Distal Radioulnar Joint Replacement in the Scarred Wrist

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.

• References

• 1 Laurentin-Pérez LA, Goodwin AN, Babb BA, Scheker LR. A study of functional outcomes following implantation of a total distal radioulnar joint prosthesis. J Hand Surg Eur Vol 2008; 33 (01) 18-28
• 2 Scheker LR, Babb BA, Killion PE. Distal ulnar prosthetic replacement. Orthop Clin North Am 2001; 32 (02) 365-376
• 3 Coffey MJ, Scheker LR, Thirkannad SM. Total distal radioulnar joint arthroplasty in adults with symptomatic Madelung's deformity. Hand (NY) 2009; 4 (04) 427-431
• 4 Zimmerman RM, Jupiter JB. Outcomes of a self-constrained distal radioulnar joint arthroplasty: a case series of six patients. Hand (NY) 2011; 6 (04) 460-465
• 5 Espinosa-Gutiérrez A, Romo-Rodríguez R. [Semiconstrained bipolar implant arthroplasty of the distal radioulnar joint. Case report]. Cir Cir 2013; 81 (01) 55-59
• 6 Degreef I, De Smet L. The Scheker distal radioulnar joint arthroplasty to unravel a virtually unsolvable problem. Acta Orthop Belg 2013; 79 (02) 141-145
• 7 Axelsson P, Sollerman C. Constrained implant arthroplasty as a secondary procedure at the distal radioulnar joint: early outcomes. J Hand Surg Am 2013; 38 (06) 1111-1118
• 8 Savvidou C, Murphy E, Mailhot E, Jacob S, Scheker LR. Semiconstrained distal radioulnar joint prosthesis. J Wrist Surg 2013; 2 (01) 41-48
• 9 Bizimungu RS, Dodds SD. Objective outcomes following semi-constrained total distal radioulnar joint arthroplasty. J Wrist Surg 2013; 2 (04) 319-323
• 10 Kakar S, Fox T, Wagner E, Berger R. Linked distal radioulnar joint arthroplasty: an analysis of the APTIS prosthesis. J Hand Surg Eur Vol 2014; 39 (07) 739-744
• 11 Galvis EJ, Pessa J, Scheker LR. Total joint arthroplasty of the distal radioulnar joint for rheumatoid arthritis. J Hand Surg Am 2014; 39 (09) 1699-1704
• 12 Kachooei AR, Chase SM, Jupiter JB. Outcome Assessment after Aptis Distal Radioulnar Joint (DRUJ) Implant Arthroplasty. Arch Bone Jt Surg 2014; 2 (03) 180-184
• 13 Martínez Villén G, García Martínez B, Aso Vizán A. Total distal radioulnar joint prosthesis as salvage surgery in multioperated patients. Chir Main 2014; 33 (06) 390-395
• 14 Sander AL, Ebert F, Marzi I, Frank J. Ergebnisse nach Implantation der Aptis-Prothese zum Ersatz des distalen Radioulnargelenks. Handchir Mikrochir plast Chir 2015; 47 (05) 306-311
• 15 Rampazzo A, Gharb BB, Brock G, Scheker LR. Functional outcomes of the aptis-scheker distal radioulnar joint replacement in patients under 40 years old. J Hand Surg Am 2015; 40 (07) 1397-1403
• 16 Giwa L, Spacey K, Packer G. Management of a complex, multioperated intra-articular distal radius fracture. J Wrist Surg 2015; 4 (03) 179-182
• 17 Imbriglia JE, Matthews D. Treatment of chronic post-traumatic dorsal subluxation of the distal ulna by hemiresection-interposition arthroplasty. J Hand Surg Am 1993; 18 (05) 899-907
• 18 Scheker LR. Implant arthroplasty for the distal radioulnar joint. J Hand Surg Am 2008; 33 (09) 1639-1644
• 19 Gummesson C, Atroshi I, Ekdahl C. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord 2003; 4 (01) 11
• 20 Wysocki RW, Cohen MS. Complications of limited and total wrist arthrodesis. Hand Clin 2010; 26 (02) 221-228
• 21 Zachary SV, Stern PJ. Complications following AO/ASIF wrist arthrodesis. J Hand Surg Am 1995; 20 (02) 339-344
• 22 Kleinman WB. Long-term study of chronic scapho-lunate instability treated by scapho-trapezio-trapezoid arthrodesis. J Hand Surg Am 1989; 14 (03) 429-445
• 23 Minami A, Kato H, Suenaga N, Iwasaki N. Scaphotrapeziotrapezoid fusion: long-term follow-up study. J Orthop Sci 2003; 8 (03) 319-322
• 24 Watson HK, Wollstein R, Joseph E, Manzo R, Weinzweig J, Ashmead IV D. Scaphotrapeziotrapezoid arthrodesis: a follow-up study. J Hand Surg Am 2003; 28 (03) 397-404
• 25 Bell MJ, Hill RJ, McMurtry RY. Ulnar impingement syndrome. J Bone Joint Surg Br 1985; 67 (01) 126-129
• 26 Lees VC, Scheker LR. The radiological demonstration of dynamic ulnar impingement. J Hand Surg: Br Eur Volume 1997; 22 (04) 448-450
• 27 Markolf KL, Lamey D, Yang S, Meals R, Hotchkiss R. Radioulnar load-sharing in the forearm. A study in cadavera. J Bone Joint Surg Am 1998; 80 (06) 879-888
• 28 Shaaban H, Giakas G, Bolton M. , et al. The load-bearing characteristics of the forearm: pattern of axial and bending force transmitted through ulna and radius. J Hand Surg [Br] 2006; 31 (03) 274-279
• 29 Papatheodorou LK, Rubright JH, Kokkalis ZT, Sotereanos DG. Resection interposition arthroplasty for failed distal ulna resections. J Wrist Surg 2013; 2 (01) 13-18
• 30 Watson HK, Brown RE. Ulnar impingement syndrome after Darrach procedure: treatment by advancement lengthening osteotomy of the ulna. J Hand Surg Am 1989; 14 (2 Pt 1): 302-306
• 31 Beckers A, Koebke J. Mechanical strain at the pisotriquetral joint. Clin Anat 1998; 11 (05) 320-326
• 32 Pevny T, Rayan GM, Egle D. Ligamentous and tendinous support of the pisiform, anatomic and biomechanical study. J Hand Surg Am 1995; 20 (02) 299-304