Abstract
Objective This study aims to define the indications of APSI and to evaluate the long-term results.
Patients and Methods This is a monocentric study including patients that underwent an arthroplasty of
the scaphoid proximal pole using an APSI between 1994 and 2010. Patients were assessed
using autoquestionnaires and measuring ranges of motion, key pinch, and grip strength.
X-ray views of the wrist were done to control the mobility of the implant and the
evolution of the carpal collapse, if present.
Results There were 19 patients included with a mean follow-up of 11 years. The mean range
of motion was 106 degrees (65% of contralateral side) in flexion-extension and 33
degrees (78% of contralateral side) in radialulnar deviation. The mean grip strength
was 72% of the contralateral side. The mean Mayo wrist score was 69/100, the mean
QuickDASH 26/100, and the mean patient-rated wrist evaluation (PRWE) 25/100. After
10 years, evolution to osteoarthritis was noted in 32% of the patients. This was associated
with a decrease of the carpal height. More specifically, capito-lunate osteoarthritis
was noted after 10 years and two out of three patients were concerned after 20 years
of follow-up. No osteoarthritis was diagnosed at the radiolunate articulation.
Conclusion APSI is a treatment option that enables patients with scaphoid nonunion advanced
collapse (SNAC), scapholunate advanced collapse (SLAC) I or II to preserve the strength
and mobility with good functional results. But this arthroplasty does not prevent
natural evolution to a carpal collapse after a follow-up of 20 years which is clinically
well tolerated.
Keywords
proximal scaphoid replacement - wrist arthroplasty - adaptive proximal scaphoid implant
- wrist arthritis
