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Lunate Pyrocarbon© Implant Arthroplasty: Analysis of Physical Function and Patient Satisfaction
Reinier Feitz, MD; Noortje J. Visser, MD, PhD; Harm Slijper, PhD; Thybout Moojen, MD, PhD
Xpert Clinic, Hilversum, Netherlands

Background: Kienbock’s disease is frequently discussed by different authors. However, the precise aetiology is still uncertain and the treatment remains controversial. A relatively new treatment is lunate implant arthroplasty using a pyrocarbon prosthesis. A literature study could not identify any outcome studies regarding this implant despite the implant being on the market since 2009. Apart from a recent paper from Mark Henry no outcome data have been published since the operative technique was first described in 2011. This study will document the first clinical outcomes.

Methods: Between 2010 and 2013 sixteen patients with Kienbock’s disease stage III were treated by lunate pyrocarbon implant arthroplasty using a single tendon graft to stabilize the implant. Average age of patients was 38 years (range 16-53). Eight males and 8 females were included. Pre-surgical and post-surgical assessment was performed with a mean follow up of 14 months (range 3-34). Assessment included an interview, questionnaire (VAS-score and PRHWE-score), examination, X-ray and measurements (active range of wrist motion and grip strength).

Results: After surgery the levels of pain and function were improved in the majority of patients with a minimum follow up of one year. Average VAS-score improved from 5 to 2.6, average PRHWE-score from 58 to 24. The average flexion- extension arc and wrist deviation arc were decreased with a decline in flexion/extension of 16/12 degrees and a decline in ulnar/radial deviation of 12/3 degrees. Grip strength was not considerably changed after surgery with improvement of average Jamar-score from 23 to 29. Most patients were very satisfied about the operation. Seven patients rated the procedure as “excellent”, 5 patient as “good”, 2 scored “moderate” and 2 scored disappointing. Two patients would not undergo the same procedure again, 14 patients would undergo the same procedure again.

Conclusion: Lunate implant arthroplasty may be a solution in symptomatic patients with a Lichtman stage IIIB or stage IV. Our study suggests that a majority of patients benefit from this procedure. However, this study reports the first clinical outcomes of a small population with a limited maximum follow-up period of 3 years. Future prospective studies with larger patient samples have to be awaited. One advantage of this technique is that it does not elimintate other options, it can be revised with standard alternative options.

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