Case Study of Arthroscopic Resection Arthroplasty of the Distal Radioulnar Joint for Osteoarthritis
Jessica K Cobb, B.S., University of South Florida Morsani College of Medicine, Tampa, FL and Tyson K Cobb, M.D., Shoulder, Elbow, Wrist, and Hand Center of Excellence, Bettendorf, IA
Introduction: Common surgical treatment options for distal radioulnar joint osteoarthritis includes, implant arthroplasty, partial or complete resection and Sauvé-Kapandji. We have been performing arthroscopic resection arthroplasty (ARA) of the Distal Radioulnar Joint (DRUJ) for osteoarthritis (OA) with reasonably good results. The purpose of this study was to report early-term outcomes.
Materials & Methods: Data were prospectively collected on all patients undergoing ARA of the of DRUJ for osteoarthritis with a minimum of a one-year follow up. General anesthesia was used on all patients. Standard radiocarpal and DRUJ arthroscopy was performed using standard portals. A radiofrequency ablator (Serfas RF; Stryker, Kalamazoo, MI) was used for denervation. Approximately 2 mm of bone was resected from both sides of the joint using a 4 mm barrel burr (Stryker, Kalamazoo, Mi). Data were prospectively collected before surgery, at postoperative intervals of 1, 3, 6, and 12 months, and annually thereafter. Numeric Rating Scale (NRS) for pain 0-10 (0=no pain, 10=worst possible pain) and satisfaction with outcomes 0-5 (0=extremely dissatisfied, 5=extremely satisfied) were obtained. Functional outcomes of grip (2ND position on 5-stage dynamometer), and disabilities of the arm, shoulder, and hand (DASH) score 0-100 (0=no disability, 100=most severe disability) were evaluated. Total arc of motion was calculated by adding flexion, extension, radial deviation, and ulnar deviation. Pronation and supination was recorded preoperatively and postoperatively.
Results: Four cases in three patients were evaluated. Mean follow up was 34 months (range 12-75). Mean age was 66 years (range 61- 69). Mean pain score was 7.5 (range 5-10) preoperatively and 0 postoperatively. Mean grip strength was 27 lb (range 10-40) before surgery and 64 lb (range 45-87) at final follow up. Mean total arc of motion was 119 (range 81-155) preoperatively and 170 (range 155-190) postoperatively. Mean pronation and supination preoperatively were 64.3 (range 13-90) and 39 (range 12-70) respectively, and 84 (range 72-90) and 70.6 (range 70-72) postoperatively. Mean DASH was 55 before surgery and 1 (range 0-3) at final follow up. Mean final satisfaction was 4.5 (range 3-5). There were 0 failures.
Conclusions: Early-term outcomes demonstrate that ARA of DRUJ may be a viable surgical option for OA. Longer follow-up and prospective studies comparing ARA of DRUJ to traditional surgical options would be useful to further evaluate this procedure.
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