Complications of Scheker semiconstrained distal radioulnar joint arthroplasty in a low-volume unit

Pääkkönen, Markus

doi:10.1016/j.hansur.2022.03.001

Cited by 7 publications

(6 citation statements)

References 9 publications

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“…Our results regarding wrist and forearm motion, VAS pain score, grip strength, and survival ratio are comparable with those of Scheker et al, 12 Bizimungu and Dodds, 17 Bellevue et al, 28 Lambrecht et al, 2 Warlop et al, 13 and Brannan et al 23 Compared with other studies, our complication rate and surgical revision rate are relatively high and quite disappointing compared with previously conducted studies. 13,[22][23][24][25]27,28 Only Lans et al 26 reported a higher surgical revision rate of 50% due to pisotriquetral arthritis, most likely as a result of altered pisotriquetral joint dynamics. Lans et al 26 also reported that accurate placement of the radial component in the severely destroyed wrist is a tedious procedure and suggested placing the radial component as distal as possible for proper fitting along the ulnar side of the radius.…”

Section: Discussionmentioning

confidence: 99%

Aptis Distal Radioulnar Joint Arthroplasty: A Multicenter Evaluation of Functional Outcomes, Complications, and Patient Satisfaction

Stougie,

Boekel,

Beumer

et al. 2023

J Wrist Surg

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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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Section: Discussionmentioning

confidence: 99%

Aptis Distal Radioulnar Joint Arthroplasty: A Multicenter Evaluation of Functional Outcomes, Complications, and Patient Satisfaction

Stougie,

Boekel,

Beumer

et al. 2023

J Wrist Surg

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“…Lately, Pääkköken and Bellevue et al described a high rate of revisions and complications with the Aptis prosthesis (60%) [ 11 , 18 ]. This is very surprising, as in our own hands, we had just one revision in all of the 20 prostheses implanted and none in the present study examining the latest 13 patients.…”

Section: Discussionmentioning

confidence: 99%

The semiconstrained DRUJ prosthesis: blessing or curse?

Sommer¹,

Sturm²,

Sterz³

et al. 2023

Eur J Trauma Emerg Surg

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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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“…Pääkkönen and Brannan [ 12 , 21 ] suggested that accurate surgical planning is required to guarantee correct placement of the implant. Data on wrist function, such as grip strength and wrist motion, may correlate with the position of the forearm rotation axis.…”

Section: Introductionmentioning

confidence: 99%

Performance of the Aptis Distal Radioulnar Joint Implant: A Clinical Case Series Including Four-Dimensional Computed Tomography Kinematic Analysis

Stougie,

van Doesburg,

Oonk

et al. 2023

JCM

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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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Complications of Scheker semiconstrained distal radioulnar joint arthroplasty in a low-volume unit

Cited by 7 publications

References 9 publications

Aptis Distal Radioulnar Joint Arthroplasty: A Multicenter Evaluation of Functional Outcomes, Complications, and Patient Satisfaction

Aptis Distal Radioulnar Joint Arthroplasty: A Multicenter Evaluation of Functional Outcomes, Complications, and Patient Satisfaction

The semiconstrained DRUJ prosthesis: blessing or curse?

Performance of the Aptis Distal Radioulnar Joint Implant: A Clinical Case Series Including Four-Dimensional Computed Tomography Kinematic Analysis

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