Lunate prosthetic arthroplasty for the treatment of Kienbock's disease: A systematic review.

Abstract

PURPOSE: Prosthetic replacement of the fragmented, collapsed and unreconstructable lunate is a treatment option in Kienbock's disease. The objective of this study is to assess the effectiveness, safety and outcomes of prosthetic lunate arthroplasty for the treatment of Kienbock's disease. METHODS: We conducted a PRISMA-P compliant systematic review PROSPERO (CRD 42021283996) searching Cochrane, Medline, PubMed and Embase databases for the outcomes of prosthetic lunate arthroplasty. Primary outcomes were patient reported outcome measures, complications and re-operations. Secondary outcomes were pain, grip strength and range of motion. RESULTS: 1093 citations were identified of which 42 studies met the inclusion criteria. Five types of prosthetic lunate arthroplasty were identified including silicone, pyrocarbon, acrylic, metal and 3D printed lunates. Swanson silicone lunates (n = 70) had a 78.5 % complication and 21.4 % re-operation rate at long-term (275.5 months) follow-up with high silicone synovitis incidence. High performance silicone lunates (n = 47) had a 63.8 % complication and 14.8 % re-operation rate at medium term (52.2 months) follow-up. Acrylic lunates (n = 14) had a complication rate of 14.2 % and re-operation rate of 7.1 % at long-term (169.4 months) follow-up. Metal lunates (n = 41) had a 7.3 % complication and re-operation rate at medium-term (120 months) follow-up. Anatomic design Pyrocarbon lunates (n = 13) with medium-term (30.3 months) follow-up had a 23 % complication rate and a 15.3 % re-operation rate with high implant dislocation incidence. 3D-Printed lunates (n = 7) with short-term (14.4 months) follow-up had no complications. CONCLUSIONS: The role of lunate prosthetic arthroplasty in the treatment of Kienbock's disease remains uncertain. Early silicone implants had unacceptably high complication and revision rates and their use has been discontinued as a result. Modern materials such as pyrocarbon and bespoke 3D printed designs remain unproven in the long-term and the challenges of maintaining implant stability remain.