from 1912 to 1940. Interposition arthroplasty is still used for some non-weight-bearing joints, such as wrist and elbow, and gives good results. This type of surgery has been further developed by the improvement in biomaterials, biomechanical studies and the regenerative medicine. This paper describes the development starting from a historical survey particularly focused on Putti's contribution and ending with the state of the art of regenerative medicine in the treatment of joint diseases. Level of evidence V.
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22
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Rhee PC, Jones DB, Shin AY, Bishop AT. Evaluation and Treatment of Scaphoid Nonunions: A Critical Analysis Review. JBJS Rev 2016; 2:01874474-201407000-00004. [PMID: 27490062 DOI: 10.2106/jbjs.rvw.m.00074] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Peter C Rhee
- Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905
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23
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Gaspar MP, Lou J, Kane PM, Jacoby SM, Osterman AL, Culp RW. Complications Following Partial and Total Wrist Arthroplasty: A Single-Center Retrospective Review. J Hand Surg Am 2016; 41:47-53.e4. [PMID: 26710734 DOI: 10.1016/j.jhsa.2015.10.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/27/2015] [Accepted: 10/28/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe our institution's experience with complications following partial and total wrist arthroplasty (TWA). METHODS We performed a retrospective review of 105 wrist surgeries in 100 patients who underwent surgery with prosthetic replacement of the distal radius, the proximal carpus, or both at a single institution. Patient factors including age, sex, body mass index, handedness, underlying disease, and previous injury were recorded. Outcomes focused particularly on postoperative complications and need for revision surgery. RESULTS Forty-seven TWAs, 52 distal radius hemiarthroplasties, and 6 proximal carpal hemiarthroplasties were reviewed with a mean follow-up duration of 35 ± 28 months. Overall complication and revision rates were 51% (53 of 105) and 39% (41 of 105), respectively. Postoperative contracture accounted for the largest number of complications needing additional surgery (20%), followed by component failure (15%). Deep infections occurred in 2 TWAs and 1 distal radius hemiarthroplasty and required removal of hardware, antibiotic spacer placement, and a prolonged course of intravenous antibiotics prior to a definitive operation. Of those patients requiring additional surgery, 41% (n = 10) underwent at least 2 procedures, and 10% (n = 4) underwent at least 6 additional surgeries. CONCLUSIONS Although TWA and partial wrist arthroplasty are attractive treatment options for the painful arthritic wrist, there remains a noteworthy potential for complications requiring additional surgery. A detailed understanding of these risks is essential for surgeons so that patients may be counseled accordingly and that alternative treatment options may be considered. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Michael P Gaspar
- Philadelphia Hand Center, Philadelphia, PA; Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.
| | - Jesse Lou
- Philadelphia Hand Center, Philadelphia, PA
| | - Patrick M Kane
- Philadelphia Hand Center, Philadelphia, PA; Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Sidney M Jacoby
- Philadelphia Hand Center, Philadelphia, PA; Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
| | - A Lee Osterman
- Philadelphia Hand Center, Philadelphia, PA; Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Randall W Culp
- Philadelphia Hand Center, Philadelphia, PA; Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
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Mandarano-Filho LG, Campioto DS, Bezuti MT, Mazzer N, Barbieri CH. Functional outcomes of proximal row carpectomy: 2-year follow-up. ACTA ORTOPEDICA BRASILEIRA 2015; 23:311-4. [PMID: 27057144 PMCID: PMC4775508 DOI: 10.1590/1413-785220152306150054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE : To evaluate functional outcomes of patients submit-ted to proximal row carpectomy for the treatment of wrist arthri-tis METHODS : This is a retrospective study using wrist motion and grip strenght of patients diagnosed with Kienböck disease and scaphoid non-union surgically treated by this technique RESULTS : Eleven patients with 2-year follow-up were evaluated. Wrist motion (flexion, extension and ulnar deviation) and grip strength were significantly better from preoperative values. Ho-wever, no difference in radial deviation was observed in these patients CONCLUSION : Proximal row carpectomy provides an alternative option for treatment of wrist arthritis, resulting in better active range of motion and grip strength in the long run. Level of Evidence IV, Case Series.
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25
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Abstract
Wrist ligamentous injuries can be challenging to treat successfully. In some cases the ligament repair or reconstruction fails, resulting in instability and progressive degenerative changes. In other cases the original injury is missed, and the patient presents for the first time with established wrist arthritis. Multiple operations have been devised to treat patients with arthrosis secondary to wrist ligament injuries. This article discusses definitive salvage operations such as intercarpal arthrodeses and proximal row carpectomy, as well as other alternatives such as wrist denervation and radial styloidectomy.
