Distal Radioulnar Joint Replacement with Wrist Arthrodesis: Long-term Follow-up
Shih-Heng Chen, MD1; Jonathan Lans, MD2; Jesse Jupiter, MD2; Luis R. Scheker, MD3
1University of Louisville School of Medicine, Louisville, KY; 2Massachusetts General Hospital, Boston, MA; 3Kleinert Kutz Hand Care Center, Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY
Introduction: 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 arthrodesis of the wrist is 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 long-term 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 an average age of 44.4±8.5 years. 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. We performed bivariate analysis to compare preoperative and postoperative outcomes.
Results: At an average follow up of 7.1 years (range 1-15 years). The average range of motion and weight lifting ability significantly improved. As for the subjective evaluations, postoperative pain scores improved significantly as did the DASH scores.
Conclusion: Distal radioulnar joint replacement with a semi-constrained prosthesis combined with wrist arthrodesis is an effective method to restore the function of the wrist and forearm that has been sacrificed by various salvage procedures.
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