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Stougie SD, Boekel LCV, Beumer A, Hoogvliet P, Strackee SD, Coert JH. Aptis Distal Radioulnar Joint Arthroplasty: A Multicenter Evaluation of Functional Outcomes, Complications, and Patient Satisfaction. J Wrist Surg 2024; 13:318-327. [PMID: 39027021 PMCID: PMC11254474 DOI: 10.1055/s-0043-1774317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 08/10/2023] [Indexed: 07/20/2024]
Abstract
Background The Aptis distal radioulnar joint (DRUJ) implant has been commonly used to replace the DRUJ and restore wrist function in patients with a severely destroyed DRUJ. Objective Promising results have been described in the literature. However, the clinical results in a multicenter setting are sparse and variable. This study evaluates the short- to midterm clinical results of 53 patients with a (mean) follow-up of 51 months. Patients and Methods Fifty-three patients (59 implants) treated between 2011 and 2020 in three different institutions were retrospectively identified in a prospectively collected database. The main indication for Aptis DRUJ arthroplasty was a destroyed DRUJ and gross distal radioulnar instability and isolated DRUJ osteoarthritis. Functional outcome, complications, and patient satisfaction were evaluated. Patients completed the Patient-Rated Wrist Evaluation (PRWE) questionnaire and an additional questionnaire about patient satisfaction and return to hobby/work. Results Implant survival was 92%, the surgical follow-up showed many complications (64,4%), and revision surgery was needed frequently (40.7%). In 13 cases, the follow-up was longer than 5 years. Three reimplantations had to be performed and two implants were permanently explanted. In spite of this all, wrist and forearm motion as well as pain reduction was adequate and patient satisfaction was reasonable (72.2%). Conclusion The Aptis DRUJ arthroplasty is a viable option that can provide adequate wrist and forearm function after secure patient selection and surgical placement of the implant in the wrist with a good bone stock of the radius. The complication rate was found to be high, yet patient satisfaction was reasonable. In the case of secondary surgery, additional surgery seems to be needed. For primary surgery, the implant seems to be successful without complications. Different complications have been described, but further analysis is warranted to find the causes of complications and to objectify the performance of the Aptis DRUJ implant. Level of Evidence IV.
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Affiliation(s)
- Shirley D. Stougie
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, The Netherlands
| | - Leonieke C. van Boekel
- Foundation for Orthopedic Research, Care and Education, Amphia Hospital, Breda, The Netherlands
| | - Annechien Beumer
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Peter Hoogvliet
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, The Netherlands
| | - Simon D. Strackee
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, The Netherlands
| | - J. Henk Coert
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, The Netherlands
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2
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Maling LC, Smith AM, Williamson M. Long-term survivorship of the Herbert ulnar head prosthesis: a multicentre retrospective cohort study. J Hand Surg Eur Vol 2024:17531934241238938. [PMID: 38534146 DOI: 10.1177/17531934241238938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Lucy C Maling
- Department of Trauma & Orthopaedics, East Kent Hospitals University NHS Foundation Trust, Queen Elizabeth the Queen Mother Hospital, Margate, Kent, UK
| | - Andrew M Smith
- Department of Trauma & Orthopaedics, East Kent Hospitals University NHS Foundation Trust, Queen Elizabeth the Queen Mother Hospital, Margate, Kent, UK
| | - Mark Williamson
- Department of Trauma & Orthopaedics, East Kent Hospitals University NHS Foundation Trust, Queen Elizabeth the Queen Mother Hospital, Margate, Kent, UK
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3
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Stougie SD, Zijlker HJ, Coert JH. Clinical Results of Patients with Combined Aptis Distal Radioulnar Joint Arthroplasty and Total Wrist Arthroplasty. J Wrist Surg 2024; 13:9-15. [PMID: 38264133 PMCID: PMC10803143 DOI: 10.1055/s-0043-1761945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/04/2023] [Indexed: 01/25/2024]
Abstract
Background Severely destroyed wrists can be managed by combined radiocarpal and distal radioulnar joint (DRUJ) replacement that reduces pain while mobility is ought to be reserved. The combination of these arthroplasties is rarely reported in the literature. Purpose This article describes the clinical outcomes of six consecutive patients with both total wrist and Aptis DRUJ arthroplasty with a median follow-up of 50 months (range: 18-108 months). Patients and Methods Patients with a TWA combined with an Aptis DRUJ arthroplasty were retrospectively identified. The patients were treated between 2011 and 2020. Results The flexion-extension arc was slightly decreased in three cases while forearm rotation was improved in three patients. Pain was adequately reduced in four patients and significant pain was seen in two patients. Although three of four patients could not return to previous work, all patients claimed to be satisfied with the result of the procedure. Conclusion This article demonstrates the possible feasibility of this combined arthroplasty in patients with a destroyed and unstable wrist. Level of Evidence Level III.
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Affiliation(s)
- Shirley D. Stougie
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hero J.A. Zijlker
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Henk Coert
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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4
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Martínez Villén G, Espada Blasco C, Rodríguez Nogué L, García González E. Long-term results of the Aptis TM total distal radioulnar joint prosthesis after previous failed surgical procedures. J Hand Surg Eur Vol 2024; 49:82-90. [PMID: 37747488 DOI: 10.1177/17531934231192375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
We present a prospective study with the results of ten Aptis total distal radioulnar joint replacements in patients who had one to five previous operations. The mean postoperative follow-up was 9.7 years (range 3-14.7). The mean postoperative range of motion of the wrist improved by 9° for extension, 15° for flexion, 10° for pronation and 14° for supination, achieving values equivalent to 88%, 78%, 97% and 88% of those of the non-operated hand. There were minimal changes in radial and ulnar deviations. Grip strength improved by 7 kg, pain decreased by 8 points, QuickDASH and Mayo wrist scores improved by 51 and 53 points, respectively. Two implants had radiolucency less than 1 mm. Serum titanium ion levels were slightly elevated in two patients. Three prostheses required revision surgery for heterotopic ossification, a prominent radial screw and a periprosthetic fracture. No prostheses were removed. Six patients returned to their former professional activities and four patients adapted their jobs.Level of evidence: IV.
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Affiliation(s)
- Gregorio Martínez Villén
- Department of Orthopaedic and Traumatology (Hand and Reconstructive Surgery Unit), Miguel Servet University Hospital, Zaragoza, Spain
| | - Carlos Espada Blasco
- Department of Orthopaedic and Traumatology (Hand and Reconstructive Surgery Unit), Miguel Servet University Hospital, Zaragoza, Spain
| | - Luis Rodríguez Nogué
- Department of Orthopaedic and Traumatology, University Hospital Royo Villanova, Zaragoza, Spain
| | - Elena García González
- Department of Clinical Biochemistry, Miguel Servet University Hospital, Zaragoza, Spain
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Sommer K, Sturm R, Sterz J, Marzi I, Frank J. The semiconstrained DRUJ prosthesis: blessing or curse? Eur J Trauma Emerg Surg 2023; 49:2097-2103. [PMID: 37493761 PMCID: PMC10520165 DOI: 10.1007/s00068-023-02304-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/03/2023] [Indexed: 07/27/2023]
Abstract
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.
