Treatment of radioscaphoid osteoarthritis by proximal resection of the scaphoid with osteocartilaginous rib graft

Radioscaphoid osteoarthritis is usually a complication of scaphoidpseudarthrosis or chronic scapholunate disjunction. As an alternativeto the classical surgical techniques used for this lesion, wepropose a novel reconstruction method consisting in partial proximalresection of the scaphoid associated with interposition of abiological spacer composed of an osteocartilaginous rib graft. Thepurpose of this study was to present the technical aspects of thisprocedure and to report preliminary results in eighteen patients withradioscaphoid osteoarthritis.We performed a retrospective analysis of eighteen patients whounderwent surgery from 1994 to 2004 for early-stage of radioscaphoidosteoarthritis with scaphoid nonunion in twelve and chronicscapholunate disjunction in eight. The procedure consisted in partialresection of the proximal portion of the scaphoid and insertion of anosteocartilaginous autograft harvested from a rib. Outcome wasbased on the clinical results (pain, motion, grip force, activity) andpatient’s satisfaction. Bone healing was measured with plain-x-raysand vitality of the osteocartilaginous graft with MRI.Mean follow-up was 4,1 years. Clinical outcome was consideredexcellent or good in fifteen patients, fair in two and poor in one(graft dislocation). All patients were satisfied or very satisfied exceptone (one failure). Radiological healing was achieved at threemonths in nine patients. Four patients underwent an MRI examinationat thirteen months which demonstrated, in all patients: no signof necrosis, healing of the graft-scaphoid interface.Compared with partial carpal arthrodesis and resection of the firstrow of the carpus, this palliative technique can be used to reconstructthe proximal portion of the carpal scaphoid with early-stageradioscaphoid osteoarthritis. As for arthroplasty or scaphoid implants,our goal was to achieve a satisfactory scaphoid height usinga biological spacer after resection of the proximal ¾ of the bone.The results of this technique are encouraging but must be examinedwith precaution due to the small number of patients and the shortfollow-up to date.