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J Wrist Surg 2019; 08(01): 055-060
DOI: 10.1055/s-0038-1670681
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Distal Radioulnar Joint Replacement in the Scarred Wrist

Jonathan Lans
1   Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Boston, Massachusetts
,
Shih-Heng Chen
2   Christine M. Kleinert Institute for Hand and Microsurgery, University of Louisville School of Medicine, Louisville, Kentucky
,
Jesse B. Jupiter
1   Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Boston, Massachusetts
,
Luis R. Scheker
1   Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Boston, Massachusetts
› Author Affiliations
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Publication History

06 February 2018

09 August 2018

Publication Date:
19 September 2018 (online)

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Abstract

Background Radiocarpal or midcarpal arthritis can occur simultaneously with arthritis of the distal radioulnar joint (DRUJ), leading to functional impairment of the wrist. Treatment often involves wrist arthroplasty or arthrodesis, either with simultaneous or secondary procedures, addressing the DRUJ. Successful treatment of solitary DRUJ arthritis with DRUJ replacement has been reported. However, outcomes in patients with multiple prior wrist surgeries are lacking. Surgery in these wrists is challenging because surgical scarring and advanced bone deformities make implant positioning more difficult. Therefore, the aim of this study was to evaluate the outcomes in patients that underwent total wrist arthrodesis and DRUJ replacement after multiple prior wrist surgeries.

Methods We prospectively enrolled patients that underwent total wrist arthrodesis and replacement of the DRUJ, either simultaneously or during separate procedures from 1999 to 2012. We included 14 patients with a median age of 43 years (interquartile range [IQR]: 35–47). As objective outcomes range of motion, weight-bearing ability, grip strength, was measured. For the subjective outcomes, we used an analogue pain score and the disabilities of the arm shoulder and hand (DASH) scores.

Results At a median follow-up of 5.6 years (IQR: 3.2–7.1). The average DRUJ range of motion and weight lifting ability significantly improved. As for the subjective evaluations, postoperative pain scores improved significantly, as did the DASH scores. Four of the patients had a postoperative complication, including infection and heterotopic ossification, of which two required reoperations. Additionally, 5 patients developed pisotriquetral arthritis requiring, pisiform excision, triquetrum excision, or the combination of both.

Conclusion Distal radioulnar joint replacement with a semiconstrained prosthesis was an effective method to restore the function of the wrist and forearm. As the surgical anatomy and soft tissue envelope were compromised in these patients, additional surgical exposure is necessary, adding to the complexity in these patients. No radiographic loosening

Level of Evidence This is a therapeutic level IV study.

Keywords

distal radioulnar joint arthritis - distal radioulnar joint replacement - midcarpal arthritis - radiocarpal arthritis - wrist arthrodesis

Authors' Contributions

Study design: S.H.C., J.B.J., L.R.S. Data assembly: S.H.C., J.L. Data analysis: S.H.C., J.L. Initial draft: S.H.C., J.L., J.B.J., L.R.S. Final approval of manuscript: S.H.C., J.L., J.B.J., L.R.S.


Note

This work was performed at the Christine M. Kleinert Institute for Hand and Microsurgery, University of Louisville School of Medicine, Louisville, Kentucky in collaboration with Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.