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Affiliation(s)
- Katharina Sommer
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt Am Main, Germany
| | - Ramona Sturm
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt Am Main, Germany
| | - Jasmina Sterz
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt Am Main, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt Am Main, Germany
| | - Johannes Frank
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt Am Main, Germany
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Stougie SD, van Doesburg MHM, Oonk JGM, Plugge L, Streekstra GJ, Dobbe JGG, Coert JH. Performance of the Aptis Distal Radioulnar Joint Implant: A Clinical Case Series Including Four-Dimensional Computed Tomography Kinematic Analysis. J Clin Med 2023; 12:5815. [PMID: 37762755 PMCID: PMC10532409 DOI: 10.3390/jcm12185815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
High complication rates and surgical revision rates following Aptis implant placement have been reported in the literature. This study evaluates the performance of the Aptis implant of twelve patients using four-dimensional kinematic analysis. The (mean) follow-up was 58 months. Wrist motion, grip strength, and kinematic analysis of both arms were used to investigate possible causes of the reported complications. In nine cases (75%), the proximal to distal translation of the distal radius along the ulnar axis in the affected forearm was too little or absent. Significant correlations were found between postoperative extension and translation of the distal radius along the ulnar axis and between the radial deviation and combined error. The four-dimensional kinematic analysis suggests that the current design of the implant could lead to limited restoration of the position of the forearm rotation axis and the translation of the radius along the ulnar axis.
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Affiliation(s)
- Shirley D. Stougie
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Margriet H. M. van Doesburg
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Joris G. M. Oonk
- Musculoskeletal Health—Restoration and Development, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Lara Plugge
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Geert J. Streekstra
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Johannes G. G. Dobbe
- Musculoskeletal Health—Restoration and Development, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Jan Henk Coert
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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7
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Giddins G. The distal radioulnar joint after distal radial fractures: when and how do we need to treat pain, stiffness or instability? J Hand Surg Eur Vol 2023; 48:230-245. [PMID: 36638098 DOI: 10.1177/17531934221140238] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The importance of distal radioulnar joint problems associated with distal radial fractures is recognized increasingly. But there remains considerable disagreement about how to treat these problems both acutely and chronically. This review outlines the knowledge about the natural history of ulnar-sided wrist problems with distal radials fractures. In particular, the recent increased understanding of the almost inevitable joint instability associated with distal radial fractures is highlighted, including the unreliability of clinical assessment and hence why there has been so much misunderstanding. Provided there is reasonable bony alignment, most ulnar-sided wrist problems can be treated non-operatively initially (typically for over a year) in anticipation of substantial improvement with time. The exception is early marked subluxation of the distal radioulnar joint (DRUJ) blocking forearm rotation, which needs urgent (typically closed) reduction.
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8
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Amundsen A, Rizzo M, Berger RA, Houdek MT, Frihagen F, Moran SL. Twenty-Year Experience With Primary Distal Radioulnar Joint Arthroplasty From a Single Institution. J Hand Surg Am 2023; 48:53-67. [PMID: 35550310 DOI: 10.1016/j.jhsa.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 12/29/2021] [Accepted: 02/11/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The use of implant arthroplasty in the distal radioulnar joint is increasing. Two main types of implants are commonly used, ulnar head prosthesis (UHP) and hemi or semi-constrained total distal radioulnar joint arthroplasty. The literature consists mainly of small patient series. The purpose of this study was to examine our long-term outcomes of distal radioulnar joint arthroplasty. METHODS Patient data were collected in a patient registry from 2000 to 2019. The follow-up included radiographic examination, physical examination, Mayo Wrist Scores, pain level, range of motion, and grip strength. Reoperations were recorded. The implants were a semi-constrained prosthesis and a metallic UHP. The mean age at surgery was 50 years. Patient demographics were similar, but the semi-constrained group had a higher preoperative percentage of instability (85 vs 52 percent). The median follow-up time was 30 months for the semi-constrained implants group and 102 months for the UHP group. RESULTS A total of 53 primary semi-constrained total joint arthroplasties and 102 UHPs were included. The grip strength and Mayo Wrist Score improved for both the implant groups. Pain reduced in 76% of the patients. Supination improved for the semi-constrained total joint arthroplasty group. Lifting capacity was better in the semi-constrained total joint arthroplasty patients. The unadjusted reoperation rate was 23% for the semi-constrained implants group and 34% for the UHP group. Twenty-two implants were bilateral; these had comparable results to unilateral implants. Kaplan-Meier survival curves demonstrated 94% survival rate for the semi-constrained implants group and 87% survival for the UHP group after 5 years. The risk factors associated with reoperation for the combined implant group included younger age at surgery, previous wrist surgery, ulnar shortening, and wrist fusion. CONCLUSIONS Distal radioulnar joint arthroplasty improved functional outcomes in both the implant groups, but reoperations were frequent. The semi-constrained implants group had better lifting capacity. The bilateral implants had comparable outcomes to the unilateral implants. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Asgeir Amundsen
- Department of Orthopedic Surgery, Østfold Hospital Trust, Kalnes, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marco Rizzo
- Division of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | | | - Frede Frihagen
- Department of Orthopedic Surgery, Østfold Hospital Trust, Kalnes, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Steven L Moran
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN.
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9
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Oonk JGM, Dobbe JGG, Strijkers GJ, van Rijn SK, Streekstra GJ. Kinematic analysis of forearm rotation using four-dimensional computed tomography. J Hand Surg Eur Vol 2022; 48:466-475. [PMID: 36524290 DOI: 10.1177/17531934221142520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This study aimed to quantify forearm kinematics with a focus on the forearm rotation axis. Ten healthy volunteers were included in the study. One three-dimensional computed tomographic scan and two four-dimensional computed tomographic scans were done in all the arms to capture forearm joint motion. After image processing, the rotation axis and the movement of the radius with respect to various axes were quantified. The rotation axis was calculated using finite helical axis analysis and a circle fitting approach. The mean error of the rotation axis found through circle fitting was 0.2 mm (SD 0.1) distally and 0.1 mm (SD 0.1) proximally, indicating an improvement in precision over the finite helical axis approach. The translations of the radius along the ulnar axis and the forearm rotation axis were 2.6 (SD 0.8) and 0.6 mm (SD 0.9), respectively. The rotation of the radius around the radial axis was 7.2°. The techniques presented provide a detailed description of forearm kinematics.
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Affiliation(s)
- Joris G M Oonk
- Amsterdam UMC location University of Amsterdam, Biomedical Engineering and Physics, Amsterdam, The Netherlands.,Amsterdam Movement Sciences, Musculoskeletal Health - Restoration and Development, Amsterdam, The Netherlands
| | - Johannes G G Dobbe
- Amsterdam UMC location University of Amsterdam, Biomedical Engineering and Physics, Amsterdam, The Netherlands.,Amsterdam Movement Sciences, Musculoskeletal Health - Restoration and Development, Amsterdam, The Netherlands
| | - Gustav J Strijkers
- Amsterdam UMC location University of Amsterdam, Biomedical Engineering and Physics, Amsterdam, The Netherlands
| | - Sybren K van Rijn
- Amsterdam UMC location University of Amsterdam, Plastic, Reconstructive and Hand surgery, Amsterdam, The Netherlands
| | - Geert J Streekstra
- Amsterdam UMC location University of Amsterdam, Biomedical Engineering and Physics, Amsterdam, The Netherlands
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10
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Clinical outcome and survival rate of the Herbert ulnar head prosthesis for reconstruction of the distal radioulnar joint depending on co-morbidity and different indications. Arch Orthop Trauma Surg 2022; 143:2789-2795. [PMID: 36515709 DOI: 10.1007/s00402-022-04728-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Ulnar head prostheses have been developed to restore the integrity of the DRUJ and relieve pain. This study aims to evaluate the long-term outcome of the clinical and radiographic results as well as the survival rate of the Herbert ulnar head prosthesis (UHP) depending on co-morbidity and different indications. MATERIALS AND METHODS The Herbert ulnar head prosthesis was implanted in 62 patients. In the majority of the patients, the indication was given due to pain during forearm rotation. This was on account of painful instability of the distal ulna following Bowers (59.7%) or Kapandji procedure (16.1%), Darrach procedure (8.1%) or painful post-traumatic (12.9%) or primary osteoarthritis (3.2%). Of the 62 patients, 34 were men and 28 women. The mean age at the time of operation was 49 years (range 18-84 years). A clinical and radiographic evaluation was performed including pain scale, range of motion, grip strength and the DASH and modified Mayo wrist scores. RESULTS The average follow-up was 84.5 months (range 8-206 months), and statistically significant reduction of pain was observed (p < 0.05). The range of motion of pro- and supination improved slightly, but not significantly, whereas the DASH score improved significantly from 56 to 43 (p < 0.05). Patients without an arthrodesis achieved better results in the DASH and in the modified Mayo wrist score. In 39 cases, a small amount of bone resorption was seen at the collar of the prosthesis in the follow-up radiographs. A revision surgery was necessary in 14 patients. The Kaplan-Meier survival rate after 15 years was 90.3%. CONCLUSION The long-term results of the UHP are encouraging regardless of different indications with a survival rate of more than 90% 7 years following surgery, high patient satisfaction and good clinical and radiographic results. LEVEL OF EVIDENCE IV.
