Pyrocarbon Lunate Replacements Perform Well at Two Years: A Retrospective Case Series and Technique from Two UK Tertiary Centres

Abstract

Background: We report medium-term results in our case series of patients with Kienböck disease receiving a pyrocarbon lunate replacement (Integra, Smith and Nephew, Watford, UK). Methods: Patients with Kienböck receiving a pyrocarbon lunate between September 2012 and November 2020, with stage 3b and above were included. Patients were staged preoperatively with radiographs and MRIs. Pre- and postoperative visual analogue scores and movement were documented. Postoperative radiographs were obtained at 6 weeks, 6 months and 1 year. Results: Seven patients were identified, all female, with a median age of 28.0 years. All but one had 3b disease and the median follow-up was 2 years (range 13-112 months). A mean 9/10 preoperative VAS score improved to 1/10 by 3 months postoperatively (p < 0.001, paired t-test). No major complications were seen, and implants were stable radiologically. Conclusions: A semi-constrained pyrocarbon lunate can provide good results for patients with advanced Kienböck's disease, offering an alternative to proximal row carpectomy salvage surgery. Level of Evidence: Level IV (Therapeutic).

Keywords: Arthroplasty; Kienböck disease; Lunate; Proximal row carpectomy; Pyrocarbon joint replacement.