2-Year Clinical and Radiographic Outcomes of Aptis Distal Radioulnar Joint Arthroplasty
Patrick S Brannan, MD; William A Ward, MD; R. Glenn Gaston, MD; Julie C Woodside, MD; R Christopher Chadderdon, MD; Benjamin Connell, BA
OrthoCarolina Research Institute, Charlotte, NC
HYPOTHESIS: The purpose of this study is to evaluate the two year clinical and radiographic outcomes of patients diagnosed with arthritis and/or instability of the distal radioulnar joint (DRUJ) that underwent a total distal radioulnar joint (APTIS) arthroplasty.
METHODS: Retrospective analysis was performed on a consecutive series of patients with minimum two year follow up. A database query was performed based upon ICD-9 codes for distal radioulnar joint arthritis/instability. Included were patients with greater than two years of follow up. The primary outcome variable was implant survival with implant loosening or revision as endpoint. Quantitative secondary outcome variables included Visual Analog Scales (VAS), Disability of the Arm, Shoulder and Hand (DASH) scores, Patient Rated Wrist Evaluation (PRWE), and Mayo Wrist Scores. Clinical outcome data points including range of motion, grip/pinch strength, and torque were measured at follow up and compared to the nonoperative extremity. Radiographic data including DRUJ morphology and complications related to the prosthesis were assessed. This included ulnar stem lucency, loosening, pedestal formation, osteolysis, and perforation. The radial component was assessed for screw malpostion, cap/screw loosening, peg lucency, and plate malposition.
RESULTS: 20 patients (13 female, 7 male) with a mean age of 57 years were assessed at mean of 41 months follow up (range 23-72 months). 12/20 previously underwent elbow/wrist procedures. No patients required component revision. One patient underwent reoperation secondary to refractory tenosynovitis of the 5th dorsal compartment. Post operative VAS scores were 2.0 and 3.8 for rest and activity, DASH score was 32.9, PRWE score was 58.4 (Pain 23.7, Function 34.7), and Mayo wrist score was 63. No patients had post operative DRUJ instability. Post operatively, range of motion was assessed for flexion, extension, radial/ulnar deviation, and pronation/supination. There was no statistically significant difference in wrist flexion/extension, ulnar deviation, and supination compared to the nonoperative extremity. Pronation differed from the nonoperative extremity by a mean of 6 degrees. 4/20 patients had radiographic lysis around the collar of the ulnar component (20%). There was no progressive lucency, loosening, or pedestal formation surrounding the ulnar component. 1/20 radial plates was malpositioned and showed evidence of screw loosening. There was no evidence radial peg lucency or cap loosening.
Conclusion: There were no revisions in a two year cohort of patients undergoing DRUJ arthroplasty. Established outcome measures yielded satisfactory clinical results. Despite intermittent radiographic osteolysis surrounding the ulnar collar, this had no bearing on clinical outcomes
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