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11
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Amundsen A, Rizzo M, Berger R, Frihagen F, Moran SL. Outcomes following Distal Radioulnar Joint Arthroplasty in the Setting of Total or Partial Wrist Fusion. J Wrist Surg 2022; 11:501-508. [PMID: 36504533 PMCID: PMC9731744 DOI: 10.1055/s-0042-1743119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 01/05/2022] [Indexed: 12/15/2022]
Abstract
Purpose To evaluate the functional outcome and complications following primary ulnar head or total distal radial ulnar joint (DRUJ) arthroplasty in patients who have a partial or total wrist fusion. Methods We conducted a retrospective review of 33 primary DRUJ implants in 31 patients who had a partial or total wrist fusion. Follow-up time averaged 67 months. There were 11 partial and 22 total wrist fusions with 22 ulnar head prosthesis and 11 total DRUJ implants. The mean age of the patients was 49 years. Eighty-one percent had previous surgeries with an average number of 4.6 previous wrist procedures. Pre- and postoperative pain levels were recorded. Mayo Wrist Scores were calculated. Grip strength, range of motion (ROM), and post-operative complications were noted. Results The pain scores improved in 67% of the patients. The Mayo Wrist Score improved significantly from a mean of 39 preoperatively to 51 postoperatively. The grip strength and pro-supination remained stable. The wrist ROM also remained stable in the patients with partial wrist fusions. During the follow-up period, 10 (30%) of the DRUJ implants were explanted, with a trend toward higher explantation rates in total wrist fusions with one in the partial fusion group and nine in the total wrist fusion group. Four of the explantations happened in the first postoperative year. Nineteen (61%) of the patients required a second surgery for a DRUJ implant-related complication; this rate was similar between the partial and total fusion groups. Conclusions DRUJ replacement resulted in improved pain scores and Mayo wrist scores in the majority of patients; however, the combination of primary DRUJ arthroplasty and total wrist fusion was associated with high complication rates. Surgeons should be aware of the high complication rate seen with DRUJ arthroplasty when combined with total wrist fusion.
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Affiliation(s)
- Asgeir Amundsen
- Department of Orthopedic Surgery, Østfold Hospital Trust, Kalnes, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marco Rizzo
- Division of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Richard Berger
- Division of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Frede Frihagen
- Department of Orthopedic Surgery, Østfold Hospital Trust, Kalnes, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Steven L. Moran
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
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12
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Brogren E, Abramo A, Tägil M. Bone Remodeling after Ulna Head Replacement in Distal Radioulnar Joint Arthroplasty: A Radiographic Comparison between a Partial and a Total Ulna Head Concept. J Wrist Surg 2022; 11:425-432. [PMID: 36339080 PMCID: PMC9633151 DOI: 10.1055/s-0041-1742098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/17/2021] [Indexed: 11/08/2022]
Abstract
Background Ulna head arthroplasty has become an eligible solution for injury or disease in the distal radioulnar joint. Bone resorption beneath the prosthetic head is often reported, but mechanism poorly understood. Purpose The aims were to evaluate bone remodeling and radiological instability in two conceptually different distal radioulnar joint arthroplasties: the total and the partial ulna head replacement. Patients and Methods We conducted a retrospective radiographic assessment of 51 ulna head arthroplasties; 26 Herbert ulna (total ulna head replacement) and 25 First Choice (partial ulna head replacement), to analyze periprosthetic bone resorption and radiologic instability. Intraoperative/immediate postoperative and 1-year radiographs were reviewed by two independent assessors. The radiographic follow-up averaged 13 (10-17) months. The size of the stem in relation to the diameter of the ulna (filling ratio) was measured on the intraoperative/immediate postoperative radiographs. Bone resorption beneath the collar of the prothesis was measured on the 1-year radiographs and expressed as a bone resorption index (BRI) between the length of the resorption and the length of the implant stem. Radiological stability was measured on both the preoperative and the 1-year lateral radiographs. Results The total ulna head prothesis presented with more extensive bone resorption beneath the prosthetic head than the partial ulna head prothesis at 1-year post surgery ( p <0.001). The filling ratio did not influence the 1-year bone resorption and there was no difference regarding radiological instability between the two prosthetic designs. Conclusion The pattern of bone adaptions after an ulna head prothesis may differ due to design and concept of the prosthesis.
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Affiliation(s)
- Elisabeth Brogren
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Translational Medicine, Lund University, Lund, Sweden
| | - Antonio Abramo
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Translational Medicine, Lund University, Lund, Sweden
| | - Magnus Tägil
- Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
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13
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Warlop J, Nuffel MV, Smet LD, Degreef I. Midterm Functional Outcome of the Linked Semiconstrained Distal Radioulnar Joint Prosthesis. J Wrist Surg 2022; 11:335-343. [PMID: 35971467 PMCID: PMC9375684 DOI: 10.1055/s-0041-1740135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 10/12/2021] [Indexed: 12/15/2022]
Abstract
Background A painful unstable distal radioulnar joint (DRUJ) can seriously compromise hand and wrist function. The semiconstrained prosthesis was developed to restore DRUJ function. To date, most outcome reports are coauthored by the designer. Questions Does independent reporting confirm the promising results of the semiconstrained DRUJ prosthesis? Are complication and failure rates acceptable? Patients and Methods We evaluated patients with the semiconstrained DRUJ implant and a minimum follow-up of 2 years. We monitored patient satisfaction and function with functionality questionnaires and measured wrist range of motion, grip, and key pinch strength. Statistical analysis was done using descriptive statistics, Pearson correlation coefficients, linear and logistic regression. Results We included 41 patients with 42 implants. Mean follow-up was 46 months (range: 24-102 months). Eighty percent of wrist had undergone previous surgery. We found a mean pronation of 83 degrees (0-90 degrees), supination of 70 degrees (0-90 degrees), flexion of 42 degrees (0-90 degrees), extension of 49 degrees (0-90 degrees), ulnar deviation of 24 degrees (0-60 degrees), and radial deviation of 14 degrees (0-40 degrees). Grip and key pinch strength were 20.1 (1-50 kg) and 6 kg (1-12 kg), respectively. Average patient-rated wrist and hand evaluation score was 42.7 (0-95), disabilities of the arm, shoulder and hand score was 38 (0-88), and visual analog scale score was 3.6 (0-8). We found a 43% complication rate (mostly minor: ulnar or radial tendinopathy, temporary hypoesthesia) with 24% reoperation and 92% prosthesis survival rate. Conclusion The linked semiconstrained DRUJ prosthesis has its value in the surgical treatment of DRUJ failure. Currently, most implants are used in secondary surgery and multioperated wrists. More research is required to assess the value of the DRUJ prosthesis as a primary procedure. Level of evidence This is a level IV, therapeutic study.
