CPT® Code 25443

1. Indications

The procedure of arthroplasty with prosthetic replacement of the scaphoid carpal bone is indicated for various conditions that compromise the integrity and function of the scaphoid. These indications include:

• Avascular Necrosis - A condition where the blood supply to the scaphoid bone is disrupted, leading to bone death and subsequent joint dysfunction.
• Traumatic Injury - Severe fractures or injuries to the scaphoid that do not heal properly, resulting in chronic pain and instability in the wrist.
• Chronic Arthritis - Degenerative joint disease affecting the scaphoid, leading to pain, stiffness, and loss of function in the wrist.

2. Procedure

The surgical procedure for arthroplasty with prosthetic replacement of the scaphoid involves several critical steps to ensure successful outcomes. These steps include:

• Step 1: Incision - A midline incision is made over the posterior aspect of the wrist, extending from the distal forearm to the proximal metacarpal. This incision provides access to the radiocarpal joint.
• Step 2: Exposure of the Joint - The retinaculum is released, starting from the ulnar border and extending to the radial border, allowing for adequate exposure of the joint. Care is taken to protect the radial and ulnar nerves using vessel loops during this process.
• Step 3: Elevation of the Joint Capsule - The dorsal aspect of the joint capsule is elevated as a single layer to facilitate access to the damaged carpal bone.
• Step 4: Resection of the Damaged Bone - The damaged scaphoid bone is resected using an oscillating saw, preparing the site for the prosthetic replacement.
• Step 5: Trial Component Placement - A trial carpal component is secured to the affected area, allowing for evaluation and necessary adjustments to ensure proper fit and function.
• Step 6: Final Prosthetic Placement - Once the trial component is deemed satisfactory, the final prosthetic components are tamped into place securely.
• Step 7: Stabilization - Sutures are placed through the triangular fibrocartilage to stabilize the prosthetic component, ensuring it remains securely positioned.
• Step 8: Closure - The dorsal aspect of the joint capsule is returned to its normal position and repaired with sutures. The retinaculum and overlying soft tissues, including the skin, are then repaired in layers to complete the procedure.

3. Post-Procedure

After the arthroplasty procedure, patients can expect a recovery period that may involve immobilization of the wrist to promote healing. Post-operative care typically includes pain management, physical therapy to restore mobility, and regular follow-up appointments to monitor the healing process. Patients should be advised on activity restrictions to prevent undue stress on the newly placed prosthetic component. The overall goal of post-procedure care is to ensure optimal recovery and restore function to the wrist joint.