Total Scaphoid Replacement: An Overview of Concepts, Materials, and Clinical Evidence

Background: This narrative literature review aims to evaluate the evolution, current concepts, indications and clinical evidence of total scaphoid replacement as a treatment option for non-reconstructable scaphoid pathology. Particular emphasis is placed on implant design, materials, fixation strategies, and the biomechanical rationale underlying modern patient-specific prosthetic approaches. Methods: A comprehensive literature search was performed in PubMed, Scopus, Embase, and Google Scholar and was supplemented by reference screening and relevant book chapters. Studies reporting full scaphoid replacement were included, while partial replacements, non-original articles, and publications outside predefined languages were excluded. Data were synthesized qualitatively with respect to anatomy, biomechanics, implant materials, surgical techniques, fixation strategies, and clinical outcomes. Results: A total of 397 records were identified through database and manual searches. After removal of duplicates, non-topic-related articles, and non-retrievable studies, 33 publications were included in the final analysis. Early acrylic and silicone prostheses showed high complication rates, with implant removal required in up to 70% of early acrylic series and secondary procedures reported in approximately 24% of silicone implant cases. Radiographic abnormalities, including cyst formation and carpal malalignment, were reported in up to 43% of silicone implants despite acceptable short-term clinical outcomes. Modern metallic and patient-specific prostheses demonstrated improved resultsand implant removal required in a minority of cases. Functional outcomes, assessed by DASH and PRWE scores where available, showed significant postoperative improvement, and pain relief was reported in more than 90% of patients in larger titanium implant series. However, follow-up durations varied widely, ranging from 6 months to 43 years, and most studies consisted of small retrospective case series. Conclusions: Total scaphoid replacement has progressed from a spacer-based salvage concept to a patient-specific reconstructive strategy informed by anatomy and biomechanics. Quantitative evidence suggests that modern prostheses can achieve high rates of pain relief and acceptable complication profiles in carefully selected patients. Nevertheless, the current literature is limited by small sample sizes, heterogeneous methodologies, and a lack of long-term prospective data. Further studies with standardized outcome measures and dynamic assessment of wrist kinematics are required to define the long-term role of total scaphoid replacement.