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Affiliation(s)
- Jaak Warlop
- Faculty of Medicine, University Hospitals Leuven, Belgium
| | - Maarten Van Nuffel
- Unit of Hand, Wrist and Elbow Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Luc De Smet
- Unit of Hand, Wrist and Elbow Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Ilse Degreef
- Unit of Hand, Wrist and Elbow Surgery, University Hospitals Leuven, Leuven, Belgium
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Salvage of Painful Porous Coated Stem Ulnar Head Prosthesis With Semiconstrained Distal Radioulnar Joint Arthroplasty. J Hand Surg Am 2022; 47:689.e1-689.e8. [PMID: 34446335 DOI: 10.1016/j.jhsa.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/04/2021] [Accepted: 07/16/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the functional outcome and complications after conversion from a painful and unstable ulnar head prosthesis to a semiconstrained distal radioulnar joint arthroplasty. METHODS We conducted a retrospective review of 11 ulnar head prostheses in 10 patients with porous coated stems that were revised to semiconstrained prostheses. The median age of the patients was 47 years. The median number of wrist surgeries prior to conversion was 4 (range, 1-9). The median time from the ulnar head implant to the revision surgery was 47 months. Pre- and postoperative pain levels were recorded. Mayo Wrist Scores were calculated. Grip strength, range of motion, and complications and reoperations were recorded. RESULTS All patients reported moderate or severe pain before surgery, whereas 3 patients reported moderate pain after surgery. The Mayo Wrist Score improved considerably from a median of 50 before surgery to 65 after surgery. The grip strength and forearm pronation-supination showed no change following surgery. The median wrist flexion-extension range improved considerably. Follow-up was a median of 64 (range, 15-132) months after revision surgery. Removal of the ulnar head implant was described as difficult by the surgeons, except in 1 case where the implant was loose. Resection of bone from the distal ulna was often necessary. One patient needed a reoperation requiring prosthesis removal for aseptic loosening of the stem 5 years after revision. There were 2 nondisplaced periprosthetic fractures successfully treated with cast immobilization and 2 additional minor complications, 1 postoperative stitch abscess, and 1 extensor carpi ulnaris tendinitis. CONCLUSIONS Conversion from an ulnar head implant to a semiconstrained prosthesis provided improved pain scores and function with a low reoperation rate in this patient series. Removal of an ulnar head prosthesis can be technically challenging, but it can be performed leaving enough bone stock for immediate implantation of a semiconstrained implant. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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15
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Taljanovic MS, Omar IM, Weaver JS, Becker JL, Mercer DM, Becker GW. Posttreatment Imaging of the Wrist and Hand: Update 2022. Semin Musculoskelet Radiol 2022; 26:295-313. [PMID: 35654096 DOI: 10.1055/s-0042-1743538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Common indications for surgical procedures of the wrist and hand include acute fractures or fracture-dislocations; nonunited fractures; posttraumatic, degenerative, and inflammatory arthritides and tendinopathies; injuries to tendons, ligaments, and the triangular fibrocartilage complex; and entrapment neuropathies. Soft tissue or osseous infections or masses may also need surgical treatment. Several of these procedures require surgical hardware placement, and most entail clinical follow-up with periodic imaging. Radiography should be the first imaging modality in the evaluation of the postoperative wrist and hand. Computed tomography, magnetic resonance imaging, diagnostic ultrasonography, and occasionally nuclear medicine studies may be performed to diagnose or better characterize suspected postoperative complications. To provide adequate evaluation of postoperative imaging of the wrist and hand, the interpreting radiologist must be familiar with the basic principles of these surgical procedures and both the imaging appearance of normal postoperative findings as well as the potential complications.
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Affiliation(s)
- Mihra S Taljanovic
- Department of Medical Imaging, The University of Arizona, College of Medicine, Tucson, Arizona.,Department of Radiology, University of New Mexico, Albuquerque, New Mexico
| | - Imran M Omar
- Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Jennifer S Weaver
- Department of Radiology, University of New Mexico, Albuquerque, New Mexico
| | - Jennifer L Becker
- Department of Medical Imaging, The University of Arizona, College of Medicine, Tucson, Arizona
| | - Deana M Mercer
- Department of Orthopaedics and Rehabilitation, University of New Mexico, Albuquerque, New Mexico
| | - Giles W Becker
- Department of Orthopaedic Surgery, University of Arizona, Tucson, Arizona
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16
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Furrer PR, Nagy L, Reissner L, Schweizer A. 3D analysis of the distal ulna with regard to the design of a new ulnar head prosthesis. BMC Musculoskelet Disord 2022; 23:527. [PMID: 35655172 PMCID: PMC9161464 DOI: 10.1186/s12891-022-05480-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
STUDY DESIGN A retrospective, single center, data analysis. OBJECTIVE Persistent pain and instability are common complications after distal ulnar head arthroplasty. One main reason may be the insufficient representation of the anatomical structures with the prosthesis. Some anatomical structures are neglected such as the ulnar head offset and the ulnar torsion which consequently influences the wrist biomechanics. METHODS CT scans of the ulnae of forty healthy and asymptomatic patients were analyzed in a three-dimensional surface calculation program. In the best fit principle, cylinders were fitted into the medullary canal of the distal ulna and the ulnar head to determine their size. The distance between the central axes of the two cylinders was measured, which corresponds to the ulnar offset, and also their rotational orientation was measured, which corresponds to the ulnar torsion. RESULTS The mean medullary canal diameter was 5.8 mm (±0.8), and the ulnar head diameter was 15.8 mm (±1.5). The distance between the two cylinder axes was 3.89 mm (±0.78). The orientation of this offset was at an average of 8.63° (±15.28) of supination, reaching from 23° pronation to 32° supination. CONCLUSION With these findings, a novel ulnar head prosthesis should have different available stem and head sizes but also have an existing but variable offset between these two elements. A preoperative three-dimensional analysis is due to the high variation of offset orientation highly recommended. These findings might help to better represent the patients natural wrist anatomy in the case of an ulnar head arthroplasty. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Pascal Raffael Furrer
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Ladislav Nagy
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Lisa Reissner
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Andreas Schweizer
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
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17
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Muder D, Vedung T. Reconstruction of the distal radioulnar joint with rib perichondrium - midterm follow-up. BMC Musculoskelet Disord 2022; 23:388. [PMID: 35473677 PMCID: PMC9039597 DOI: 10.1186/s12891-022-05335-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 04/14/2022] [Indexed: 11/19/2022] Open
Abstract
Background Reconstruction of an osteoarthritic distal radioulnar joint (DRUJ) in patients with high physical demands and a long lifetime expectancy is challenging. A variety of methods like implant surgery and salvage procedures as partial or total ulnar head resection and the Sauve-Kapandji procedure are reasonable options in the elderly patient but not in young individuals since it often compromises manual power and stability and may cause impingement problems. Reconstruction of the DRUJ with rib perichondrium is a new treatment option with promising short-term outcome. The aim the present study was to investigate if the outcome is consistent over time. Methods Four female patients with a mean age of 40.5 years suffered severe unilateral osteoarthritis in the DRUJ. They underwent reconstruction of the joint with rib perichondrium transplants. Preoperatively, mean pain under manual load was 8.5 (range 7–10) and 4.2 (range 2–5) at rest, using the visual analogue scale (VAS). Range of motion (ROM) in forearm rotation was on average 118° and grip strength was 86% in comparison to the contralateral hand. The outcome was assessed at a clinical follow-up in 2016, measuring ROM, grip-strength, pain at rest and under manual load and DASH-score. Radiological examination was performed. An additional follow-up by letter was performed in 2021 using a patient-reported-outcome survey (PROS). The patients were asked to grade the ROM and grip-strength as changed or unchanged in comparison to the clinical follow-up in 2016. Results At clinical follow-up at a mean of 3.1 years (range 1–5) after surgery, pain level had decreased to VAS 1.5 (0–5) under load and all patients were pain free at rest. Forearm rotation was on average 156° (range 100–180) and grip strength was 97% of the unoperated hand. The mean DASH-score was 14.4 (0–45). An additional follow-up by letter was conducted at a mean of 7.5 years (5.5–9.5) after surgery. ROM and grip strength were reported as unchanged by all patients in relation to the previous clinical follow-up. No additional surgery or complications were reported. Conclusion Reconstruction of the osteoarthritic DRU-joint with rib perichondrium transplantation can provide good clinical outcome with perseverance over time. Level of evidence IV.
