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Outcomes Following Total Joint Arthroplasty of the Distal Radioulnar Joint in Rheumatoid Arthritis Patients
Elkin Galvis, MD1; Joel Pessa2; Luis Scheker1; (1)Christine M. Kleinert Institute for Hand and Microsurgery, (2)UT Southwestern Medical Center
Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA
Hypothesis Patients with rheumatoid arthritis display a spectrum of wrist disease that may be ultimately disabling. These individuals experience severe pain, instability, and limited function of the distal radioulnar joint (DRUJ). The technique of total joint replacement specifically addresses these problems. The present study evaluates the clinical and radiological results of total distal radioulnar joint replacement, as well as patient satisfaction. Methods Seventeen patients underwent total joint replacement with a DRUJ implant between the years 2005 and 2011. Mean age at time of the surgery was 57 years. Mean follow-up was 39 months (range 12-79 months). Pain level using VAS, pronation, and supination were recorded before and after surgery. Patient satisfaction survey was utilized, as well as the postoperative DASH and PRWE scores. Any complications were noted. Carpal ulnar translocation was assessed radiologically using three different indexes. The presence or absence of implant loosening or bone resorption was also recorded. The mean follow-up using radiography was 22 months. Additional findings in the radio carpal joint were documented. Results Twenty-two joint replacements were performed in 17 patients using a standard technique (1). The initial VAS score was 7.3. Pain decreased after surgery to 2.4 (p = 0.02). The initial mean pronation was 56 degrees and supination 57 degrees. Postoperative mean pronation was 78 degrees and supination 71 degrees: improvement of pronation and supination were 39% (p=0.297) and 27% (p=0.043) respectively. Final DASH score was 24 and PRWE 25. Fifteen patients reported significant pain relief. All patients were satisfied. Bone resorption was noted in the distal ulna in 6 patients: however, no osteolysis in the proximal portion around the ulnar stem was observed (figure 1). The measurements of ulnar translocation showed no difference between the initial and final radiography. As an additional finding at the clinical endpoint, 6 patients underwent radio carpal fusion. No infection was observed. Two patients required additional surgery after DRUJ replacement. Summary Points • DRUJ replacement is a technique with a high degree of patient satisfaction and a low complication profile. • Wrist function as measured by pronation and supination is increased. • Objective data show that pain is decreased. • The results of this study suggest that total replacement of the DRUJ is of benefit to the patient with rheumatoid disease. • DRUJ replacement could improve the overall performance of the patient daily activities, making it a useful option available for treatment of the rheumatoid wrist.
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