Wrist Hemiarthroplasty Combined with Proximal Row Carpectomy

Abstract

Individuals with advanced lunate collapse due to Kienböck’s disease and associated arthritis who also have physically demanding lifestyles are often not considered appropriate for total wrist arthroplasty (TWA) due to a higher risk for implant loosening, particularly of the distal component. Wrist hemiarthroplasty combined with a proximal row carpectomy (PRC) has shown promising early clinical results in select patients with arthritis for whom there are very limited options. Based on these results, active patients with advanced arthritis of the wrist caused by Kienböck’s disease may be candidates for this procedure, particularly those with distal radius or capitate articular degeneration who are not appropriate for other motion preserving procedures.

In this chapter, the concept of hemiarthroplasty combined with PRC, including an assessment in a cadaver study and the early clinical outcomes in a series of patients, is presented. It is important to recognize that the procedure is relatively new and it is considered an “off-label” use of an implant system in the USA and some other countries.