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Abstract
STUDY DESIGN Systematic review of measurement properties. OBJECTIVES To summarize the measurement properties of the Patient-Rated Wrist Evaluation (PRWE) questionnaire. BACKGROUND The PRWE is a region-specific outcome measure initially developed for assessing pain and function in individuals with distal radius fracture. However, subsequent research has expanded its use to other wrist/hand conditions. A systematic review of the measurement properties of the PRWE can enhance the understanding of its clinical applicability across different wrist/hand pathologies. METHODS The MEDLINE, Embase, and CINAHL databases were searched using predefined search terms. A hand search of the bibliography of the primary studies was performed. Studies assessing at least 1 measurement property of the PRWE, either in the English version or versions in other languages, were included in this review. Two raters performed data extraction and critical appraisal of the primary studies using standardized instruments. RESULTS A total of 22 primary studies met the inclusion criteria. The overall quality of the 22 studies ranged from 38% to 88%, with 9 scoring greater than 70%. Agreement between the raters who determined the quality of the studies was 0.75 (unweighted kappa). The measurement properties of the PRWE were summarized for different wrist/hand conditions. CONCLUSION The PRWE is reliable, valid, and responsive across many wrist/hand conditions. Future studies should focus on determining values for the minimal detectable change and clinically important differences for the PRWE across different patient populations.
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Fowler JR, Tang PC, Imbriglia JE. Osteochondral resurfacing with proximal row carpectomy: 8-year follow-up. Orthopedics 2014; 37:e856-9. [PMID: 25275971 DOI: 10.3928/01477447-20140924-50] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 02/20/2014] [Indexed: 02/03/2023]
Abstract
Degenerative arthrosis of the proximal row remains a challenging problem for both patients and surgeons. Proximal row carpectomy is a motion-preserving treatment option, with studies documenting acceptable long-term outcomes. Proximal row carpectomy is an attractive option because there is no need for fusion to occur between the carpal bones, as in 4-corner fusion. As a result, laborers and smokers may be able to return to work more quickly. However, capitate chondrosis traditionally has been considered a contraindication to proximal row carpectomy. The goal of this study was to review the long-term follow-up of patients who underwent osteochondral resurfacing of capitate chondrosis performed in the same setting as proximal row carpectomy. Final follow-up was obtained in 5 of 8 (63%) patients at an average of 101 months (range, 99-102) after surgery. Grip strength improved at each time point, but wrist flexion and extension decreased. The average Mayo Wrist Score was 74 (range, 65-85) and remained stable or improved in all patients between the 18-month visit and the final visit. The Disabilities of the Arm, Shoulder and Hand (DASH) score was unchanged at final follow-up compared with 18-month follow-up (P=.7). This study found that osteochondral resurfacing of the capitate in the setting of proximal row carpectomy for patients with capitate chondrosis offers good outcomes compared with standard proximal row carpectomy in patients without capitate chondrosis on patient-directed outcome tools (DASH, Mayo Wrist Score) at long-term follow-up of 101 months.
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28
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Wall LB, Didonna ML, Kiefhaber TR, Stern PJ. Proximal row carpectomy: minimum 20-year follow-up. J Hand Surg Am 2013; 38:1498-504. [PMID: 23809467 DOI: 10.1016/j.jhsa.2013.04.028] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Revised: 04/21/2013] [Accepted: 04/23/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE Proximal row carpectomy (PRC) is a motion-sparing procedure for degenerative disorders of the proximal carpal row. Reported results at a minimum 10-year follow-up consistently show maintenance of strength, motion, and satisfaction with an average conversion rate to radiocarpal arthrodesis of 12%. We hypothesized that PRC would continue to provide a high level of satisfaction and function at a minimum of 20 years. METHODS Seventeen wrists in 16 patients, including 7 laborers, underwent PRC for symptomatic degenerative disorders of the proximal carpal row at an average age of 36 years. Patients returned for radiographic and clinical evaluation, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire and Patient-Related Wrist Evaluation were used for subjective assessment. Follow-up was a minimum of 20 years (average, 24 y). RESULTS Eleven wrists (65%) underwent no further surgery at a minimum 20-year follow-up. The average time to failure of PRC, defined as the time from PRC to radiocarpal arthrodesis, was 11 years (range, 8 mo to 20 y). Ten of 11 patients who did not undergo radiocarpal arthrodesis continued to be satisfied, with minimal decrease in motion and grip strength compared with the uninvolved side. Average score for QuickDASH was 16 and for Patient-Related Wrist Evaluation was 26. The flexion-extension arc was 68°, and grip strength was 72% of the contralateral side. All patients returned to their original employment. There was no correlation between degenerative radiographic changes and satisfaction level. The predicted probability of failure revealed a higher risk in patients who underwent PRC at a younger age, which leveled off at age 40 years. CONCLUSIONS PRC provides satisfaction at a minimum of 20 years with a survival rate of 65%. Whereas we recommend a minimum age for PRC between 35 and 40 years, young patients should not be excluded as PRC candidates; these patients should undergo appropriate preoperative counseling of their increased failure risk secondary to their young age. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Lindley B Wall
- Washington University Orthopaedics, St. Louis, Missouri 63110, USA.
