Abstract
Treatment of failures after prior wrist surgeries with major articular destruction
is challenging. In most cases, total wrist fusion is the only possible salvage procedure.
We propose a new interposition arthroplasty with a pyrocarbon implant called Amandys.
A total of 16 patients, 14 men and 2 women, with a mean age of 56 years were operated
on for a failure of wrist surgery performed previously, with an average time lapse
of 12 years. The prior surgeries were partial wrist arthrodesis in seven cases, silicone
implant interpositions in five cases, advanced Kienböck disease (Lichtman IV) treatment
in two cases, proximal row carpectomy in one case, and an isolated scaphoidectomy
in one case. A prospective study with clinical and radiological evaluation was performed
with a mean follow-up of 24 months (6 to 41 months).
Pain and function showed significant improvement. The mean pain score decreased from
7 of 10 to 4 of 10, postoperatively. The mean grip strength was 19 kg (53% of the
contralateral side), and the mean range of motion in flexion extension was 68 degrees.
Mean strength and range of motion did not change significantly with the operation.
The mean QuickDASH (Disability Arm Shoulder and Hand) score decreased from 59 of 100
to 39 of 100. The mean Patient-Rated Wrist Evaluation decreased from 57 of 100 to
33. Two patients (12.5%) required revision for implant repositioning. No dislocation
or subsidence of the implant was noted.
Pyrocarbon interposition arthroplasty is a new option for treatment of advanced wrist
destruction. Preliminary short-term results suggest that it may be a reliable alternative
to total wrist fusion. The level of evidence of this study is IV (therapeutic case
series).
Keywords
wrist arthroplasty - pyrocarbon implant - wrist osteoarthritis - interposition - failure
