Flexible implant arthroplasty of the radiocarpal joint. Surgical technique and long-term study.

The wrist joint is frequently impaired in rheumatoid, post-traumatic, and degenerative arthritis. Stable radiocarpal motion, even limited, can improve functional hand adaptations, especially if the proximal or distal joints are disabled. A flexible silicone intramedullary stemmed hinged implant was developed in 1967 to be used as an adjunct to resection arthroplasty of the radiocarpal joint while at the same time maintaining the radiocarpal relation and allowing wrist motion in all planes. The surgical technique includes proper contracture release, bone preparation, extensor tendon repair and balancing, and dorsal and palmar capsuloligamentous repair to allow only 60 degrees of total passive flexion/extension and 10 degrees radial/ulnar deviation. This procedure can be combined with ulnar head capping. Metal bone liners (grommets) may be used to protect the radiocarpal implant from sharp bone edges. From January 1970 to April 1983, 181 wrist implant procedures had been performed in 139 patients, most of whom had rheumatoid arthritis. Stable, pain-free functional motion was obtained in the majority of cases. Roentgenograms showed the implants to be well tolerated by bone. Complications were infrequent. Because this procedure does not require cementing or significant bone resection, revision or arthrodesis procedures are facilitated.