Long-term results after semiconstrained distal radioulnar joint arthroplasty: A focus on complications

Fuchs, Nina V.; Meier, Larissa; Giesen, Thomas; Calcagni, Maurizio; Reissner, Lisa

doi:10.1016/j.hansur.2020.01.010

Cited by 15 publications

(13 citation statements)

References 20 publications

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“…Multiple previous reports confirmed significant clinical improvement after DRUJ replacement. 18,[24][25][26] We compared the difference between both wrists and found ratios (prosthetic vs. nonprosthetic) of 60 to 93% for ROM and strength. Also, we found a significant correlation between subjective and objective outcome, with grip and pinch force appearing more important than ROM.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

Midterm Functional Outcome of the Linked Semiconstrained Distal Radioulnar Joint Prosthesis

et al. 2021

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“…Reconstructions with this type of prosthesis have been reported to show improvement of range of motion, grip strength and pain (Bizimungu and Dodds, 2013;Kachooei et al, 2014). However reports have also mentioned postoperative complications, such as extensor tendonitis, ectopic bone formation, infection and loosening (DeGeorge et al, 2019;Fuchs et al, 2020;Moulton and Giddins, 2017).…”

Section: Introductionmentioning

confidence: 99%

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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“…The leading reasons for suboptimal outcomes are persistent pain, prosthesis instability and a restricted range of motion [ 7 , 9 , 10 ]. Complication rates needing revision surgery are reported in up to 29% of cases [ 7 , 11 , 12 ]. In most of the literature on this topic, the inventors of the prostheses are involved, which might introduce a certain bias of positive outcome of their data [ 10 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…Complication rates needing revision surgery are reported in up to 29% of cases [ 7 , 11 , 12 ]. In most of the literature on this topic, the inventors of the prostheses are involved, which might introduce a certain bias of positive outcome of their data [ 10 , 12 ]. The authors of this paper, experienced hand surgeons, cannot confirm the good results presented by the inventors of the prostheses, and in the cases of limited range of motion and instability, suspect that an insufficient representation of the osseous anatomy is one improvable component.…”

Section: Introductionmentioning

confidence: 99%

3D analysis of the distal ulna with regard to the design of a new ulnar head prosthesis

Furrer

Nagy

Reissner

et al. 2022

BMC Musculoskelet Disord

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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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Long-term results after semiconstrained distal radioulnar joint arthroplasty: A focus on complications

Cited by 15 publications

References 20 publications

Midterm Functional Outcome of the Linked Semiconstrained Distal Radioulnar Joint Prosthesis

Midterm Functional Outcome of the Linked Semiconstrained Distal Radioulnar Joint Prosthesis

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

3D analysis of the distal ulna with regard to the design of a new ulnar head prosthesis

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