Patient-specific lunate prosthesis with perilunate ligament reconstruction: surgical technique

The lunate bone plays a central role in force transmission, proximal carpal row integrity, and kinematics of the wrist. In cases of irreparable pathologies to the lunate bone, prosthetic replacement is appealing to avoid salvage procedures. Previous attempts at lunate replacement yielded inconsistent results due to non-anatomical implant design and lack of ligament reconstruction, which posed a risk of dislocation and carpal collapse. Nowadays, the CAD design process and 3D printing of bio-compatible materials such as titanium make it possible to manufacture patient-specific lunate implants. We present a technique and first clinical results of a patient-specific lunate replacement that includes reconstruction of the most important perilunate ligaments to suspend the implant and restore carpal integrity.