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Affiliation(s)
- Daniel Muder
- Department of Surgical Sciences/Orthopedics & Hand Surgery, Uppsala University, Entrance 70, 1st floor, 751 85, Uppsala, Sweden.,Department of Orthopedics, Falu Lasarett, Lasarettsvägen 10, 791 82, Falun, Sweden
| | - Torbjörn Vedung
- Department of Surgical Sciences/Orthopedics & Hand Surgery, Uppsala University, Entrance 70, 1st floor, 751 85, Uppsala, Sweden. .,Elisabeth Hospital, Aleris Healthcare AB, Geijersgatan 20, 752 26, Uppsala, Sweden.
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18
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Pääkkönen M. Complications of Scheker semiconstrained distal radioulnar joint arthroplasty in a low-volume unit. HAND SURGERY & REHABILITATION 2022; 41:441-444. [PMID: 35460957 DOI: 10.1016/j.hansur.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
Abstract
Semiconstrained arthroplasty of the distal radioulnar joint (DRUJ) (Scheker prosthesis, Aptis Medical, Glenview, KY, USA) is a treatment option in case of irreparable destruction of the DRUJ. In our unit, a Scheker endoprosthesis was implanted in 5 wrists in 4 patients. 3/5 wrists (60%) in 3/4 patients (75%) underwent revision surgery. Reasons for revision surgery were implant loosening, periprosthetic fracture of the radius and suspicion of periprosthetic infection. Asymptomatic loosening of the screw of the radial head cover was detected in one wrist. Scheker arthroplasty is technically demanding. The prosthesis is prone to failure over the long term. Before implantation, all patients should be informed of the high risk of revision surgery.
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Affiliation(s)
- M Pääkkönen
- Department of Hand Surgery, The Division of Diseases of the Musculoskeletal System, Turku University Hospital, University of Turku and CoE TYKS ORTO, TYKS Kirurginen Sairaala, Luolavuorentie 2, PL 28, 20701 Turku, Finland.
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19
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Lambrecht D, Vanhove W, Hollevoet N. Clinical and radiological results of distal radioulnar joint arthroplasty with the Aptis prosthesis. J Hand Surg Eur Vol 2022; 47:379-386. [PMID: 34861132 DOI: 10.1177/17531934211063608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report the results of the treatment of disorders of the distal radioulnar joint with the semi-constrained Aptis prosthesis. Nineteen patients were assessed at a mean follow-up of 7 years. All patients had been operated on previously at the wrist, forearm or elbow. The Disabilities of Arm, Shoulder and Hand score had a mean value of 40, the Patient-Rated Wrist Evaluation score had a mean of 49 and the visual analogue scale for pain had a mean of 3.9. The mean ranges of pronation, supination, wrist flexion and wrist extension were 78°, 76°, 60° and 51°, respectively. The mean grip strength was 23 kg. Complications were noted in ten patients. Eighteen patients would undergo the operation again. The 10-year cumulative survival rate was 84%. The Aptis prosthesis may be a solution to treat patients in whom previous surgery at the distal radioulnar joint has failed.Level of evidence: IV.
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Affiliation(s)
- Delphine Lambrecht
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Wim Vanhove
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Nadine Hollevoet
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
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20
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Estermann L, Reissner L, Rosskopf AB, Schweizer A, Nagy L. Clinical, radiological and patient-rated outcome comparison between total and partial ulnar head implants. J Hand Surg Eur Vol 2022; 47:257-263. [PMID: 34622695 DOI: 10.1177/17531934211048406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study aimed to analyse the clinical and radiological outcomes after ulnar head replacement and to compare partial and total ulnar head implants. Twenty-two patients with 23 implants were available with a mean follow-up time of 7 years (range 1.3 to 17) after distal radioulnar joint arthroplasty. At the final follow-up, patients had a low level of pain at rest and during effort, a median Disabilities of the Arm, Shoulder, and Hand (DASH) score of 12 and Patient-Rated Wrist Evaluation score of 12 with partial ulnar head implants, and scores of 20 and 22 in total ulnar head implants, respectively. While the range of motion in patients with partial ulnar head implants was slightly reduced in comparison with the preoperative condition and to the patients with total ulnar head implants, there was a tendency to a higher grip strength and rotational torque. Both types of prosthesis showed sigmoid notch resorptions and resorptions around the neck. We conclude that the results after partial ulnar head replacement do not significantly differ from the total ulnar head implants in many aspects.Level of evidence: III.
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Affiliation(s)
- Lea Estermann
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Lisa Reissner
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Andrea B Rosskopf
- Department of Radiology, Balgrist University Hospital, Zurich, Switzerland
| | - Andreas Schweizer
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Ladislav Nagy
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
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21
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Brannan PS, Ward WA, Gaston RG, Chadderdon RC, Woodside JC, Connell B. Two-Year Clinical and Radiographic Evaluation of Scheker Prosthesis (Aptis) Distal Radioulnar Joint Arthroplasty. J Hand Surg Am 2022; 47:290.e1-290.e11. [PMID: 34266682 DOI: 10.1016/j.jhsa.2021.04.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/15/2021] [Accepted: 04/29/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the clinical and radiographic outcomes of patients who underwent semiconstrained distal radioulnar joint arthroplasty. METHODS A retrospective analysis was performed on a series of patients who underwent distal radioulnar joint arthroplasty with more than a 23-month follow up. The quantitative outcome variables included the visual analog scale for pain; Disability of the Arm, Shoulder, and Hand (DASH) score; Patient-Rated Wrist Evaluation (PRWE); and Mayo wrist score. The range of motion, grip strength, torque, and lifting capacity were measured at final follow up and compared with that of the nonsurgical extremity. Complications related to the prosthesis were assessed. RESULTS Twenty-one patients (mean age 57 years) were assessed at an average 41-month follow up (23-73 months). Fifteen underwent prior hand, wrist, or elbow procedures. Four patients required 5 reoperations. The postoperative median visual analog scale pain score was 0.6 at rest and 2.1 with activity. The median postoperative DASH score was 26.7, PRWE 41, and Mayo wrist score was 65. Upon comparing the supination torque of the operative and intact sides, the operative side was found to average 87% of the intact side on a work simulator and 77% on the simulator's D-ring. Eight of 20 patients had lysis around the collar of the ulnar component (40%), as detected using radiography. Three of 21 (14%) radial plates were malpositioned, with 2 resulting in a fracture. The overall complication rate was 29%. CONCLUSIONS Distal radioulnar joint arthroplasty using the Scheker prosthesis demonstrated good patient pain scores and the restoration of supination strength. The collar lysis resulted in weaker supination and grip strength. Still, the patients experienced mild levels of pain and moderate disability. A moderate complication rate persisted, as reported by other authors. Accurate radial component placement is important. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Patrick Shea Brannan
- Hand Center, OrthoCarolina, Charlotte, NC; Department of Orthopaedics and Sports Medicine, University of Arkansas for Medical Sciences, Fayetteville, AR
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22
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Vilkki SK. Distal Radio-Ulnar Joint Reconstruction after failed Darrach operation using free autogenous second toe Metatarso-phalangeal joint transfer. Development of the technique and a long-term (over 25 year) follow-up. Injury 2021; 52:3691-3696. [PMID: 33775414 DOI: 10.1016/j.injury.2021.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 02/02/2023]
Abstract
During the development of microvascular surgery in 1980-95 many new methods to overcome different traumatic disorders were studied. Previously unsolved problems could be treated using free tissue transfer. Typical problems in wrist surgery were the painful complications from ulna head resection. No sound or acceptable artificial protheses for ulna head were available. Author did study the possibilities of reversal of resected ulna head using an autogenous microvascular joint transfer. First it was done using cadaver models and evaluating the possibilities of a toe MTP-II joint in replacing the distal radio-ulnar joint. Then same principle was used in three clinical cases. All patients had suffered a poor result after ulna head resection or Darrach procedure. First two cases had complications but third case from year 1994 resulted in a good outcome. This paper introduces the development of a surgical technique for the replacement of the resected ulna head. Also, it will describe the excellent long-term result achieved in the last case with 26-year follow-up. Although today many sophisticated prosthetic replacement techniques have become developed for this purpose, this kind of autogenous reconstruction might have a place in treating similar problems in young posttraumatic patients. Also it demonstrates the potential benefit of microsurgery in a difficult wrist problem.
