Midterm Functional Outcome of the Linked Semiconstrained Distal Radioulnar Joint Prosthesis

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.

Long-term results of the AptisTM total distal radioulnar joint prosthesis after previous failed surgical procedures

“…Between 1997 and 2018, the DRUJ Aptis TM was implanted in more than 3600 patients worldwide (Lans et al., 2019), with patient satisfaction of 98% (Calcagni and Giesen, 2017; Moulton and Giddins, 2017). Although many of these results have been reported with the implant designer as author or co-author (Galvis et al., 2014; Lans et al., 2019; Laurentin-Pérez et al., 2008; Rampazzo et al., 2015; Savvidou et al., 2013; Scheker, 2008; Scheker and Martineau, 2013), other studies published by independent authors agree with the increasing use and the effectiveness of the device (Bellevue et al., 2018; Brannan et al., 2022; DeGeorge et al., 2019; Degreef and De Smet, 2013; Kachooei et al., 2014; Lambrecht et al., 2022; Lees, 2023; Martínez Villén et al., 2014; Reissner et al., 2016; Warlop et al., 2022). However, a systematic review by Moulton and Giddins (2017) of the total DRUJ prosthesis, found only 12 full-text studies with adequate methodological quality.…”

“…Warlop et al. (2022) reported discrete radiographic periprosthetic osteolysis in three prostheses out of a total of 42 (7%) with a mean implant follow-up of 3.8 years; Brannan et al.…”

“…(2015), Brannan et al. (2022) and Warlop et al. (2022) provide more detailed information about radiological changes observed in the implants over time.…”

“…The number of operations in patients before undergoing DRUJ prosthetic arthroplasty is usually very high (Bellevue et al., 2018; Brannan et al., 2022; Lambrecht et al., 2022; Moulton and Giddins, 2017; Rampazzo et al., 2015; Warlop et al., 2022). Patients with multiple previous operations have more complications and removals of prostheses, and less pain reduction than those who have not been operated on previously (Bellevue et al., 2018; Lambrecht et al., 2022; Rampazzo et al., 2015; Warlop et al., 2022). In our series, pain rather than reduced range of motion was the main indication for prosthetic surgery, notably pain caused by radioulnar impingement after a Kapandji–Sauvé procedure.…”

“…The percentage of complications for the Aptis TM prosthesis reported in different studies ranges from 12% to 43% (Warlop et al., 2022). In our series, 3/10 of the prostheses required revision surgery directly related to the implant.…”