Long Term Successful Wrist and Finger Joint Arthroplasty Using Cadaveric Meniscus for Osteochondral Defects in the Radiocarpal, Metacarpal, and Proximal Interphalangeal Joints
Don Hoang, MD1, Myles J. Cohen, MD2, David A. Kulber, MD2.
1Keck School of Medicine, Los Angeles, CA, USA, 2Cedar Sinai Medical Center, Los Angeles, CA, USA.
PURPOSE: Osteochondral defects of the radiocarpal, MCP, PIP joints often necessitate arthroplasty or arthrodesis. A novel adjunct for severely arthritic joint salvage using cadaveric meniscus for joint resurfacing is an off-the-shelf alternative to address intra-articular defects and restore normal contact.
METHODS: 14 patients with osteochondral defects (five radiocapitate, five MCP, three PIP, one CMC joint) underwent cadaveric meniscus arthroplasty. Patient demographics, perioperative pain, range of motion, complications were reviewed.
RESULTS: Patients 17 to 73 years old (mean 54.6) underwent joint reconstruction for SNAC (n=1), SLAC wrist (n=4), or osteoarthritis of MCP/CMC (n=6) or PIP (n=3) joints. Successful arthroplasty with joint space preservation occurred in all cases. Patients underwent postoperative hand therapy at 3 weeks and had significant reductions in pain scores (average 9.7 to 1.7) [p<0.01] and improved degrees of active range of flexion 15 (wrist), 46 (MCP), PIP (50) [p<0.01] and extension 30 (wrist) [p < 0.05]. No complications resulted; one revision tenolysis and capsulotomy were performed for a PIP and MCP arthroplasty. Post-operative films reveal preserved joint space after an average 19.7 months follow-up (range 8 - 54).
CONCLUSION: Cadaver meniscus is a viable joint salvage adjunct to preserve pain-free motion and avoid total joint arthrodesis as seen in this 14 patient case series. Hand joint arthroplasty with cadaveric meniscus may be advantageous due to its low metabolic demand, biointegration, and surgically malleability.
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