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Affiliation(s)
- Simo K Vilkki
- Department of Hand and Micro Surgery, Tampere University Hospital, Tampere, Finland.
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23
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Farias-Eisner G, Zoller SD, Iannuzzi N. Treatment Options for Distal Radioulnar Joint Arthritis: Balancing Functional Demand and Bony Resection. Hand Clin 2021; 37:575-586. [PMID: 34602137 DOI: 10.1016/j.hcl.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The distal radioulnar joint is a complex anatomic structure that allows for a combination of rotation and translation with extrinsic and intrinsic stabilizers that maintain stability through a delicate equilibrium. Traumatic, congenital, inflammatory, and degenerative processes can disturb this sensitive balance, resulting in distal radioulnar joint arthritis. We discuss the joint's anatomy and biomechanics and the clinical approach to the patient. We review the surgical treatment options, expected outcomes, and their shortcomings. Selecting the best surgical intervention often means choosing the procedure with the set of complications and limitations best suited for the specific patient.
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Affiliation(s)
- Gina Farias-Eisner
- Hand, Elbow & Shoulder Center at University of Washington Medical Center -Roosevelt, 4245 Roosevelt Way Northeast, Second Floor Seattle, WA 98105, USA
| | - Stephen D Zoller
- Hand, Elbow & Shoulder Center at University of Washington Medical Center -Roosevelt, 4245 Roosevelt Way Northeast, Second Floor Seattle, WA 98105, USA
| | - Nicholas Iannuzzi
- Orthopaedic Surgery, Puget Sound VA, Department of Orthopaedics and Sports Medicine, Hand, Elbow & Shoulder Center at University of Washington Medical Center -Roosevelt, 4245 Roosevelt Way Northeast, Second Floor, Seattle, WA 98105, USA.
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24
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Orbay J, Vernon L, Poirier S, Morales V, Cambo R, Mercer D. Effect of Ulnar Head Offset on Distal Radioulnar Joint Stability. J Hand Surg Am 2021; 46:816.e1-816.e7. [PMID: 33722471 DOI: 10.1016/j.jhsa.2020.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 10/15/2020] [Accepted: 12/29/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE A complete ulnar head replacement may be indicated in cases of distal radial ulnar joint (DRUJ) dysfunction to address bony pathology in lieu of using a constrained total DRUJ prosthesis. Complete ulnar head implants are simple, but they may be unstable if soft tissue tension is not adequately restored. We hypothesized that incorporating an increased offset in the complete ulnar head replacement would lead to increased tension on the distal oblique interosseous ligament, increased contact force at the DRUJ, and improved joint stability. METHODS Using a specially designed jig, we measured instability by comparing displacement under load (stiffness) of the DRUJ in 10 cadaveric specimens under 4 different conditions: (1) intact, (2) native head after excision of the triangular fibrocartilage complex, (3) replacement of the ulnar head with a standard offset ulnar head, and (4) replacement of the ulnar head with an increased offset ulnar head. No soft tissue repair was done. We measured anteroposterior displacement under load with maximum translation of 10 mm or maximum loads of 50 N. We tested all specimens with the forearm positioned in neutral, supination, and pronation. RESULTS Excising the triangular fibrocartilage complex decreased the average stiffness of the DRUJ to 46% of the intact state, creating a simulated state of DRUJ instability. Replacing the ulnar head with the standard offset head increased average stiffness to 54% of the intact state. Increasing the ulnar head offset with the simulated total ulnar head replacement increased average stiffness to 77% of the intact state. CONCLUSIONS An increased offset ulnar head replacement improves DRUJ stability compared with a standard anatomic offset ulnar head replacement. CLINICAL RELEVANCE Understanding DRUJ morphology and offset is important in the treatment of DRUJ arthritis and instability.
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Affiliation(s)
- Jorge Orbay
- Miami Hand and Upper Extremity Institute, Miami, FL.
| | | | | | | | | | - Deana Mercer
- Department of Orthopedics and Rehabilitation, University of New Mexico, Albuquerque, NM
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Cerezal L, Llopis E, Canga A, Piñal FD. Postoperative Imaging of Ulnar Wrist Pain. Semin Musculoskelet Radiol 2021; 25:329-345. [PMID: 34374067 DOI: 10.1055/s-0041-1731331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Ulnar wrist pain, caused by a broad spectrum of bone and soft tissue injuries, is the most common clinical condition of the wrist. Multiple surgical techniques and their variants in the treatment of these injuries are constantly evolving. Postoperative evaluation of the wrist for many surgeons is limited to serial clinical and radiographic monitoring. However, imaging methods such as ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and arthrographic techniques (arthrographic CT and arthrographic MRI) play a fundamental role in diagnosing and managing postsurgical complications.The several critical aspects in evaluating the postsurgical wrist imaging spectrum are familiarity with the surgical techniques, knowledge of the original clinical problem, understanding the strength and limitations of the different radiologic modalities, and effective communication between surgeon and radiologist.
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Affiliation(s)
- Luis Cerezal
- Department of Radiology, Diagnóstico Médico Cantabria (DMC), Santander, Spain
| | - Eva Llopis
- Department of Radiology, Hospital de la Ribera, Valencia, Spain
| | - Ana Canga
- Department of Radiology, Marqués de Valdecilla University Hospital, Santander, Spain
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26
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Barret H, Lazerges C, Chammas PE, Degeorge B, Coulet B, Chammas M. Modification of matched distal ulnar resection for distal radio-ulnar joint arthropathy: Analysis of distal instability and radio-ulnar convergence. Orthop Traumatol Surg Res 2020; 106:1597-1603. [PMID: 33160877 DOI: 10.1016/j.otsr.2020.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 06/30/2020] [Accepted: 07/06/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND In palliative surgery on the distal radio-ulnar joint (DRUJ), ulnar head resection and the Sauvé-Kapandji procedure are often followed by instability and radio-ulnar convergence. The objective of this study was to evaluate the stability of the DRUJ after modified matched distal ulnar resection performed alone or with partial or complete wrist arthrodesis. HYPOTHESIS A modification of matched distal ulnar resection, consisting in reconstruction of the sixth compartment and dorsalisation of the extensor carpi ulnaris, minimises these complications, regardless of the cause and associated procedures. PATIENTS AND METHODS A single-centre retrospective study was conducted in 46 patients (50 wrists) who underwent modified matched distal ulnar resection. The 50 wrists fell into three groups: total wrist arthrodesis according to Millender, n=21 (TWA group); radius to proximal row arthrodesis, n=17 (RPRA group); and isolated matched distal ulnar resection, n=12 (IMDUR group). Seventy per cent of patients had rheumatoid arthritis. Each patient underwent a clinical and radiographic assessment, with an analysis of radio-ulnar convergence, DRUJ stability, and ulno-carpal impingement, as well as of ulnar translation of the carpus in the IMDUR group. RESULTS After the mean follow-up of 8.2±5.4 years, 62% of patients were pain-free, with a mean VAS pain score of 1.3±2.1, and 90% of patients said they would have the procedure again. Clinical and radiographic instability due to excessively proximal resection was noted in 2 (4%) wrists, of which 1 required repeat surgery. Ulno-carpal impingement due to excessively distal resection occurred in 2 (4%) wrists. No significant ulnar translation of the carpus was noted in the IMDUR group (DiBenedetto: 0.011±1.9). Range of motion was similar in the three groups (mean pronation=77±17°; and mean supination=79±8°) (p>0.05). Mean grip strength was 85±35% compared to the other side. DISCUSSION Our modification of matched distal ulnar resection minimises the complications specific of other ulnar head resection techniques or of the Sauvé-Kapandji procedure, namely, radio-ulnar convergence and DRUJ instability. LEVEL OF PROOF IV; retrospective comparative study.
