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
“…Brannan et al reached slightly better results with a score of 26.7 after the same procedure [ 16 ]. Mehling et al accomplished worse results with an ulna head prosthesis by Herbert with patients displaying a median score of 43 [ 17 ].…”
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.
“…Brannan et al reached slightly better results with a score of 26.7 after the same procedure [ 16 ]. Mehling et al accomplished worse results with an ulna head prosthesis by Herbert with patients displaying a median score of 43 [ 17 ].…”
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.
“…Bei guten Voraussetzungen des Knochenstocks und der ligamentären Voraussetzungen zeigt die Ulnakopfprothese vielversprechende Ergebnisse. Die 10-Jahres-Standzeiten werden mit knapp 90 % angegeben trotz der häufig sekundären Implantation [ 51 , 52 ]. …”
Section: Therapie Der Handgelenkarthroseunclassified
ZusammenfassungDer Begriff Handgelenkarthrose kann als Überbegriff für verschiedene, oft unabhängige Arthrosebereiche verwendet werden, da das Handgelenk aus mehreren Teilbereichen zusammengesetzt ist. Die radiokarpale Arthrose entsteht oft nach nicht therapierten Bandverletzungen, bei fehlheilenden Knochenfrakturen im Carpus oder nach Radiusfrakturen mit Gelenkbeteiligung. Eine typische Sequenz der Ausbreitung ist bekannt für die radiokarpale Arthrose nach SL(skapholunär)-Insuffizienz oder Skaphoidpseudarthrose. Zu den weiteren Ursachen zählen Entzündungen, Kristallablagerungen oder Knochennekrosen. Die ulnokarpale Arthrose tritt bei Niveauunterschieden zwischen Ulna und Radius posttraumatisch oder auch primär auf. Bei der Therapie der Handgelenkarthrose sollte nach Ausschöpfung von konservativen Maßnahmen ein operatives Verfahren gewählt werden, das unter Berücksichtigung der operativen Risiken und des individuellen Anspruchs eine möglichst gute Belastung und Restbeweglichkeit ermöglicht. Bei Rettungsoperationen werden die defekten Knorpelbereiche entweder direkt fusioniert oder durch geeignete umleitende Teilfusionen und Resektionsarthroplastiken ausgeschaltet. Die genaue Analyse der betroffenen Zonen ist entscheidend für die Auswahl eines geeigneten Eingriffs.
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