Objective Outcomes Following Semi-Constrained Total Distal Radioulnar Joint Arthroplasty

Abstract

A dysfunctional distal radioulnar joint (DRUJ) can significantly compromise an individual's forearm rotation, grip, and weight bearing at the hand and wrist. This retrospective study reports surgeon- and therapist-collected objective wrist function and subjective pain scores of 10 patients who received the Scheker total DRUJ prosthesis. A review of these patients' medical records was performed to collect preoperative measurements of wrist range of motion (ROM), grip strength, and pain scores (0–10 scale). The degree of pronation, supination, flexion, extension, radial deviation, and ulnar deviation were the outcome measures used to evaluate wrist ROM. Postoperative measurements were collected at a follow up of 5 ± 1.1 years in our clinic (minimum follow-up of 2yrs). Mean final wrist flexion and extension were 32.1 ± 22.8° and 44.8 ± 13.9°, respectively. Mean final supination and pronation were 72.5 ± 14.4° and 69.5 ± 14.6°, respectively. Average grip strength was 54.9 ± 23.7 lbs. The mean pain score was 3.6 ± 3.1. Although there were no statistically significant changes in any of these outcome measures, the Scheker prosthesis improved wrist ROM (with the exception of wrist flexion) and decreased pain. Grip strength decreased by less than 1 lb but was still higher than the postoperative grip strength measurements in the literature for this prosthesis. Because of the self-stabilizing nature of this prosthesis and the satisfactory functional outcomes from this study and other studies, the Scheker prosthesis is still a viable option for DRUJ pathology that is refractory to nonimplant arthroplasties. This is a therapeutic level IV study.

Keywords

distal radioulnar joint - arthroplasty - wrist - Scheker prosthesis

• References

• 1 Linscheid RL. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res 1992; (275) 46-55
• 2 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 (6) 879-888
• 3 Field J, Majkowski RJ, Leslie IJ. Poor results of Darrach's procedure after wrist injuries. J Bone Joint Surg Br 1993; 75 (1) 53-57
• 4 Fornalski S, Lee TQ, Gupta R. Chronic instability of the distal radioulnar joint: A review. The University of Pennsylvania Orthopaedic Journal. 2000; 13: 1-9
• 5 Garcia-Elias M. Failed ulnar head resection: prevention and treatment. J Hand Surg Br 2002; 27 (5) 470-480
• 6 Gordon KD, Dunning CE, Johnson JA, King GJ. Kinematics of ulnar head arthroplasty. J Hand Surg Br 2003; 28 (6) 551-558
• 7 Herbert TJ, van Schoonhoven J. Ulnar head replacement. Tech Hand Up Extrem Surg 2007; 11 (1) 98-108
• 8 Sauerbier M, Hahn ME, Fujita M, Neale PG, Berglund LJ, Berger RA. Analysis of dynamic distal radioulnar convergence after ulnar head resection and endoprosthesis implantation. J Hand Surg Am 2002; 27 (3) 425-434
• 9 Willis AA, Berger RA, Cooney III WP. Arthroplasty of the distal radioulnar joint using a new ulnar head endoprosthesis: preliminary report. J Hand Surg Am 2007; 32 (2) 177-189
• 10 Scheker LR, Babb BA, Killion PE. Distal ulnar prosthetic replacement. Orthop Clin North Am 2001; 32 (2) 365-376 , x
• 11 Scheker LR. Implant arthroplasty for the distal radioulnar joint. J Hand Surg Am 2008; 33 (9) 1639-1644
• 12 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 (1) 18-28
• 13 Cocchiarella L, Andersson GB. Guides to the evaluation of permanent impairment, 6th ed. Chicago: American Medical Association; 2008
• 14 Savvidou C, Murphy E, Mailhot E, Jacob S, Scheker LR. Semiconstrained distal radioulnar joint prosthesis. J Wrist Surg 2013; 2: 41-48
• 15 Zimmerman RM, Jupiter JB. Outcomes of a self-constrained distal radioulnar joint arthroplasty: a case series of six patients. Hand (NY) 2011; 6 (4) 460-465
• 16 Axelsson P, Sollerman C. Constrained implant arthroplasty as a secondary procedure at the distal radioulnar joint: early outcomes. J Hand Surg Am 2013; 38 (6) 1111-1118
• 17 Ewald TJ, Skeete K, Moran SL. Preliminary experience with a new total distal radioulnar joint replacement. J Wrist Surg 2012; 1 (1) 23-30