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Master Thesis

« Adaptive proximal scaphoid implant » : indications et résultats à long terme

Abstract : Introduction : Adaptive proximal scaphoid implant (APSI) is a pyrocarbon implant which does not need any fixation. In radio-scaphoid osteoarthritis APSI is used to replace the proximal pole of the scaphoid with the intent to prevent carpal collapse by maintaining the height and kinematic of the carpus. Only few studies report results of APSI and the follow-up is short. 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 all patients that underwent an arthroplasty of the scaphoid proximal pole using an APSI between 1994 and 2010. Patients were assessed using auto-questionnaires, measuring ranges of motion, hand strength and dynamic X-ray views.
Results : There were 19 patients included with a mean follow-up of 11 years. The mean range of motion were 106° in flexion-extension and 33° in radial-ulnar deviation. The mean grip strength was 72% of the contralateral side. The mean Mayo Wrist score was 69/100, the mean QDASH 26/100 and the mean 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. No osteoarthritis was diagnosed at the radio-lunate articulation.
Conclusion : APSI is a treatment option that enables patients with SNAC, SLAC I/ 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.
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Master Thesis
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Marie-Anne Poumellec. « Adaptive proximal scaphoid implant » : indications et résultats à long terme. Médecine humaine et pathologie. 2018. ⟨dumas-02505604⟩

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