Stage IV Kienböck's disease: Proximal row carpectomy and application of RCPI implant

Marcuzzi, A.; Colantonio, F.; Petrella, Giovanna; Özben, Hakan; Russomando, A.

doi:10.1016/j.hansur.2016.12.005

Cited by 21 publications

(22 citation statements)

References 36 publications

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“…36 Another alternative for the treatment of advanced stages of wrist destruction is proximal row carpectomy with a resurfacing capitate pyrocarbon implant (RCPI). Most studies [37][38][39][40] reported very few cases with a limited follow-up. Few series 37,[41][42][43] have reported interesting outcomes with this implant at mid-to long term.…”

Section: Discussionmentioning

confidence: 99%

Medium-Term Outcomes for Amandys Implant: A 5-Year Minimum Follow-Up of 63 Cases

et al. 2021

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Background Amandys is a pyrocarbon interposition implant used as a therapeutic alternative to total wrist fusion (TWF) or total wrist arthroplasty (TWA) in painful and disabling extensive destruction of the wrist. Objective To review mid-term outcomes in a continuous prospective series of patients who underwent wrist arthroplasty Amandys with a minimum follow-up of 5 years. Methods Clinical evaluation included a satisfaction survey, pain, two functional scores, the short version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and the Patient-Rated Wrist Evaluation (PRWE), active wrist mobility, and grip strength compared with the contralateral side. Radiological evaluation was used to detect implant subsidence, carpal migration, bone lysis, or implant malposition. All per- and postoperative complications were collected. Results Fifty-nine patients (63 procedures) were evaluated with a mean follow-up of 7 years; 57% of the patients were males, and the mean age was 58 years. Among the patients, 90% were satisfied or very satisfied. Pain was significantly improved, with a gain of 4/10 (p < 0.001). Functional outcomes also improved between the second and fifth year of follow-up. Active mobility was preserved and grip strength was significantly improved by 7 kg (p < 0.001). No implant subsidence or carpal migration was observed. Ten patients (11.9%) underwent revision surgery for conflict (1%), rotation (6%), or implant dislocation (5%). All complications and revisions occurred early with no new events after 1 year of follow-up. Discussion Mid-term clinical and radiological outcomes were stable with improvement of functional scores. The survival rate was comparable to that reported for TWF with conserved mobility. We report fewer complications compared with those reported for TWA or TWF. Early instability of the implant was the main etiology of the revisions. Repositioning of the implant was successful. No conversion to TWA or TWF was necessary. Conclusions Mid-term outcomes of the Amandys implants were encouraging. Patients conserved good wrist motion with improved strength and functional scores. The implant was well tolerated. Functional outcomes continue to improve with the follow-up. The survival rate remains stable after 2 years. The level of evidence of this study is IV (therapeutic case series).

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Section: Discussionmentioning

confidence: 99%

Medium-Term Outcomes for Amandys Implant: A 5-Year Minimum Follow-Up of 63 Cases

et al. 2021

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“…The use of PRC–RCPI for advanced Kienböck's disease (Stage IV) has been described recently in six patients as an alternative to more traditional approaches, including partial or total wrist arthrodesis, wrist denervation and PRC (De Smet and Degreef, 2009; Marcuzzi et al., 2017). According to these authors, the technique was effective and provided good clinical results with a significant reduction of pain and improvement in grip strength and ROM.…”

Section: Discussionmentioning

confidence: 99%

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

Ferrero¹,

Summa

Giacalone³

et al. 2020

J Hand Surg Eur Vol

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In this retrospective study we report on two comparable groups of patients with advanced carpal arthritis treated with either proximal row carpectomy combined with a pyrocarbon resurfacing of the capitate (31 patients) or a four-corner arthrodesis and dorsal plating (26 patients). Follow-up time was 46 months (24–118). Except for a modestly higher radial wrist deviation in the patients treated with four-corner arthrodesis, there were no significant differences in outcomes between the groups. Asymptomatic progression of osteoarthritis in the lunate fossa was observed in four cases in both groups. Two cases were converted to a total wrist arthrodesis in the pyrocarbon group compared with one case in the four-corner arthrodesis group. Although four-corner arthrodesis remains the reference standard in the treatment of wrist osteoarthritis with involvement of the midcarpal joint, proximal row carpectomy combined with pyrocarbon resurfacing of the capitate is an alternative option. It can even be used in selected cases with erosion of the lunate fossa. Level of evidence: III

