Clinical, Radiographic And Patient-Perceived Outcome After Radial Hemi-Wrist Arthroplasty With A New Implant: 20 Cases With 5-Year Follow-Up.
Daniel Reiser, MD, PhD1; Marcus Sagerfors, MD, PhD2; Per Wretenberg, MD, PhD3; Kurt Pettersson, MD, PhD2; Per Fischer, MD, PhD4
1Örebro University Hospital, Örebro, Sweden; 2Dep of Hand Surgery, Örebro, Sweden; 3Dep of Orthopedics, Örebro, Sweden; 4Örebro Universitet, Örebro, Sweden
Introduction Proximal row carpectomy is one of the main treatments for end-stage arthritis of the radiocarpal joint. The use of soft tissue interpositional grafts to resurface the radiocapitate articulation has been previously described in addressing osteochondral defects. Here, we present our experience with using meniscus interposition arthroplasty to resurface the radiocapitate articulation in patients with wrist arthritis who would have otherwise been contraindicated to receiving proximal row carpectomies.
Materials & Methods A retrospective study was performed from 2011-2022 and CPT codes 25215 and 25332 were used to identify all patients who underwent proximal row carpectomy with or without meniscus interposition arthroplasty. Patient demographics (age, sex, occupation, hand dominance, etc.) were collected. Improvement in pain was the primary outcome measure . Wrist range of motion and reconstruction failure requiring a fusion procedure were the secondary outcomes. Patients were excluded if there was inadequate documentation regarding the primary/secondary outcomes or if follow-up was less than three months.
Results We identified a total of 83 patients and 43 met inclusion criteria. Fifteen patients (35%) underwent proximal row carpectomy with meniscus interposition arthroplasty and 28 patients (65%) underwent proximal row carpectomy alone. Patients with and without meniscus interposition arthroplasty had documented improvement in pain postoperatively (93% vs. 95%, P>0.05) at a median follow-up time of 11 (3-38 months, range) and 9 months (3-64 months, range), respectively. Postoperative wrist range of motion (Flexion: +9 vs. -4, P<0.05, Extension: +12 vs. -4, P=0.10) trended to increase in patients undergoing meniscus interposition arthroplasty compared to proximal row carpectomy alone. No patients undergoing meniscus interposition arthroplasty required allograft removal or reconstruction failure requiring arthrodesis.
Conclusions Our mid- to long-term outcomes in patients with end-stage wrist arthritis who receive proximal row carpectomy and meniscus interposition arthroplasty for osteochondral defects of the radiocapitate joint are comparable to those receiving proximal row carpectomy alone. Postoperative range of motion may be better when using meniscus compared to proximal row carpectomy alone although this requires further research. Meniscus interposition grafts are a viable adjunct to obviate the need for wrist arthrodesis in patients who traditionally would be contraindicated for a proximal row carpectomy.
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