Klinische Ergebnisse nach Sauv�-Kapandji-Operation in Abh�ngigkeit der Erkrankung

The semiconstrained DRUJ prosthesis: blessing or curse?

PURPOSE

There are numerous operative procedures to treat osteoarthritic changes or a significant instability of the distal radioulnar joint (DRUJ). The key problem of most methods is the destabilization of the forearm leading to secondary painful impingement between the radius and ulna, as well as a significant limitation of forearm rotation. The Aptis-Prosthesis designed by Scheker represents a complete substitute for the DRUJ. It is mostly used after the failure of various treatment options to solve the primary problems (arthritis, instability). We have used this type of prosthesis mostly after multiple operative treatments for more than 25 years.

METHODS

In the following retrospective study, we analyzed the data of patients that received an Aptis-prosthesis between 2016 and 2021. We have implanted this prosthesis in 13 cases (11 female, 2 male). Routinely, we document the clinical outcome concerning range of motion (ROM), grip strength, and pain according to numeric rate scaling (NRS) after more than 12 months (month 12-24). In addition, complications, osseous changes, and the rate of loosening of the prosthesis were registered. Furthermore, DASH-Score and patients ' satisfaction were evaluated. Also-as with other implants-follow-up x-rays were performed.

RESULTS

Removal or significant revision of any of the prostheses was not needed. The ROM was 68.1° ± 19.7° for pronation and 72.3° ± 20.9° for supination, grip strength amounted to 27.7 kg ± 11.0 kg equaling 83% of the contralateral side. NRS was 0 at rest and 1.2 (0-2) under weight-bearing. A lysis margin of the radial tap was noted in the radiological examination in 2 patients but without any signs of loosening. The DASH-Score added up to 31.8 ± 13.8 (13-55). All patients were satisfied or very satisfied having this implant.

CONCLUSION

The semiconstrained Aptis-prosthesis is a safe and efficient treatment option after failed DRUJ surgeries. It is striking that of the 20 implanted prostheses no significant revision or explantations were necessary over a period of 25 years.

Long-term results of Sauvé-Kapandji procedure

The Sauvé-Kapandji procedure is an established treatment option for distal radioulnar joint dysfunction. We retrospectively analysed 36 patients following Sauvé-Kapandji procedure between 1997 and 2013. Fifteen patients were available for a follow-up after a mean of 13 years (range 6 to 23). Six patients needed revision surgery because of ulnar stump instability. Radiographs and sonography were performed to quantify the instability of the proximal ulnar stump. These showed a radioulnar convergence of 8 mm without weight and 2 mm while lifting 1 kg. Sonographically, the proximal ulnar stump dislocated by 8 mm to the volar side while applying pressure to the palm, compared with 4 mm on the contralateral side. Sonographically measured ulnar stump instability showed a positive strong correlation with the Disabilities of the Arm, Shoulder and Hand questionnaire and Patient-Reported Wrist Evaluations and a negative strong correlation with grip strength and supination torque. Because of the high incidence of revision surgery due to instability of the proximal ulnar stump, we restrict the use of the Sauvé-Kapandji procedure only to very selected cases.Level of evidence: IV.

A study of functional outcomes following implantation of a total distal radioulnar joint prosthesis

This paper reports a long-term follow-up measuring pain, range of motion and weight-bearing ability, following implantation of a total distal radioulnar joint prosthesis. This prosthesis differs from excision arthroplasties and ulnar head replacements by replacing all three components of the distal radioulnar joint, viz. the sigmoid notch, the ulnar head and the triangular fibrocartilage. The design allows longitudinal migration of the radius throughout pronation and supination, as well as load bearing of the wrist. Thirty-one patients receiving the prosthesis returned or were interviewed by telephone at a mean of 5.9 (range 4-9) years. Pronation increased from a mean of 65.5 degrees (range 5-90 degrees ) to 74 degrees (range 20-90 degrees ) and supination from 53 degrees (range 5-90 degrees ) to 70 degrees (range 20-90 degrees ) while greatly diminishing and/or eliminating pain. Grip increased from a mean of 10 kg (22 lbs) to 24 kg (52 lbs). Weight bearing was restored or increased in 29 of 31 patients.

Functional outcome of en bloc excision and osteoarticular allograft replacement with the Sauve-Kapandji procedure for Campanacci grade 3 giant-cell tumor of the distal radius

PURPOSE

Multiple options have been reported for reconstruction of Campanacci grade 3 giant-cell tumor of the distal radius after resection. In 1990, the senior author described an allograft reconstruction combined with a Sauve-Kapandji procedure after distal radius resection and reported preliminary results in 3 patients. The purpose of this study was to assess with validated patient outcome surveys the intermediate to long-term outcomes of all patients treated with this surgery and to analyze their functional results and document tumor control.

METHODS

All cases of distal radius osteoarticular allograft combined with the Sauve-Kapandji reconstruction for Campanacci grade 3 giant-cell tumors performed from 1986 to 2000 by a single surgeon were evaluated by clinical and radiologic examinations; the Disabilities of the Arm, Shoulder, and Hand questionnaire; the Short Form-36; and Mayo Wrist scores.

RESULTS

Nine consecutive patients (7 women, 2 men) with an average age at follow-up evaluation of 42 years and with a Campanacci grade 3 giant-cell tumor of the distal radius formed the study population. Clinical follow-up time after reconstruction averaged 7 years. Examination showed an average of 51 degrees of extension and 19 degrees of flexion of the wrist and 63 degrees of supination and 79 degrees of pronation of the forearm. Grip strength measured in 5 patients averaged 23 kg. The Disabilities of the Arm, Shoulder, and Hand questionnaire; the Short Form-36; and the Mayo Wrist scores averaged 15, 72, and 73, respectively. These scores indicate modest functional impact. No patient had tumor recurrence, metastases, nonunion, or proximal ulna instability.

CONCLUSIONS

En bloc resection of a Campanacci grade 3 giant-cell tumor of the distal radius followed by reconstruction with an osteoarticular allograft and a Sauve-Kapandji procedure with autogenous bone graft results in a reasonable functional outcome at intermediate to long-term follow-up evaluation.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.