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“…Поэтому в таких случаях часто выполняются частичные артродезы костей запястья (STT или SС) с удалением полулунной кости или без такового, эндопротезирование полулунной кости, удаление проксимального ряда костей запястья или тотальный артродез кистевого сустава. Несмотря на хорошие исходы лечения после удаления проксимального ряда костей запястья, данная операция значительно нарушает биомеханику кистевого сустава и обычно рассматривается в качестве последней попытки сохранить функцию кистевого сустава перед его тотальным артродезом [6,11,15,22]. L. Innes и R.J. Strauch провели исследование исходов лечения болезни Кинбека, основываясь на публикациях ресурсов PubMed, Medline и Cochrane за 1998-2008 гг.…”

Section: Discussionunclassified

“…Разработано множество способов лечения указанного заболевания, ни один из которых не позволяет добиться стабильно хороших результатов [6]. С этой целью выполняются различные варианты костной пластики кровоснабжаемыми и некровоснабжаемыми трансплантатами, пересаживаемыми как в свободном, так и в несвободном варианте, в том числе с использованием стволовых мезенхимальных клеток, остеотомий лучевой и головчатой костей, частичного или тотального артродеза кистевого сустава, его эндопротезирования либо пластики полулунной кости костным цементом [6,7,8,9,10,11,12,13,14,15,16,17,18]. Во многом тактика оперативного лечения основана на рентгенологической картине изменений самой полулунной кости и близлежащих костей кистевого сустава.…”

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Surgical Treatment of Patient with Advanced Kienböck’s Disease: A Case Report

Хоминец

Ткаченко

Иванов

et al. 2020

Traumatology and Orthopedics of Russia

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Relevance. For more than a century, many methods of treating Kienböck’s disease have been developed, although none of them could achieve consistently good results. The transposition of the pisiform into the lunate location after removal of the latter, as well as the combination of this operation with a shortening osteotomy of the radius, is considered as one of the promising methods of this disease treatment. The purpose of this publication was to demonstrate the options of the modern reconstructive surgery for the treatment the stage IIIb Kienböck’s disease. Case presentation. A clinical case of a successful non-free transplant of a blood-supplied pisiform in aseptic necrosis of the lunate is described. A patient was a 21 year old military serviceman with stage IIIb Kienböck’s disease complicated by persistent pain syndrome and severe dysfunction of the left wrist. He underwent removing the fragmented lunate with replacing it with a pisiform on the tendon feeding pedicle and performing simultaneous shortening osteotomy of the radius. The displaced bone was fixed with an anchor to the dorsal surface of the distal radial metaepiphysis. In 12 months after the surgery, an improvement of the wrist function was achieved in the form of an increase in the range of motion compared with the preoperative period and a significant decrease in the level of pain syndrome. The radiological examination at the same time showed the preservation of the shape, size and intraarticular localization of the bone autograft. Conclusion. The use of transposition of the blood-supplied pisiform on a permanent tendon feeding pedicle into the region of the removed lunate demonstrated, in our opinion, the favorable possibilities of successful surgical treatment of the late stages of Kienböck’s disease. A favorable outcome of such treatment is possible only in a specialized hospital, where there are trained specialists in the field of hand surgery, and there are also opportunities for employment a modern rehabilitation complex aimed at restoring movements in the hand joints, taking into account the strength and coordination parameters of its anatomical structures.

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Stage IV Kienböck's disease: Proximal row carpectomy and application of RCPI implant

Cited by 21 publications

References 36 publications

Medium-Term Outcomes for Amandys Implant: A 5-Year Minimum Follow-Up of 63 Cases

Medium-Term Outcomes for Amandys Implant: A 5-Year Minimum Follow-Up of 63 Cases

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

Surgical Treatment of Patient with Advanced Kienböck’s Disease: A Case Report

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