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Shah CM, Stern PJ. Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrist arthritis. Curr Rev Musculoskelet Med 2013; 6:9-17. [PMID: 23325545 PMCID: PMC3702758 DOI: 10.1007/s12178-012-9149-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) are the two most common patterns of posttraumatic wrist arthritis. This review discusses the etiology and clinical evaluation, as well as up-to-date treatment options, for both of these conditions. Classic as well as newer innovative techniques are discussed with clinical outcomes in order to provide an evidence-based review of the world's literature on SLAC/SNAC wrist.
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Affiliation(s)
- Chirag M. Shah
- Hand Surgery Specialists, Inc., 538 Oak Street, Suite 200, Cincinnati, OH 45219 USA
| | - Peter J. Stern
- Hand Surgery Specialists, Inc., 538 Oak Street, Suite 200, Cincinnati, OH 45219 USA
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Abstract
Proximal row carpectomy (PRC) is a motion-preserving treatment for the degenerated wrist. PRC provides painless wrist range of motion with few complications. PRC treats specifically scapholunate advanced collapse, scaphoid non-union advanced collapse, chronic perilunate dislocations, and Kienbock's disease. The best candidates are older than 35 with an intact capitate head and lunate facet of the distal radius. Proximal row carpectomy provides satisfactory postoperative wrist range of motion and grip strength with few complications, especially when there is no capitolunate arthrosis. Postoperative progressive changes at the radiocapitate articulation have been documented, yet these changes tend to remain asymptomatic.
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Affiliation(s)
- Lindley B Wall
- Washington University Orthopedics, St Louis, MO 63110, USA
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Abstract
This article reviews the history of total wrist arthroplasty as a treatment option for painful, nonfunctional wrists in disease states. Technologic advances in materials, wear properties, and manufacturing now account for increased implant longevity. They may also improve total wrist replacement design, survival, and hence patient function. Also, alternative surgical treatments such as distal radius hemiarthroplasty may serve as a treatment option for patients with higher activity levels and diffuse arthritis. With careful patient selection, soft tissue considerations, and novel implant designs, TWA may become a viable treatment staple for patients with functional wrist disability.
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Affiliation(s)
- Rowena McBeath
- The Philadelphia Hand Center, P.C., Thomas Jefferson University Hospital, 834 Chestnut Street, Philadelphia, PA 19107, USA.
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Novel approach for posttraumatic panarthritis of the wrist using a pyrocarbon interposition arthroplasty (Amandys®): Preliminary series of 11 patients. ACTA ACUST UNITED AC 2012; 31:188-94. [DOI: 10.1016/j.main.2012.07.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 06/28/2012] [Accepted: 07/01/2012] [Indexed: 11/19/2022]
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Abstract
The authors present a solution for motion preservation in severe wrist arthritis with intercarpal involvement. Acellular dermal allograft is used as an interposition arthroplasty in these situations, rather than local tissue flaps such as previously described. Proximal row carpectomy has been shown to be one of the most successful procedures to correct chronic destructive arthritis in the wrist, keeping useful motion. Traditionally, a contraindication for proximal row carpectomy includes an arthritis that invades the lunate-capitate joint. The authors describe a technique to extend the traditional indications by covering the eroded articular surfaces with dermal allograft scaffold.
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Scapholunate advanced collapse and scaphoid nonunion advanced collapse arthritis--update on evaluation and treatment. J Hand Surg Am 2011; 36:729-35. [PMID: 21463735 DOI: 10.1016/j.jhsa.2011.01.018] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 01/17/2011] [Indexed: 02/02/2023]
Abstract
Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse are common patterns of wrist arthritis. Scaphoid nonunion advanced collapse is caused by trauma, whereas SLAC wrist may also result from chronic pseudogout and can appear bilaterally without a clear history of injury. Surgical treatment for SLAC wrist includes 4-corner arthrodesis, capitolunate arthrodesis, complete wrist arthrodesis, proximal row carpectomy (PRC), denervation, and radial styloidectomy. Scaphoid nonunion advanced collapse wrist has the additional surgical option of excision of the distal ununited scaphoid fragment. Controversy persists over the relative merits of PRC versus 4-corner arthrodesis and whether PRC may be performed in the setting of capitate arthritis.
Collapse
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