Technique: Osteochondral Grafting of Capitate Chondrosis in PRC

Abstract

Proximal row carpectomy (PRC) has been shown in multiple studies to be an effective motion-preserving procedure for wrist arthritis. The operation consists of resection of the scaphoid, lunate, and triquetrum. 1 The proximal capitate and lunate fossa of the radius form the new wrist articulation, which makes the ideal patient free of degenerative changes at those articular surfaces. 2-8 Various authors, as well as the senior author, have maintained that when there is mild degeneration of these articular surfaces, PRC can still provide good to excellent results. [2][3][4][5][6]9 However, as wrist arthritis progresses, as in stage III scapholunate advanced collapse (SLAC) wrist or stage II/III scaphoid nonunion advanced collapse (SNAC) wrist, the proximal capitate becomes arthritic. With advanced degeneration, alternative surgical procedures include scaphoid excision, four-bone fusion, and wrist fusion. However, there Keywords ► osteochondral graft ► proximal row carpectomy AbstractBackground Proximal row carpectomy (PRC) is a useful treatment option for wrist arthritis, but the operation is contraindicated when there is arthritis of the capitate head. We describe a technique that involves resurfacing of a capitate that has focal chondrosis, using an osteochondral graft harvested from the resected carpal bones. Materials and Methods PRC patients who had a focal area of capitate chondrosis underwent osteochondral grafting of the capitate. Pre-and postoperative pain level, employment status, motion, grip strength, and Modified Mayo Wrist Scores (MMWS) were assessed. Postoperative Disability of the Arm, Shoulder, and Hand (DASH) scores were also calculated.

Proximal row carpectomy of the wrist in the setting of midcarpal arthritis: Survivorship and associated complications in soft tissue interposition versus capitate resurfacing

“…Notably, in a series of 17 patients, it was found that six required conversion to radiocarpal arthrodesis at an average of 11 yr. 4 Technical variations to PRC, such as interposition of tissues into the radio-capitate joint and resurfacing of the capitate have been considered in order to delay conversion. [10][11][12][13][14][15][16][17][18][19] These variations have allowed indications for PRC to expand to new patient populations, such as those with degeneration of the capitate head, Kienbock's disease, and complex carpal fractures.…”

“…[10][11][12][13]20,21 Resurfacing techniques using osteochondral grafts or pyrocarbon implants to create a new proximal surface for the capitate have also been described. [14][15][16][17][18][19] Although both interposition and resurfacing have demonstrated similar outcomes to standard PRC, it remains unknown which variation should be considered superior in terms of outcomes and survivability. 10,11,18 Therefore, studies evaluating patients receiving either treatment continue to be essential to inform treatment decisions.…”

“…While interposition during PRC is typically performed utilizing the dorsal wrist capsule, some analyses have demonstrated efficacy with material such as decellularized dermal or meniscal allografts 10–13,20,21. Resurfacing techniques using osteochondral grafts or pyrocarbon implants to create a new proximal surface for the capitate have also been described 14–19. Although both interposition and resurfacing have demonstrated similar outcomes to standard PRC, it remains unknown which variation should be considered superior in terms of outcomes and survivability 10,11,18.…”