Does The Capitate Anatomy Affect On The Load Of Radiocarpal Joint After The Proximal Row Carpectomy? Analyses Of The Capitate Anatomy And Finite Element Analyses
Hidemasa Yoneda, MD Ph.D1; Michiro Yamamoto, MD, PhD2
1Nagoya University, Nagoya, Japan; 2Nagoya University Graduate School of Medicine, Nagoya, Japan
Introduction: Distal component loosening is a common mode of failure in total wrist arthroplasty (TWA). A radial hemi wrist arthroplasty (RHWA) has the potential to avoid the problems related to fixation of the distal component in TWA. The aim of this study is to investigate patient related outcome and implant survival of a new RHWA design.
Materials & Methods A pilot study of 20 consecutive RHWA’s. The patients were assessed preoperatively and one year postoperatively for range of motion, grip strength, Visual Analogue Scale (VAS) pain scores and functional scoring using Patient Rated Wrist Evaluation (PRWE), Disabilities of the Arm Shoulder and Hand (DASH) and Canadian Occupational Performance Measure (COPM). Radiographs were analyzed at 12 months and 5 Years (mean 5,1y) postoperatively.
Results: DASH and PRWE-scores improved significantly, wrist range of motion remained largely unchanged except for wrist flexion, which decreased significantly. VAS-pain score during activity was significantly reduced, hand grip strength remained largely unchanged. A total number of 46 secondary surgeries were undertaken in 16 wrists including 7 revisions. Another 6 patients are waiting for revision to wrist arthrodesis.
Conclusions: The new implant resulted in improved functional scoring and improved VAS pain-scores, but a high number of cases needed secondary surgery due to persistent pain. The high revision rate is a major concern and further use of the implant in its current form can not be recommended.
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