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Wrist Hemiarthroplasty: A Motion-sparing Treatment Alternative for Wrist Arthritis
Dzi-Viet Nguyen, DO; H. Brent Bamberger, DO; Marc Trzeciak, DO; Grandview Hospital and Medical Center
Grandview Hospital and Medical Center, Dayton, OH, USA

Introduction

We offer an alternative to four corner fusion for the treatment of scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC) wrist with mid carpal arthritis. This study prospectively examined the functional outcome of patients before, and 2, 6, 12, and 24 months after having a Maestro® wrist hemiarthroplasty for post-traumatic arthritis of the wrist. We used the distal half of the component (Maestro®) seated in the lunate fossa.

Materials and Methods

We treated 8 patients treated with a wrist hemiarthroplasty over the last 6 years. In this group of patients, 6 presented with a SLAC, 1 presented with SNAC, and 1 presented with capitolunate arthritis. The average patient age was 65.0 years (range 47-81 years old). There were 5 males and 3 females. Average followup was 24 months (Range 1 month to 6 years).

Our objective parameters that were evaluated included range of motion (ROM), grip strength, pre and post op DASH scores, and radiographs.

Results

The average ROM at 6 months postoperatively were 40.3° of flexion, 39.3° of extension, 87° of supination, 77.8° of pronation, 14.5° of radial deviation, and 13.8° of ulnar deviation.

Average grip strength on the operative side by Jamar dynamometer was 49 pounds (range 20-72 pounds) versus 86 pounds (range 75-98 pounds) on the contralateral side. Average preoperative DASH scores (0-100 points) were 58.3 versus postoperatively averaging 55.7 (range 32 – 78). Radiographs revealed no component loosening or radiocarpal dislocations.

Complications included 2 patients converted to a total wrist arthroplasty (TWA), and 1 patient converted to a wrist arthrodesis. There were no infections.

Conclusion

Our data supports that a wrist hemiarthroplasty is a reasonable motion-sparing alternative to four corner fusion especially in patients with a fixed DISI. Advantages include that it is technically easy, no risk for nonunion, limited bone resection, and conversion to TWA possible. Disadvantages include that the long-term wear is unknown, there is a theoretical risk of dislocation, and component loosening is possible.


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