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J Hand Surg Am. 2015 Jul;40(7):1397-1403.e3. doi: 10.1016/j.jhsa.2015.04.028.

Functional Outcomes of the Aptis-Scheker Distal Radioulnar Joint Replacement in Patients Under 40 Years Old.

Author information

1
Plastic Surgery Department, Cleveland Clinic, Cleveland, OH.
2
Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY.
3
Kleinert Institute, Louisville, KY. Electronic address: lscheker@kleinertkutz.com.

Abstract

PURPOSE:

To study the functional results after Aptis-Scheker distal radioulnar joint (DRUJ) replacement in young patients.

METHODS:

We performed a retrospective study selecting all patients under age 40 years, with a clinical and radiological follow-up longer than 2 years, who underwent DRUJ replacement. Patients' charts were reviewed and age at surgery, profession, hobbies, comorbidities, diagnosis, previous procedures, and complications were recorded. Preoperative and postoperative Disabilities of Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation scores, visual analog scale score, grip strength, lifting capacity, and wrist range of motion were recorded. Functional results and characteristics of the patients were correlated with linear regression. A Kaplan-Meier curve was plotted.

RESULTS:

We performed 46 arthroplasties. Average patient age was 32 years. Forty-one arthroplasties were performed for pain and 5 for pain and instability. Average follow-up was 61 months. Thirty-seven patients underwent multiple procedures before DRUJ replacement (1.7 ± 1.2 procedures). Extensor carpi ulnaris release with implant coverage using a local adipofascial flap (5) or dermal-fat graft (4) was the most common procedure performed after implantation of the prosthesis. Thirty surgeries were undertaken to address complications after DRUJ replacement in 15 wrists. A total of 36 procedures not related to DRUJ replacement were performed in 15 wrists after the arthroplasty. Grip, lifting, Disabilities of Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation scores, visual analog scale score, and supination showed statistically significant improvement after surgery. Functional results were comparable in patients who received the implant with either a standard or extended stem. Patient age and number of the previous procedures did not correlate with functional results. The 5-year survival of the implant was 96%.

CONCLUSIONS:

In this group of young patients, the implant improved the functional status of the extremity. The most frequent complication was extensor carpi ulnaris tendonitis, which was addressed by interposition of an adipofascial flap.

TYPE OF STUDY/LEVEL OF EVIDENCE:

Therapeutic IV.

KEYWORDS:

Arthritis; distal radioulnar joint; implant; prosthesis; replacement

PMID:
26095055
DOI:
10.1016/j.jhsa.2015.04.028
[Indexed for MEDLINE]

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