Distal Radioulnar Joint Replacement in the Scarred Wrist

Lans, Jonathan; Chen, Shih‐Heng; Jupiter, Jesse B.; Scheker, Luis R.

doi:10.1055/s-0038-1670681

Cited by 13 publications

(27 citation statements)

References 30 publications

(35 reference statements)

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“…Galvis et al (2014) reported good results with a total wrist arthrodesis and an Aptis prosthesis, especially in patients with RA. Forearm function and objective and subjective outcomes were improved after implantation of an Aptis prosthesis in patients with a wrist arthrodesis (Lans et al, 2019). Several soft tissue complications have been reported after implantation of an Aptis prosthesis.…”

Section: Discussionmentioning

confidence: 90%

Clinical and radiological results of distal radioulnar joint arthroplasty with the Aptis prosthesis

Lambrecht

Vanhove

Hollevoet

2021

J Hand Surg Eur Vol

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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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Section: Discussionmentioning

confidence: 90%

Clinical and radiological results of distal radioulnar joint arthroplasty with the Aptis prosthesis

Lambrecht

Vanhove

Hollevoet

2021

J Hand Surg Eur Vol

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“…Lans et al found a reoperation rate of 50% in DRUJ replace-ment after multiple wrist surgeries and suggested a more distal placement of the radial component after sufficient soft tissue mobilisation. 28 Martínez Villén et al reported persisting pain in two out of five multioperated patients. 29 A higher need for additional surgery in multioperated wrists is not evident in our study.…”

Section: Discussionmentioning

confidence: 97%

Midterm Functional Outcome of the Linked Semiconstrained Distal Radioulnar Joint Prosthesis

et al. 2021

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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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“…This must be seen in relation to the complexity of the cases with many previous surgeries and both wrist fusions and DRUJ arthroplasty. The patients in our cohort had a median of four previous procedures, as opposed to two in the study by Lans et al 14 Also, the Mayo Wrist Score is strongly influenced by wrist motion, lowering the scores in all patients in the study. Other patient-reported outcome measures scores might be more suitable for a procedure that is combined with a wrist fusion.…”

Section: Discussionmentioning

confidence: 65%

“…39 A recent paper by Lans et al reported on 14 patients with total wrist fusions and the semi-constrained Aptis implant with a median follow-up of 5.6 years. 14 The authors found an improvement in pain, pronation, supination, DASH scores, and weight-lifting capacity. Complications included two cases of superficial infection and one deep infection that required implant removal/exchange.…”

Section: Discussionmentioning

confidence: 91%

“…In Willis et al initial report on nonconstrained ulnar head arthroplasty, they suggested that total and partial wrist fusions in the setting of DRUJ arthroplasty could result in increasing loads through the arthroplasty resulting in early failure or dislocation; however, no study has specifically examined clinical outcomes in this subset of patients. 14 The aim of this study was to evaluate the functional outcome of primary ulnar head or total DRUJ implants in patients who also had a partial or total wrist fusion and to assess the incidence of reoperation and explantation in this group of patients.…”

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confidence: 99%

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Outcomes following Distal Radioulnar Joint Arthroplasty in the Setting of Total or Partial Wrist Fusion

et al. 2022

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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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Distal Radioulnar Joint Replacement in the Scarred Wrist

Cited by 13 publications

References 30 publications

Clinical and radiological results of distal radioulnar joint arthroplasty with the Aptis prosthesis

Clinical and radiological results of distal radioulnar joint arthroplasty with the Aptis prosthesis

Midterm Functional Outcome of the Linked Semiconstrained Distal Radioulnar Joint Prosthesis

Outcomes following Distal Radioulnar Joint Arthroplasty in the Setting of Total or Partial Wrist Fusion

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