Distal scaphoid resection for degenerative arthritis secondary to scaphoid nonunion: a 20-year experience.

PURPOSE: To evaluate the long-term results of distal scaphoid excision for degenerative arthritis secondary to scaphoid nonunion and compare them with our original results published in 1999.

METHODS

Nineteen patients who were treated by distal scaphoid resection arthroplasty from 1987 through 2010 were included. The mean follow-up was 15 years (range, 10-25 y) vs 4 years in the previous study. Clinical evaluation included measurement of the visual analog pain scale, wrist range of motion, and grip strength. Radiographs were taken at follow-up to assess for signs of arthritis and wrist collapse.

RESULTS

The outcomes of this procedure include increased grip strength and total arc of motion, a small decrease in revised carpal height ratio, and a small increase in radiolunate angle. Two patients failed distal scaphoid resection arthroplasty necessitating proximal row carpectomy (1) and wrist arthrodesis (1) for recalcitrant pain. More than half of the remaining patients developed midcarpal arthritis on radiographs that was asymptomatic. No patients developed radiolunate arthritis.

CONCLUSIONS

This study showed that distal scaphoid resection arthroplasty produced favorable, long-term clinical results and did not result in noteworthy wrist collapse. Midcarpal arthritis, which may develop after the procedure, did not cause appreciable deterioration in patient outcomes. This procedure also did not eliminate the option of using additional, more conventional reconstructive procedures if needed.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.