Salvage of advanced carpal collapse: proximal row carpectomy with pyrocarbon resurfacing of the capitate versus four-corner arthrodesis

Ferrero, M.A. Martín; Summa, Pietro G. di; Giacalone, Francesco; Senesi, Letizia; Sapino, Gianluca; Battiston, Bruno

doi:10.1177/1753193420931416

Cited by 10 publications

(8 citation statements)

References 30 publications

(29 reference statements)

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“…Eight studies used a CR method to address capitate arthritis; six studies used a resurfacing capitate pyrocarbon implant (RCPI). 14 15 16 17 18 19 Notably, only pyrocarbon implants were used in included studies. Two studies used an osteochondral autograft (OC) harvested from excised carpal bones.…”

Section: Resultsmentioning

confidence: 99%

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Proximal Row Carpectomy Modifications for Capitate Arthritis: A Systematic Review

et al. 2022

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Introduction Proximal row carpectomy (PRC) is a motion-sparing procedure for radiocarpal arthritis with reliable results. Traditionally, proximal capitate arthritis is a contraindication to PRC; however, PRC with modifications are proposed to circumvent this contraindication. PRC modifications can be broadly grouped into capitate resurfacing (CR) and capsular interposition (CI) procedures which could expand PRC indications. Our primary question was to characterize the outcomes achievable with various PRC modifications. Our secondary question was to determine which PRC modification was the optimal procedure when capitate arthritis was present. Methods A systematic review was conducted to examine the outcomes of modified PRC procedures. Independent reviewers appraised multiple databases for PRC studies with modifications for capitate arthritis in adult patients (age >18 years) with a minimum of three cases and extractable outcomes. Modified PRC procedures included capsular/allograft interposition, resurfacing capitate pyrocarbon implants, and osteochondral grafting. Pertinent outcomes included patient demographics, range-of-motion, grip strength, patient-reported outcomes, and complications, including salvage rates. Results Overall, 18 studies met the inclusion criteria—10 studies (n = 147) on CI and 8 studies on CR (n = 136). PRC with CI had the greatest flexion–extension arc and grip strength. Complications were marginally higher in the CR group (4%), while the CI group had a higher conversion to total wrist arthrodesis (10%). Conclusion Techniques to address capitate arthritis center around resurfacing or soft tissue interposition. PRC modifications with CI produces better range-of-motion and grip strength but higher conversion to total wrist arthrodesis. Higher conversion rates may be attributable to longer follow-up periods in studies examining CI compared with CR. Level of Evidence This is a Level III study.

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Section: Resultsmentioning

confidence: 99%

“…Particularly, there was no difference in grip strength between the two groups. 15 The use of osteochondral grafts was initially described for articular defects in the knee. 32 Tang et.al described the initial use of osteochondral grafts in the proximal capitate in a case series of eight patients.…”

Section: Capitate Resurfacingmentioning

confidence: 99%

Proximal Row Carpectomy Modifications for Capitate Arthritis: A Systematic Review

et al. 2022

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“…In these cases, a four-corner fusion or capitolunate arthrodesis was not possible because of osteoarthritis of the radiocarpal joint. Another recent article compares the results of a proximal row carpectomy with RCPI implant (PRC-RCPI) and a four-corner arthrodesis (4CA) for advanced carpal arthritis [ 3 ]. The first group had 31 patients and the second group 26.…”

Section: Discussionmentioning

confidence: 99%

“…Pyrocarbon Capitate Resurfacing has been primarily used for capitate resurfacing in cases of proximal row carpectomy for degenerative wrist diseases [1][2][3]. Our positive experience with the RCPI (resurfacing capitate pyrocarbon implant) prosthesis in elective cases has led us to consider its use also in comminuted capitate fractures.…”

Section: Introductionmentioning

confidence: 99%

Two cases of pyrocarbon capitate resurfacing after comminuted fracture of the capitate bone

Ruijs

Rezzouk²

2020

Case Reports in Plastic Surgery and Hand Surgery

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“…In 2010, Goubier., et al performed a study in seven patient where a pyrocarbon implant was used to replacement the head of the capitate in addition to PRC for the treatment of midcarpal arthritis [7]. In fact, resurfacing of capitate head with a pyrocarbon implant (RCPI) in association with PRC it seems to lead to good results, preserving wrist motion in SNAC wrist stage III [3,6,[8][9][10].…”

Section: Snac Describes the Specific Pattern Of Wrist Arthritis That ...mentioning

confidence: 99%

Treatment of Scaphoid Nonunion Advanced Collapse Stage III with Proximal Row Carpectomy and Resurfacing of Capitate with Pyrocarbon Implant - Results of 2-Year of Follow-Up

Cunha¹,

Nunes²,

Ribau³

et al. 2022

Act Scie Ortho

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Objective: We intend to demonstrate the functional results of a patient with post-traumatic radiocarpal arthrosis due to a scaphoid nonunion advanced collapse who underwent surgical treatment with proximal row carpectomy and capitate resurfacing with pyrocarbon implant. Material and Methods:A 51-year-old male patient, working as a sculptor, presented to our consultation with a scaphoid nonunion advanced collapse due to a non-treated scaphoid fracture 20 years before. Clinically he had pain and radiocarpal instability. Radiographically, there was collapse of the scaphoid and lunate, advanced radiocarpal osteoarthritis and proximal migration of capitate.In 2018, he underwent proximal row carpectomy and capitate resurfacing with pyrocarbon implant through a dorsal approach. The patient was immobilized with a wrist cast for 4 weeks. physical rehabilitation started after remove of the cast. Unrestrained activities were allowed at 12 weeks after surgery. Every 6 months the patient was observed in our consultation.Results: After two and a half years of follow-up, the patient presents a presented a significant improvement on wrist pain, with an initial Visual Analogue Scale score of 9/10 and a current one of 3/10 and a satisfactory wrist mobility, with approximately 20º of extension and 30º of flexion, which allows the execution of his work activity. He refers, however, to a decrease in grip strength. On reassessment radiographs, there is a periprosthetic radiolucent line of 1mm, with progression of radiocarpal arthrosis. Conclusion:Post-traumatic radiocarpal arthrosis has a negative impact on patients' quality of life. There are several surgical treatment options varying from proximal row carpectomy, total wrist prosthesis, partial or total arthrodesis. In the present case, capitate resurfacing with pyrocarbon implant associated with proximal row carpectomy proved to be a good surgical option, with satisfactory results, especially in the reduction of pain, providing the patient wrist mobility compatible with the daily living activities.

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Salvage of advanced carpal collapse: proximal row carpectomy with pyrocarbon resurfacing of the capitate versus four-corner arthrodesis

Cited by 10 publications

References 30 publications

Proximal Row Carpectomy Modifications for Capitate Arthritis: A Systematic Review

Proximal Row Carpectomy Modifications for Capitate Arthritis: A Systematic Review

Two cases of pyrocarbon capitate resurfacing after comminuted fracture of the capitate bone

Treatment of Scaphoid Nonunion Advanced Collapse Stage III with Proximal Row Carpectomy and Resurfacing of Capitate with Pyrocarbon Implant - Results of 2-Year of Follow-Up

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