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Affiliation(s)
- Hugo Barret
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques SOS main, Montpellier, France.
| | - Cyril Lazerges
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques SOS main, Montpellier, France
| | - Pierre-Emmanuel Chammas
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques SOS main, Montpellier, France
| | - Benjamin Degeorge
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques SOS main, Montpellier, France
| | - Bertrand Coulet
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques SOS main, Montpellier, France
| | - Michel Chammas
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques SOS main, Montpellier, France
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Breyer JM, Vergara P. Solutions for the Unstable and Arthritic Distal Radioulnar Joint. Hand Clin 2020; 36:523-530. [PMID: 33040964 DOI: 10.1016/j.hcl.2020.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
An unstable and osteoarthritic distal radioulnar joint presents with considerable functional impairment, pain, and weakness in gripping manipulation of objects. A wide variety of surgical alternatives have been described to address these concerns. Resection arthroplasties include different types of distal ulna resection and soft tissue procedures; good overall results have been described for these types of procedures, although they have shown limitations in achieving and maintaining pain relief and stability, especially in more active patients. Since the late 1980s, partial and total joint arthroplasties have emerged as good alternatives for treatment in young and more active patients.
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Affiliation(s)
- Juan Manuel Breyer
- Orthopedic Department, Hospital del Trabajador, 185 Ramon Carnicer 185, Santiago, Providencia, Chile; Orthopedic Department, Clinica Alemana-Universidad del Desarrollo, Santiago, Chile.
| | - Pamela Vergara
- Orthopedic Department, Hospital del Trabajador, 185 Ramon Carnicer 185, Santiago, Providencia, Chile; Orthopedic Department, Clinica Las Condes, Santiago, Chile
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Gvozdenovic R, Boeckstyns M, Merser S. Ulnar Head or Total Distal Radioulnar Joint Replacement, Isolated and Combined with Total Wrist Arthroplasty: Midterm Results. J Wrist Surg 2020; 9:411-416. [PMID: 33042644 PMCID: PMC7540653 DOI: 10.1055/s-0040-1712981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
Purpose Various implants have been described for ulnar head replacement (UHR) or for total replacement of the distal radioulnar joint (DRUJ). Many series are small and few reports on mid- or long-term results. This study is primarily aimed to report on the midterm results after ulnar head only and total DRUJ replacement using the uHead in the treatment of painful disorders of the DRUJ. The secondary aim of the study was to eventually assess the combination of UHR and total wrist arthroplasty (TWA). Materials and Methods We included 20 consecutive patients in whom an UHR with the uHead was performed at our institution between February 2005 and March 2017. There were 6 men and 14 women with mean age of 59 years (range: 36-80 years). The mean follow-up time was 5 years (range: 2-15 years). Data were recorded prospectively before operation and at follow-up examinations and entered in a registry. The patients were followed-up at 3 and 6 weeks and 3, 6, and 12 months postoperatively and thereafter annually. In five cases, the uHead was implanted simultaneously with a Remotion TWA. In four cases, a Remotion TWA had been implanted previously. Kaplan-Meier survival analysis was used to estimate the cumulative probability of remaining free of revision. A nonparametric Wilcoxon's signed-rank test was used for comparing data not normally distributed (qDASH [quick disabilities of the hand, shoulder, and arm] scores), and the paired parametric Student's t -test was used for normally distributed data (pain and visual analogue scale [VAS] scores, range of motion, and grip strength). Significance was set at a p -value of less than 0.05. Results Pain, grip strength, and the function improved significantly. Pain after surgery decreased with 50 points on the VAS score scale of 100, from 66 (mean), preoperatively (range: 16-97) to 16 (mean; range: 0-51), postoperatively, while grip strength nearly doubled from 12 KgF (mean; range: 4-22), before to 21 KgF (mean; range: 6-36), after the surgery. Patients function measured with qDASH scores improved from 56 (mean; range: 36-75), preoperatively to 19 (mean; range: 4-47), postoperatively. Wrist extension, flexion, and ulnar and radial deviation did not change to a clinically or statistically significant extend, neither did supination nor pronation improved after surgery. While three UHRs were revised early because of pain problems and/or unsatisfactory forearm rotation in two cases and infection in one, 17 had an uncomplicated postoperative course and these patients were satisfied with the results of the surgery at all the follow-ups. Due to limited number of cases, the calculation of significance in comparing combined cases with UHR only cases was abandoned. Conclusion Ulnar head arthroplasty (uHead) showed significant improvement in pain, grip strength, and the function of the patients with a painful disability of the DRUJ, without impairment on mobility on the midterm follow-up. The overall implant survival over the time and the complication rate was acceptable.
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Affiliation(s)
- Robert Gvozdenovic
- Department of Orthopedic Surgery, Hand Surgery Unit, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Michel Boeckstyns
- Department of Orthopedic Surgery, Section of Hand Surgery, Capio/CFR Hospital in Hellerup, Hellerup, Denmark
| | - Søren Merser
- Department of Orthopedic Surgery, Rigshospitalet, Copenhagen, Denmark
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Jones NF, Graham DJ. Radical Resection of a Recurrent Giant Cell Tumor of the Distal Ulna and Immediate Reconstruction With a Distal Radio-Ulnar Joint Implant Arthroplasty. Hand (N Y) 2020; 15:727-731. [PMID: 31965863 PMCID: PMC7543204 DOI: 10.1177/1558944719895779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Giant cell tumors (GCTs) of the distal ulna are rare. Despite being benign, they can be locally aggressive and may recur following conventional treatment by curettage and bone grafting. Salvage reconstructive options after failed conventional treatment include Darrach resection, Suave-Kapandji procedure, hemi-arthroplasty, or total joint arthroplasty. Methods: We discuss reconstruction options for the distal radio-ulnar joint following tumor resection, and present the outcomes of a constrained distal radio-ulnar prosthesis in a 29-year-old male following resection of a distal ulna GCT. Results: Reconstruction of the distal radio-ulnar joint by a constrained prothesis yielded excellent functional outcomes following resection of a GCT of the distal ulna. Conclusions: This case demonstrates that successful oncologic and functional outcomes can be achieved by radical resection of a recurrent GCT of the distal ulna and reconstruction with a constrained total joint arthroplasty.
