Capitate Resurfacing Implant Arthroplasty with and without Interposition: Preliminary Results
Josef N Tofte, MD1; Rick Tosti, MD2; Michael P. Gaspar, MD3; Meredith Osterman, MD4; Leonid I Katolik, MD5; A. Lee Osterman, MD6; Randall Culp, MD7
1Philadelphia Hand to Shoulder Center, Philadelphia, PA; 2Orthopaedic Surgery and Sports Medicine, Philadelphia Hand Center, King of Prussia, PA; 3Philadelphia Hand Center of Thomas Jefferson University, Philadelphia, PA; 4Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA; 5The Philadelphia Hand Center, Philadelphia, PA; 6Department of Orthopaedic Surgery, Thomas Jefferson University Hospital - The Philadelphia Hand Center, Philadelphia, PA; 7The Philadelphia Hand Center, Thomas Jefferson University, Philadelphia, PA
Background
Scapholunate injury, scaphoid nonunion, advanced Keinböck’s disease, and trauma lead to wrist arthritis. Proximal row carpectomy (PRC) is a durable, motion-preserving surgery used to treat wrist arthritis when the proximal capitate and lunate fossa cartilage are relatively preserved. Capitate resurfacing hemiarthroplasty expands the indications of PRC to include wrist arthritis with capitate or lunate fossa involvement.
Methods
Patients with at least six months clinical follow up who had previously undergone capitate resurfacing hemiarthroplasty with or without interposition of dorsal capsule or allograft from September 2015 to July 2019 were retrospectively reviewed, and clinical, radiographic, and patient-reported outcomes were analyzed. Patients with inadequate clinical or radiographic follow up, preexisting or coincident major wrist reconstructive surgery or arthroplasty, previous PRC, or failed 4CF were excluded.
Results
Thirty-two patients and 33 wrists met inclusion criteria. Patients underwent capitate resurfacing hemiarthroplasty for scapholunate advanced collapse, scaphoid non-union advanced collapse, Keinböck’s disease, and idiopathic pancarpal osteoarthritis at a mean age of 65 years. Fourteen underwent capitate resurfacing hemiarthroplasty without interposition, ten underwent dorsal capsular interposition, and nine underwent allograft interposition. Follow up averaged 13 months (range 6-33). Postoperative visual analogue scores were low. The mean flexion-extension arc was 69° (mean 34° flexion and 36° extension)— 84% of ipsilateral preoperative motion (p = 0.060) and 72% of contralateral motion. The mean grip strength was 38 lbs— 73% of contralateral and 99% of the ipsilateral preoperative strength (p = 0.939). Flexion-extension arcs of interposition patients (mean 79°) were significantly greater than non-interposition (mean 55°) patients (p = 0.004). Radiographic attenuation of the distance between the proximal implant and the lunate facet averaged -0.6mm. Complications included reoperation for stiffness in three patients, early subluxation in one patient, and early erosion of the lunate fossa with revision to allograft interposition in two patients for an overall reoperation rate of 18%. One patient who underwent reoperation for early erosion was noted to have a loose implant at the time of surgery, which was revised intraoperatively with a cemented resurfacing. No other patients had late loosening or late instability.
Conclusions
Capitate resurfacing hemiarthroplasty is a viable alternative to partial or total wrist fusion that preserves motion and grip strength at an average clinical follow up of 13 months. Interposition may yield improved motion and protect the lunate fossa.
Figure 1. Anteroposterior and lateral radiograph of resurfacing hemiarthroplasty with interposition.
Figure 2. Intraoperative photograph of resurfacing hemiarthroplasty with interposition.
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