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All-Metal Distal Radius Hemiarthroplasty Combined with Proximal Row Carpectomy
Mark Elzik, MD1; Abdo Bachoura, MD2; Sidney Jacoby, MD3; A. Lee Osterman4; Randall W. Culp, MD3
1The Philadelphia Hand Center, Philadelphia, PA; 2Thomas Jefferson University, Philadelphia, PA; 3Thomas Jefferson University Hospital, Philadelphia, PA; 4The Philadelphia Hand Center, Thomas Jefferson University, Philadelphia, PA
Introduction: A relatively novel surgical treatment option for end-stage wrist arthritis is distal radius hemiarthroplasty combined with proximal row carpectomy (PRC). Patients who desire more motion during physical activity but would otherwise undergo total wrist fusion or total wrist arthroplasty may be appropriate candidates for this procedure. Our previous experience using a distal radius component lined with a polyethylene bearing surface revealed high complication rates, in part due to aseptic loosening. In this report, we present our outcomes using an all-metal distal radius component.
Materials and Methods: A retrospective chart review was completed for 26 patients who underwent primary wrist hemiarthroplasty combined with PRC or revision hemiarthroplasty using the metallic distal radial component of the Re-Motion prosthesis (Small Bone Innovations, Morrisville, PA). 7 patients were excluded either due to follow up less than 6 months or previous wrist hemiarthroplasty. There were 11 males and 8 females, with a mean age of 63 years (range, 50-81) at the time of surgery. Specific diagnoses included scapholunate advanced collapse n=9, scaphoid non-union advanced collapse n=2, inflammatory arthritis n= 3, post-traumatic arthritis n=5. Preoperative wrist flexion, extension and grip strength were compared to the postoperative values. Radiographic findings and complications were noted. The Patient Rated Wrist Evaluation (PRWE) was obtained. A paired t-test was used and statistical significance was set at p <0.05.
Results: The mean clinical follow up duration was 1.3 years (range, 0.6-2.0). The wrist flexion-extension arc was 71¼ preoperatively and became 53¼ post-operatively, p=0.005, n=18. Grip strength of the affected side was 55% of the opposite hand preoperatively and improved to 69% postoperatively, p=0.269, n=11. The mean PRWE after a mean of 2.0 years was 42 (range, 8-81).
Conclusions: Short-term outcomes of the all-metal distal radius hemiarthroplasty combined with PRC reveal maintenance of a functional arc of wrist motion and a trend towards improved grip strength. Various complications occurred including impingement of the prosthesis on the trapezium, capitate or hamate. This was addressed with subsequent partial excision. In addition, there is a relatively high incidence of unfavorable radiographic findings. Despite this, several patients had minimal pain and high levels of function. Longer follow up for this type of implant is required to fully assess the clinical impact of radiographic changes. Furthermore, subgroup analysis may help to better define the most appropriate candidates for this procedure.
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