Osteochondral resurfacing in proximal row carpectomy.

Purpose: degenerative changes of the capitate or the lunate fossa historically have been a contraindication to proximal row carpectomy (PRC). The goal of our study was to evaluate the results of PRC combined with autologous osteochondral grafting taken from one of the carpal bones of the proximal row (lunate or triquetrum) and transplanted on a chondral defect of the capitate head or the lunate fossa. Methods: between 2010 and 2014, 11 patients underwent a PRC surgery associated with osteochondral resurfacing of the capitate or lunate fossa in our unit. In all cases location, grade and diameter of chondrosis were recorded, as well as the graft harvest origin. Pre-operative and post-operative examinations included: Visual Analog Scale for pain, Range of Motion, and a Quick Disability of the Arm, Shoulder and Hand questionnaire. All patients underwent an MRI or CT control of graft at 1 year after surgery. Results: the results of our study at a mean of 55.5 months of follow-up (26-74 months) showed statistically significant reduction in pain and in QDASH scores with return to work of all manual workers and to sportive activity like swimming and tennis in 3 cases. ROM after surgery is 111º in flexion-extension and 37º in radial-ulnar deviation. Graft at 12 months after surgery showed complete integration in all cases. Conclusions: our study confirms that chondrosis of capitate head and lunate fossa are not an absolute contraindication for a PRC procedure in pathological conditions of the carpus. The technique represents an alternative to wrist arthrodesis (total or radioscapho- lunate) in chondrosis of the lunate fossa, as to S+4CF, capitate head implant, capsular or allograft interposition when the capitate head is involved.