Constrained Implant Arthroplasty for Distal Radioulnar Joint Arthrosis: Evaluation and Management of Soft Tissue Complications

Brent R. DeGeorge, Richard A. Berger, Alexander Yong-Shik Shin

Research output: Contribution to journalArticle

Abstract

Purpose: Distal radioulnar joint (DRUJ) prostheses designed as semiconstrained devices aiming to replace the function of the ulnar head, sigmoid notch of the radius, and triangular fibrocartilage complex have demonstrated the capacity to restore the functional status of the DRUJ. However, soft tissue complications including tendons, nerves, and wounds, although documented, have not been the primary focus of prior reports. This study investigated short- to medium-term soft tissue complications after DRUJ semiconstrained implant arthroplasty. Methods: We performed a retrospective review of patients undergoing semiconstrained DRUJ implant arthroplasty with clinical and radiological follow-up greater than 1 year. Data were reviewed with a focus on soft tissue complications after arthroplasty. Results: Fifty DRUJ implant arthroplasties were performed over 10 years in 49 patients. Patients’ average age was 47.8 years. Average duration of follow-up was 35.8 ± 3.7 months. A total of 46 patients underwent multiple operations before DRUJ arthroplasty. Postoperative pronosupination range of motion, grip strength, and visual analog scale pain scores were significantly improved after DRUJ arthroplasty. Wound-healing problems occurred in 11 arthroplasties; however, all wounds subsequently healed without operative intervention. Wound-related complications were significantly increased in patients with a history of rheumatoid arthritis or immunosuppression. Eighteen operations were required to address complications in 8 patients. Extensor tendinopathy was the most common indication for reoperation; 5 tenosynovectomy procedures were required in 4 wrists. A prominent screw requiring removal was identified in 3 cases of tenosynovitis. Periprosthetic fractures were identified in 3 wrists; 2 of these required reoperation for open treatment. Removal of hardware was required in 2 patients; these patients required 9 subsequent reoperations. Conclusions: Distal radioulnar joint arthrosis is a major problem and patients commonly undergo multiple reconstructive surgeries before DRUJ implant arthroplasty. No instances of wound-related complications or tendinopathy occurred in patients without previous surgeries, and wound-related complications occurred at a higher frequency with a history of rheumatoid arthritis or immunosuppression. Type of study/level of evidence: Prognostic IV.

Original languageEnglish (US)
Pages (from-to)614.e1-614.e9
JournalJournal of Hand Surgery
Volume44
Issue number7
DOIs
StatePublished - Jul 1 2019

Fingerprint

Joint Diseases
Arthroplasty
Joints
Reoperation
Wounds and Injuries
Tendinopathy
Wrist
Immunosuppression
Rheumatoid Arthritis
Reconstructive Surgical Procedures
Triangular Fibrocartilage
Periprosthetic Fractures
Joint Prosthesis
Tenosynovitis
Hand Strength
Sigmoid Colon
Pain Measurement
Articular Range of Motion
Tendons
Wound Healing

Keywords

  • Aptis
  • arthroplasty
  • distal radioulnar joint

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Constrained Implant Arthroplasty for Distal Radioulnar Joint Arthrosis : Evaluation and Management of Soft Tissue Complications. / DeGeorge, Brent R.; Berger, Richard A.; Shin, Alexander Yong-Shik.

In: Journal of Hand Surgery, Vol. 44, No. 7, 01.07.2019, p. 614.e1-614.e9.

Research output: Contribution to journalArticle

@article{dfbca7ba274748739d65179eca3e56c2,
title = "Constrained Implant Arthroplasty for Distal Radioulnar Joint Arthrosis: Evaluation and Management of Soft Tissue Complications",
abstract = "Purpose: Distal radioulnar joint (DRUJ) prostheses designed as semiconstrained devices aiming to replace the function of the ulnar head, sigmoid notch of the radius, and triangular fibrocartilage complex have demonstrated the capacity to restore the functional status of the DRUJ. However, soft tissue complications including tendons, nerves, and wounds, although documented, have not been the primary focus of prior reports. This study investigated short- to medium-term soft tissue complications after DRUJ semiconstrained implant arthroplasty. Methods: We performed a retrospective review of patients undergoing semiconstrained DRUJ implant arthroplasty with clinical and radiological follow-up greater than 1 year. Data were reviewed with a focus on soft tissue complications after arthroplasty. Results: Fifty DRUJ implant arthroplasties were performed over 10 years in 49 patients. Patients’ average age was 47.8 years. Average duration of follow-up was 35.8 ± 3.7 months. A total of 46 patients underwent multiple operations before DRUJ arthroplasty. Postoperative pronosupination range of motion, grip strength, and visual analog scale pain scores were significantly improved after DRUJ arthroplasty. Wound-healing problems occurred in 11 arthroplasties; however, all wounds subsequently healed without operative intervention. Wound-related complications were significantly increased in patients with a history of rheumatoid arthritis or immunosuppression. Eighteen operations were required to address complications in 8 patients. Extensor tendinopathy was the most common indication for reoperation; 5 tenosynovectomy procedures were required in 4 wrists. A prominent screw requiring removal was identified in 3 cases of tenosynovitis. Periprosthetic fractures were identified in 3 wrists; 2 of these required reoperation for open treatment. Removal of hardware was required in 2 patients; these patients required 9 subsequent reoperations. Conclusions: Distal radioulnar joint arthrosis is a major problem and patients commonly undergo multiple reconstructive surgeries before DRUJ implant arthroplasty. No instances of wound-related complications or tendinopathy occurred in patients without previous surgeries, and wound-related complications occurred at a higher frequency with a history of rheumatoid arthritis or immunosuppression. Type of study/level of evidence: Prognostic IV.",
keywords = "Aptis, arthroplasty, distal radioulnar joint",
author = "DeGeorge, {Brent R.} and Berger, {Richard A.} and Shin, {Alexander Yong-Shik}",
year = "2019",
month = "7",
day = "1",
doi = "10.1016/j.jhsa.2018.09.003",
language = "English (US)",
volume = "44",
pages = "614.e1--614.e9",
journal = "Journal of Hand Surgery",
issn = "0266-7681",
publisher = "W.B. Saunders Ltd",
number = "7",

