Résection de la première chaîne de carpe et remplacement prothétique avec RCPI. Plus de dix ans d’expérience personnelle

Abstract

Proximal row carpectomy is an accepted treatment for degenerative wrist diseases like scaphoid nonunion advanced collapse (SNAC), scapholunate advanced collapse (SLAC), scaphoid chondrocalcinosis (SCAC) and advanced stages of Kienbock disease (KDAC). From March 2004 to November 2018, we treated 91 patients by proximal row carpectomy and replacement of capitate's head with RCPI implant. Forty patients were affected by SNAC, 20 by SLAC, 15 by SCAC, 7 by KDAC, 3 by failure of previous PRC, 3 by chronic transcapho perilunate fracture-dislocations, 2 Apsis prosthesis luxation and 1 patient by gout wrist. Mean age at surgery was 54 years (range 22–81). Patients were evaluated by active and passive range of motion (ROM), Jamar grip strength, Disability of the arm, Shoulder and Hand (DASH) score, visual analogue scale (VAS). They were requested to express their satisfaction or unsatisfaction after surgery. Radiographs were undertaken to check implant stability, sinking or failure, subchondral osteolysis and ulnar instability. We controlled 74 patients, average follow-up was 63 (range 14–134) months. Mean VAS was 1.4 (8.4 preoperatively), complete pain relief (VAS 0) was achieved in 31 patients, average grasp strength was 22.1 kg (12.3 kg preoperatively); average ROM was 78° for flexion-extension and 24° for radial-ulnar deviation. Mean DASH score was 8.4 (56.9 before). In 50 cases, implant was correctly anchoraged. In 19 patients, a slight medial translation was observed, without pain. Two patients affected by stage 3rd SLAC and 4th SLAC, presented ulnar instability with impingement between implant and caput ulnae at 6 months from surgery. The patient affected by gout, 2 years after had a recurrence of stiffness with calcification incorporating the implant. One patient had an infection 7 years after intervention: she underwent implant removal and application of a cemented antibiotic spacer. Seventy-one patients were satisfied, 3 unsatisfied. When arthritis affects capitate's head, PRC is not indicated: replacement with resurfacing capitate pyrocarbon implant (RCPI) combined with PRC represents a good alternative to four corner arthrodesis or capitate-lunate arthrodesis associated to scaphoidectomy. RCPI prosthesis associated to PRC demonstrated good clinical and radiographic results on 74 patients controlled: it can be indicated in cases of SNAC, SLAC, SCAC 4th stage with alterated articular surface of lunate fossa of distal radius, KDAC and chronic peri-lunar fracture-dislocations with severe arthrosis.