Secondary Wrist Arthritis in Active Workers: Does Capitate Pyrocarbon Resurfacing (RCPI) Improve Proximal Row Carpectomy? A Retrospective Cohort Study

Abstract

Background: Proximal Row Carpectomy (PRC) is a widespread, safe and effective salvage surgical procedure for wrist arthritis. Some authors believe that PRC results in low grip strength (GS), due to the loss of carpal height, supporting the idea to discourage PRC in high-demanding patients. Resurfacing Capitate Prosthesis Implant (RCPI) allows extending the indication for PRC also in case of deformity and/or arthritis of the head of capitate, with possible implications of clinical outcomes, including GS. Methods: Retrospective multicentre study on a population of active workers, affected by secondary post traumatic wrist arthritis, who underwent PRC (27 patients) or PRC + RCPI (20 patients), Primary outcome was to assess GS between PRC and PRC + RCPI. Secondary outcome was to assess CHR and to search for any possible contributors to GS. Active range of motion (AROM), hand function (DASH, Work-DASH, VAS, PRWHE), pain, time to return to work, job maintenance, major complications and general satisfaction were also assessed. Results: PRC + RCPI results in more GS maintenance compared with PRC alone, with higher values of CHR. CHR values were associated with GS with a good correlation. According to linear regression model analysis within PRC + RCPI group (GS–CHR), it is esteemed that the increase in parameter CHR is associated with an increase in parameter GS. Looking at a multiple linear regression model analysis built on the whole sample (GS% increase – (group × CHR) + GS% pre-operative). It is estimated that the increase of one unit of the GS coefficient is associated with an increase in GS% increase. Furthermore, higher pre-operative GS values positively influence post-operative GS. No differences were revealed between the two treatments in terms of the remaining secondary outcomes. Conclusions: PRC alone and PRC + RCPI are both effective salvage procedures for wrist arthritis. RCPI provides a better GS preservation, in part due to the carpal height preservation.

Proximal Row Carpectomy Modifications for Capitate Arthritis: A Systematic Review

“…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.…”

“…Two studies compared PRC + RCPI with traditional PRC and found increased grip strength and carpal height in the PRC + RCPI group, though traditional PRC provided more extension. 14 16 Ferrero et.al compared the PRC + RCPI to 4CF and found no difference in outcomes with the exception of 4CF having increased radial deviation compared with PRC + RCPI. Particularly, there was no difference in grip strength between the two groups.…”

“…31 With a similar modulus of elasticity to bone, excellent wear characteristics and good biocompatibility with bone and cartilage pyrocarbon implants are ideal to use when situating adjacent to Outcomes from the RCPI have demonstrate a flexionextension arc range of 55 to 82 with a grip strength range of 16 to 38 across six studies. [14][15][16][17][18][19] Across the studies, only three (2%) patients required salvage to wrist arthrodesis over a follow-up range of 13 to 72 months. Two studies compared PRC þ RCPI with traditional PRC and found increased grip strength and carpal height in the PRC þ RCPI group, though traditional PRC provided more extension.…”