}

TY - JOUR

T1 - Constrained Implant Arthroplasty for Distal Radioulnar Joint Arthrosis

T2 - Evaluation and Management of Soft Tissue Complications

AU - DeGeorge, Brent R.

AU - Berger, Richard A.

AU - Shin, Alexander Yong-Shik

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Purpose: Distal radioulnar joint (DRUJ) prostheses designed as semiconstrained devices aiming to replace the function of the ulnar head, sigmoid notch of the radius, and triangular fibrocartilage complex have demonstrated the capacity to restore the functional status of the DRUJ. However, soft tissue complications including tendons, nerves, and wounds, although documented, have not been the primary focus of prior reports. This study investigated short- to medium-term soft tissue complications after DRUJ semiconstrained implant arthroplasty. Methods: We performed a retrospective review of patients undergoing semiconstrained DRUJ implant arthroplasty with clinical and radiological follow-up greater than 1 year. Data were reviewed with a focus on soft tissue complications after arthroplasty. Results: Fifty DRUJ implant arthroplasties were performed over 10 years in 49 patients. Patients’ average age was 47.8 years. Average duration of follow-up was 35.8 ± 3.7 months. A total of 46 patients underwent multiple operations before DRUJ arthroplasty. Postoperative pronosupination range of motion, grip strength, and visual analog scale pain scores were significantly improved after DRUJ arthroplasty. Wound-healing problems occurred in 11 arthroplasties; however, all wounds subsequently healed without operative intervention. Wound-related complications were significantly increased in patients with a history of rheumatoid arthritis or immunosuppression. Eighteen operations were required to address complications in 8 patients. Extensor tendinopathy was the most common indication for reoperation; 5 tenosynovectomy procedures were required in 4 wrists. A prominent screw requiring removal was identified in 3 cases of tenosynovitis. Periprosthetic fractures were identified in 3 wrists; 2 of these required reoperation for open treatment. Removal of hardware was required in 2 patients; these patients required 9 subsequent reoperations. Conclusions: Distal radioulnar joint arthrosis is a major problem and patients commonly undergo multiple reconstructive surgeries before DRUJ implant arthroplasty. No instances of wound-related complications or tendinopathy occurred in patients without previous surgeries, and wound-related complications occurred at a higher frequency with a history of rheumatoid arthritis or immunosuppression. Type of study/level of evidence: Prognostic IV.

AB - Purpose: Distal radioulnar joint (DRUJ) prostheses designed as semiconstrained devices aiming to replace the function of the ulnar head, sigmoid notch of the radius, and triangular fibrocartilage complex have demonstrated the capacity to restore the functional status of the DRUJ. However, soft tissue complications including tendons, nerves, and wounds, although documented, have not been the primary focus of prior reports. This study investigated short- to medium-term soft tissue complications after DRUJ semiconstrained implant arthroplasty. Methods: We performed a retrospective review of patients undergoing semiconstrained DRUJ implant arthroplasty with clinical and radiological follow-up greater than 1 year. Data were reviewed with a focus on soft tissue complications after arthroplasty. Results: Fifty DRUJ implant arthroplasties were performed over 10 years in 49 patients. Patients’ average age was 47.8 years. Average duration of follow-up was 35.8 ± 3.7 months. A total of 46 patients underwent multiple operations before DRUJ arthroplasty. Postoperative pronosupination range of motion, grip strength, and visual analog scale pain scores were significantly improved after DRUJ arthroplasty. Wound-healing problems occurred in 11 arthroplasties; however, all wounds subsequently healed without operative intervention. Wound-related complications were significantly increased in patients with a history of rheumatoid arthritis or immunosuppression. Eighteen operations were required to address complications in 8 patients. Extensor tendinopathy was the most common indication for reoperation; 5 tenosynovectomy procedures were required in 4 wrists. A prominent screw requiring removal was identified in 3 cases of tenosynovitis. Periprosthetic fractures were identified in 3 wrists; 2 of these required reoperation for open treatment. Removal of hardware was required in 2 patients; these patients required 9 subsequent reoperations. Conclusions: Distal radioulnar joint arthrosis is a major problem and patients commonly undergo multiple reconstructive surgeries before DRUJ implant arthroplasty. No instances of wound-related complications or tendinopathy occurred in patients without previous surgeries, and wound-related complications occurred at a higher frequency with a history of rheumatoid arthritis or immunosuppression. Type of study/level of evidence: Prognostic IV.

KW - Aptis

KW - arthroplasty

KW - distal radioulnar joint

UR - http://www.scopus.com/inward/record.url?scp=85055016800&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055016800&partnerID=8YFLogxK

U2 - 10.1016/j.jhsa.2018.09.003

DO - 10.1016/j.jhsa.2018.09.003

M3 - Article

C2 - 30344019

AN - SCOPUS:85055016800

VL - 44

SP - 614.e1-614.e9

JO - Journal of Hand Surgery

JF - Journal of Hand Surgery

SN - 0266-7681

IS - 7

ER -