APSI scaphoid hemiarthroplasty – long-term results

Abstract

ObjectiveThis study is aimed at evaluating the long-term results of proximal scaphoid hemiarthroplasty for post-traumatic avascular necrosis at this institution.MethodsTwelve patients who underwent this procedure were identified, and the mean follow-up time was 6.5 years (range: 5–8 years). All patients were male, with a mean age of 39 years (range: 28–55 years). In eight patients, the non-dominant limb was affected. The procedure was carried out through a dorsal approach and all patients underwent the same rehabilitation protocol. Cases were evaluated regarding complications, pain, range of motion, functional status (Mayo Wrist Score), and disability (QuickDASH Score).ResultsNo immediate post-operative complications, such as infection or dislocation of the implant, were observed. All patients presented with peri-implant osteolysis at follow-up, on a radiograph study. None of the patients was forced to abandon their previous professional activity, although about 50% required some type of adaptation at their workplace. The mean functional capacity was, according to the Mayo Wrist Score, of 67.5 points (range: 50–80), corresponding to a satisfactory degree of function. The QuickDASH disability score presented a mean of 25 (range: 3–47.7).ConclusionThe results of this series are in line with previously published studies about this technique. Hemiarthroplasty with a pyrocarbon implant is a safe technique for the treatment of post-fracture avascular necrosis of the scaphoid proximal pole. This technique allowed for satisfactory functional results at a mean follow-up of 6.5 years.

Adaptive proximal scaphoid implant (APSI): a systematic review of the literature

“…All procedures were performed using a dorsal approach 4,[12][13][14]16 except two studies: One used a volar approach in 4/41 cases and lateral in 2/41 cases, 15 the second performed arthroscopic scaphoidectomy. 7 Associated stiloidectomy was performed in four studies 4,12,13,15 for a total of 87/118 (73%) patients; two studies did not perform stiloidectomy, 7,16 and one 14 performed the stiloidectomy, but the percentage was not reported. A dorsal capsulodesis was performed in two studies-eight of 39 patients (20%) 13 and all patients 36/36.…”

“…Five studies recommended three weeks wearing full time a spica splint before beginning rehabilitation of the wrist. 4,12,[14][15][16] Aribert suggested a shorter immobilization of 2 weeks, while Gras et al suggested an immediate ROM at home.…”

“…The Disability of Arm, Shoulder, and Hand score (DASH) or QDASH was evaluated in five studies. 7,[12][13][14]16 The median postoperative DASH was 19.6 (range 7.6-26). The Mayo wrist score was evaluated in four studies 7,12,13,16 with a median value of 74 (range 67,5-80).…”

“…7,[12][13][14]16 The median postoperative DASH was 19.6 (range 7.6-26). The Mayo wrist score was evaluated in four studies 7,12,13,16 with a median value of 74 (range 67,5-80).…”

Prosthetic Replacement of the Scaphoid Proximal Pole: Should It Be the Future?

“…The prosthetic replacement of the scaphoid represents an alternative to more invasive surgical techniques 1 such as partial scaphoidectomy with removal of the proximal fragment which generally leads to a carpal collapse, resection of the first carpal row with risk of progression of arthritis and reduction in the grip strength, 4-corner fusion or total prosthetic replacement of the wrist which is indicated in case of radiocarpal and intercarpal generalized arthritis, and associated with a reduction in the range of movement. 2,3 The scaphoid implants allow the radiocarpal biomechanics to be restored, treating only the injured bone, and allowing the most invasive surgical operations to be performed subsequently, in case of failure. 4 The adaptive proximal scaphoid implant (APSI) is a partial scaphoid prosthesis, ovoid and unfixed, which replaces the proximal pole of the scaphoid.…”