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Affiliation(s)
- Neil F. Jones
- University of California, Los Angeles, USA,Neil F. Jones, Department of Orthopaedic Surgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095, USA.
| | - David J. Graham
- Gold Coast University Hospital, Southport, Queensland, Australia
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Yayac M, Padua FG, Banner L, Seigerman DA, Beredjiklian PK, Aita DJ, Fletcher D. Treatment Outcomes in Patients Undergoing Surgical Treatment for Arthritis of the Distal Radioulnar Joint. J Wrist Surg 2020; 9:230-234. [PMID: 32509428 PMCID: PMC7263868 DOI: 10.1055/s-0040-1702200] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 01/07/2020] [Indexed: 10/24/2022]
Abstract
Objective Surgical treatment options for distal radioulnar joint (DRUJ) arthritis include distal ulnar resection (DUR), DRUJ arthrodesis, and ulnar head replacement. Ulnar convergence leading to persistent pain and clicking is a relatively common complication of complete DUR and DRUJ arthrodesis with distal ulnar segment resection (DRUJA). This led to the development of the distal ulna hemiresection (DUHR) and distal ulnar stump stabilization techniques to reduce the risk of this complication. Patients may experience incomplete relief of pain and limited range of motion (ROM) with these procedures. We hypothesized that there would be no differences in outcomes between the treatment groups, but patients undergoing DUHR, tendon interposition, or distal ulnar stump stabilization would be at lower risk of complications. Methods Records were retrospectively reviewed for 121 patients undergoing DRUJ procedures between 2000 and 2018 at a single institution to collect patient demographics, surgical details, preoperative diagnosis, and outcomes including complications, revision procedures, ROM, pain, and swelling. Patients were grouped for analysis by procedure type: DUR (Darrach procedure), DUHR (Bowers procedure), and DRUJA (Sauve-Kapandji procedure). Continuous variables were compared using an analysis of variance test and categorical variables using the Freeman-Halton extension of the Fisher's exact test. A multivariate logistic regression analysis was performed to identify significant predictors of outcomes. Results Seventy-three patients underwent a DUR procedure, while 33 patients underwent a DUHR procedure and 11 underwent a DRUJA procedure. Mean follow-up was 70.6 months. Patients undergoing DRUJA were significantly younger than those undergoing DUR or DUHR procedure (42.4 vs. 60.0 vs. 62.1, p < 0.001). No significant differences between groups were demonstrated in measured outcomes. Posttraumatic arthritis was the most common preoperative diagnosis (43.4%). Persistent pain was the most common negative outcome (25.6%) followed by limited ROM (19.7%). Five patients (4.3%) suffered postoperative complications, most common being rupture of extensor tendons. Five patients (4.3%) underwent revision procedures. Body mass index (BMI) was a significant predictor of persistent pain (odds ratio = 1.09, p = 0.031). Conclusion The results of our study suggest that outcomes are equivalent between the three distinct treatment groups. Despite the potential benefits, hemiresection, tendon interposition, and distal stump stabilization had no significant effect on outcomes in this study. More than a quarter (25.6%) of patients undergoing DRUJ procedures experience persistent pain postoperatively, while one-fifth (19.7%) experienced limited ROM. Patients with higher BMI are at a significantly greater risk of experiencing persistent postoperative pain. Level of Evidence This is a Level III, retrospective comparative study.
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Affiliation(s)
- Michael Yayac
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Fortunato G. Padua
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lauren Banner
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Daniel A. Seigerman
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Pedro K. Beredjiklian
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Daren J. Aita
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Daniel Fletcher
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
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Fuchs N, Meier LA, Giesen T, Calcagni M, Reissner L. Long-term results after semiconstrained distal radioulnar joint arthroplasty: A focus on complications. HAND SURGERY & REHABILITATION 2020; 39:186-192. [PMID: 32126291 DOI: 10.1016/j.hansur.2020.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 12/31/2019] [Accepted: 01/24/2020] [Indexed: 11/19/2022]
Abstract
Arthroplasty of the distal radioulnar joint (DRUJ) using a semiconstrained DRUJ implant yields good outcomes according to the literature. The aim of this study was to investigate the subjective, clinical and radiographic outcomes with a special focus on complications in nine patients with a mean follow-up of 6years and to compare them with our previously published 3-year follow-up results. No subjective or objective changes were seen between the 3-year and the 6-year follow-up. In the previous study, one implant loosening and two irritations of the superficial branch of the radial nerve occurred. We saw three complications that needed surgery in addition to the three complications already found 3years after surgery. One patient with a large ulna had loosening of the cemented ulnar stem and therefore the prosthesis was explanted. One patient had an allergic reaction to the metal alloy of the prosthesis, which also led to removal. One patient had an ulnar impaction syndrome caused by too-distal placement of the implant that needed revision. Prior studies reported low complication rates. In our study, six complications occurred in four out of nine patients, requiring reoperation including two revisions and two implant removals. A precise surgical technique is mandatory to avoid the otherwise frequent complications and potential implant failures. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- N Fuchs
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
| | - L A Meier
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - T Giesen
- Centro Manoegomito, Clinica Ars Medica, Via Grumo 16, 6929 Gravesano, Switzerland.
| | - M Calcagni
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
| | - L Reissner
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
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Salvage Operation for a Failed Total Wrist Prosthesis and Darrach Procedure by Total Wrist Revision and Distal Radioulnar Joint Arthroplasty. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2020; 2:61-65. [PMID: 35415472 PMCID: PMC8991625 DOI: 10.1016/j.jhsg.2019.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 09/06/2019] [Indexed: 11/30/2022] Open
Abstract
An unstable distal ulnar stump after Darrach resection, alongside pathology of the radiocarpal joint, is difficult to manage without fusion of at least one joint. Currently, no standard 2-in-1 arthroplasty is available. We report the case of a 72-year-old woman with loosening of the radial stem of a Universal 2 total wrist prosthesis combined with radioulnar impingement after a Darrach procedure. Because of poor radial bone stock, the standard fixation technique of a semi-constrained distal radioulnar joint prosthesis (Aptis) was not possible. We present a technique to fix the semi-constrained distal radioulnar joint prosthesis as well as a total wrist prosthesis by a custom 3-dimensional printed flange prosthesis to the ulnar border of the radius. Three years after surgery, the patient remained pain-free, with 60° flexion, 75° extension, 80° pronation, and 80° supination.
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DeGeorge BR, Berger RA, Shin AY. Constrained Implant Arthroplasty for Distal Radioulnar Joint Arthrosis: Evaluation and Management of Soft Tissue Complications. J Hand Surg Am 2019; 44:614.e1-614.e9. [PMID: 30344019 DOI: 10.1016/j.jhsa.2018.09.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 07/05/2018] [Accepted: 09/04/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Distal radioulnar joint (DRUJ) prostheses designed as semiconstrained devices aiming to replace the function of the ulnar head, sigmoid notch of the radius, and triangular fibrocartilage complex have demonstrated the capacity to restore the functional status of the DRUJ. However, soft tissue complications including tendons, nerves, and wounds, although documented, have not been the primary focus of prior reports. This study investigated short- to medium-term soft tissue complications after DRUJ semiconstrained implant arthroplasty. METHODS We performed a retrospective review of patients undergoing semiconstrained DRUJ implant arthroplasty with clinical and radiological follow-up greater than 1 year. Data were reviewed with a focus on soft tissue complications after arthroplasty. RESULTS Fifty DRUJ implant arthroplasties were performed over 10 years in 49 patients. Patients' average age was 47.8 years. Average duration of follow-up was 35.8 ± 3.7 months. A total of 46 patients underwent multiple operations before DRUJ arthroplasty. Postoperative pronosupination range of motion, grip strength, and visual analog scale pain scores were significantly improved after DRUJ arthroplasty. Wound-healing problems occurred in 11 arthroplasties; however, all wounds subsequently healed without operative intervention. Wound-related complications were significantly increased in patients with a history of rheumatoid arthritis or immunosuppression. Eighteen operations were required to address complications in 8 patients. Extensor tendinopathy was the most common indication for reoperation; 5 tenosynovectomy procedures were required in 4 wrists. A prominent screw requiring removal was identified in 3 cases of tenosynovitis. Periprosthetic fractures were identified in 3 wrists; 2 of these required reoperation for open treatment. Removal of hardware was required in 2 patients; these patients required 9 subsequent reoperations. CONCLUSIONS Distal radioulnar joint arthrosis is a major problem and patients commonly undergo multiple reconstructive surgeries before DRUJ implant arthroplasty. No instances of wound-related complications or tendinopathy occurred in patients without previous surgeries, and wound-related complications occurred at a higher frequency with a history of rheumatoid arthritis or immunosuppression. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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