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Functional Outcome of the Distal Radioulnar Joint Replacement in Patients Younger than 40 Years Old
Antonio Rampazzo, MD; Bahar Bassiri Gharb, MD; Rebecca Jones; Luis Scheker, MD
Christine M. Kleinert Institute, Louisville, KY

Introduction: Distal Radio-Ulnar Joint (DRUJ) replacement has been traditionally considered the last option in the treatment of osteoarthritis in elderly patients. This study evaluates the functional results after DRUJ replacement in a young population of patients with high functional demands.

Materials and Methods: A retrospective study was performed in patients under 40 years of age who underwent DRUJ replacement. Patientsí charts were reviewed and age at surgery, profession, hobbies, comorbidities, diagnosis, previous procedures and complications were recorded. Preoperative and postoperative DASH and PRWE scores, Visual Analogue Scores for pain (VASp), grip strength, lifting capacity, wrist pronation, supination, flexion, extension, radial and ulnar deviation were recorded. The differences between the pre- and post-procedure values were studied with Studentís, Fisherís and ANOVA tests. Functional results and characteristics of the patients were correlated with the linear regression test. A Kaplan-Meyer curve was plotted.

Results: Forty-six joints were replaced in 41 patients. The average age was 32 years (range 18-39). Twelve patients presented with comorbidities. Forty-one patients underwent surgery for pain and 5 patients for pain and instability. The average follow-up was 61 months (range 24-99). The procedures performed prior to joint replacement were: distal radius treatment (22), ulna shortening (13), DRUJ ligament reconstruction (8), Darrach procedure (5), TFCC repair (4), Sauve-Kapandji procedure (2), previous DRUJ replacement (2) and other wrist procedure (13). Thirty-seven patients underwent multiple procedures before the DRUJ replacement (2.3± 1.6). Twenty procedures were performed after implantation of the prosthesis: Extensor Carpi Ulnaris release and implant coverage with dermal-fat graft (9), removal of ostheophytes from the distal ulnar stump (4), replacement of the UHMW polyethylene ball (2), adjustment of the radial plate (1), replacement of ulnar stem (2), excision of PIN neuroma (1) and partial lunate excision (1). Grip, lifting, DASH and PRWE scores, VASp and supination showed a statistically significant improvement after surgery (p< 0.05). Functional results were comparable in patients who received the implant with standard or extended stem (p>0.05). Age and number of previous procedures didnít correlate with the functional results (p>0.05). The 5-year survival of the implant was 95.7% (CI:0.899-1.0)

Conclusions: In this group of high demand patients the implant improved the functional status of the extremity. The most frequent complication was ECU tendonitis which was addressed by incorporating into the main procedure the interposition of an adipofascial flap to cover the prosthesis. The major complication (infection, implant loosening and mechanical failure) rate was low (4%)

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