Midterm Performance of Distal Radial Ulnar Joint Arthroplasty
Nicholas E Crosby, MD; Indiana Hand to Shoulder Center, Indianapolis, IN; Charles Maloy, MD; Indiana University Health, Indianapolis, IN
Distal radioulnar joint (DRUJ) degeneration causes significant pain and loss of motion. There are a variety of different treatment options with no clear consensus on the best. These include but are not limited to: Darrach resection, Sauve-Kapandji arthrodesis, hemi resection, Wafer resection, and Ulnar head replacement. Total arthroplasty of the DRUJ is an option that is gaining some popularity and has been used in our group for nearly thirteen years. The purpose of our study is to describe the clinical outcomes of our series of DRUJ arthroplasty.
Materials and Methods:
The study was a retrospective review of our series of Aptis DRUJ arthroplasties as well as a prospective data collection through clinical evaluation. We utilized the manufacturer database to obtain a list of all the Aptis implants used at our institution between 2005 and 2015, and we identified 58 total arthroplasties that had been performed. 46 had adequate records and follow up available for review. Charts were reviewed and wrist range of motion, VAS pain scores, age at the time of surgery, length of time to final follow up, and any complications were identified and recorded. We then contacted these patients and recruited them to return for clinical and radiographic evaluation. Range of motion, strength, questionnaires and x-ray information was collected on 27 patients.
Patients demonstrated statistically significant differences in extension, supination and VAS. With contralateral wrist comparisons, there were statistically significant differences in flexion, extension, ulnar deviation, and radial deviation, with less ROM seen in the post surgery wrist for all of these variables. In pronation and supination, no statistically significant difference was seen, and there was no statistically significant difference in grip strength. 27 of 46 were available for clinical follow up for questionnaires at an average of 35 months postoperative (15-83). Average postoperative DASH was 25.3 and PWRE was 24.6. On reviewing our complications we found that we had 10 total complications out of 46 patients or 22%.
In conclusion, the Aptis DRUJ arthroplasty reliably maintained or improved wrist ROM and decreased pain. We report a 22% complication rate with 15% of our patient's needing additional surgery. Ultimately, however even after complications, the patients had good pain relief and maintained function.
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