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Clinical Outcomes Following Midcarpal Hemiarthroplasty Of The Wrist
Kate Spacey, MRCS, MBBS1; Aftab Siddiqui1; Gregory Packer, FRCS1; Scott W. Wolfe, MD2
1Trauma and Orthopaedics, Southend University Hospital Foundation Trust, Essex; 2Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY

Introduction: Wrist hemiarthroplasty by means of proximal carpal row resurfacing is indicated for patients suffering from radiocarpal arthritis with a preserved distal carpal row. Compared to alternative procedures, such as total arthroplasty or arthrodesis, resurfacing the proximal carpal row preserves the anatomic centre of rotation and radial length without ligamentous disruption and maintains the natural coupled motion of the wrist at the midcarpal articulation.

Method: The KinematX prosthesis has been implanted into 20 of our patients. Further to our earlier results [1], data was collected prospectively with a mean follow up of 114.3 weeks (range 59-168 weeks). Data collected included; pre and postoperative Mayo and DASH scores with grip strength, range of movement and prosthetic complications.

Results: The KinematX prosthesis was implanted to 11 males and 9 females, with an average procedural time of 54 minutes. The operative side was dominant in 65% of cases. Indications included; scapholunate advanced collapse (eleven), osteoarthritis (five), Keinbock’s (one) psoriatic (two) and inflammatory arthritis (one). Average wrist flexion-extension improved postoperatively from 63 degrees to 99.2 degrees. Preoperative assessment revealed an average Mayo wrist score of 34.1, and DASH score of 50.3. Postoperatively, the average Mayo wrist score improved to 64.5 and DASH score to 21.9. The average percentage grip strength of the operative compared to nonoperative hand increased from 66.3% to 96.3% postoperatively. Stiffness occurred in 4 patients who underwent manipulation under anaesthesia within 5 months of primary surgery. One patient underwent revision for aseptic loosening; otherwise there were no cases with radiographic evidence of loosening or capitolunate narrowing. At latest follow-up 76.9% of patients had returned to work.

Conclusion: Our data suggests the KinematX prosthesis is safe and reliable, however a larger population with longer follow-up will determine the durability and overall success of the implant.

The level of of evidence for this study is therapeutic level IV (case series).


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