Advertisement

Two-Year Clinical and Radiographic Evaluation of Scheker Prosthesis (Aptis) Distal Radioulnar Joint Arthroplasty

      Purpose

      To evaluate the clinical and radiographic outcomes of patients who underwent semiconstrained distal radioulnar joint arthroplasty.

      Methods

      A retrospective analysis was performed on a series of patients who underwent distal radioulnar joint arthroplasty with more than a 23-month follow up. The quantitative outcome variables included the visual analog scale for pain; Disability of the Arm, Shoulder, and Hand (DASH) score; Patient-Rated Wrist Evaluation (PRWE); and Mayo wrist score. The range of motion, grip strength, torque, and lifting capacity were measured at final follow up and compared with that of the nonsurgical extremity. Complications related to the prosthesis were assessed.

      Results

      Twenty-one patients (mean age 57 years) were assessed at an average 41-month follow up (23–73 months). Fifteen underwent prior hand, wrist, or elbow procedures. Four patients required 5 reoperations. The postoperative median visual analog scale pain score was 0.6 at rest and 2.1 with activity. The median postoperative DASH score was 26.7, PRWE 41, and Mayo wrist score was 65. Upon comparing the supination torque of the operative and intact sides, the operative side was found to average 87% of the intact side on a work simulator and 77% on the simulator’s D-ring. Eight of 20 patients had lysis around the collar of the ulnar component (40%), as detected using radiography. Three of 21 (14%) radial plates were malpositioned, with 2 resulting in a fracture. The overall complication rate was 29%.

      Conclusions

      Distal radioulnar joint arthroplasty using the Scheker prosthesis demonstrated good patient pain scores and the restoration of supination strength. The collar lysis resulted in weaker supination and grip strength. Still, the patients experienced mild levels of pain and moderate disability. A moderate complication rate persisted, as reported by other authors. Accurate radial component placement is important.

      Type of study/level of evidence

      Therapeutic IV.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hagert C.G.
        The distal radioulnar joint in relation to the whole forearm.
        Clin Orthop Relat Res. 1992; : 56-64
        • Markolf K.L.
        • Lamey D.
        • Yang S.
        • Meals R.
        • Hotchkiss R.
        Radioulnar load-sharing in the forearm. A study in cadaver.
        J Bone and Joint Surg. 1998; 80: 879-888
        • Shaaban H.
        • Giakas G.
        • Bolton M.
        • Williams R.
        • Scheker L.R.
        • Lees V.C.
        The distal radioulnar joint as a load-bearing mechanism—a biomechanical study.
        J Hand Surg. 2004; 29: 85-95
        • Kleinman W.B.
        Stability of the distal radioulna joint: biomechanics, pathophysiology, physical diagnosis, and restoration of function what we have learned in 25 years.
        J Hand Surg. 2007; 32: 1086-1106
        • Bieber E.J.
        • Linscheid R.L.
        • Dobyns J.H.
        • Beckenbaugh R.D.
        Failed distal ulna resections.
        J Hand Surg. 1988; 13: 193-200
        • Field J.
        • Majkowski R.J.
        • Leslie I.J.
        Poor results of Darrach’s procedure after wrist injuries.
        J Bone and Joint Surg. 1993; 75: 53-57
        • Lluch A.
        The Sauve-Kapandji procedure: indications and tips for surgical success.
        Hand Clinics. 2010; 26: 559-572
        • Bowers W.H.
        Distal radioulnar joint arthroplasty: the hemiresection-interposition technique.
        J Hand Surg. 1985; 10: 169-178
        • Glowacki K.A.
        Hemiresection arthroplasty of the distal radioulnar joint.
        Hand Clinics. 2005; 21: 591-601
        • Watson H.K.
        • Ryu J.
        • Burgess R.C.
        Matched distal ulnar resection.
        J Hand Surg. 1986; 11: 812-817
        • Watson H.K.
        • Gabuzda G.M.
        Matched distal ulna resection for postraumatic disorders of the distal radioulnar joint.
        J Hand Surg. 1992; 17: 724-730
        • Bain G.I.
        • Pugh D.M.
        • MacDermid J.C.
        • Roth J.H.
        Matched hemiresection interposition arthroplasty of the distal radioulnar joint.
        J Hand Surg. 1995; 20: 944-950
        • Bell M.J.
        • Hill R.J.
        • McMurtry R.Y.
        Ulnar impingement syndrome.
        J Bone and Joint Surg. 1985; 67: 126-129
        • McKee M.D.
        • Richards R.R.
        Dynamic radio-ulnar convergence after the Darrach procedure.
        J Bone Joint Surg. 1996; 78: 413-418
        • Lees V.C.
        • Scheker L.R.
        The radiological demonstration of dynamic ulnar impingement.
        J Hand Surg. 1997; 22: 448-450
        • Swanson A.B.
        Implant arthroplasty for disabilities of the distal radioulnar joint; use of a silicone rubber capping implant following resection of the ulnar head.
        Orthop Clin North Am. 1973; 4: 373-382
        • van Schoonhoven J.
        • Fernandez D.L.
        • Bowers W.H.
        • Herbert T.J.
        Salvage of failed resection arthroplasties of the distal radioulnar joint using a new ulnar head prosthesis.
        J Hand Surg. 2000; 25: 438-446
        • Sauerbier M.
        • Hahn M.E.
        • Fujita M.
        • Neale P.G.
        • Berglund L.J.
        • Berger R.A.
        Analysis of dynamic distal radioulnar convergence after ulnar head resection and endoprosthesis implantation.
        J Hand Surg. 2002; 27: 425-434
        • Berger R.A.
        • Cooney W.P.
        Use of an ulnar head prosthesis for treatment of an unstable distal ulnar resection: review of mechanics, indications, and surgical technique.
        Hand Clinics. 2005; 21: 603-620
        • Willis A.A.
        • Berger R.A.
        • Cooney W.P.
        Arthroplasty of the distal radioulnar joint using a new ulnar head endoprosthesis: preliminary report.
        J Hand Surg. 2007; 32: 177-189
        • van Schoonhoven J.
        • Muhdorfer-Fodor M.
        • Fernandez D.L.
        • Herbert T.J.
        Salvage of failed resection arthroplasties of the distal radioulnar joint using an ulnar head prosthesis: long-term results.
        J Hand Surg. 2012; 37: 1372-1380
        • Kakar S.
        • Swann R.P.
        • Perry K.I.
        • Wood-Wentz C.M.
        • Sin A.Y.
        • Moran S.L.
        Functional and radiographic outcomes following distal ulna implant arthroplasty.
        J Hand Surg. 2012; 37: 1364-1371
        • Scheker L.R.
        Implant arthroplasty for the distal radioulnar joint.
        J Hand Surg. 2008; 33: 1639-1644
        • Axelsson P.
        • Karrholm J.
        New methods to assess forearm torque and lifting strength: reliability and validity.
        J Hand Surg. 2018; 43: 865.e1-865.e10
        • Laurentin-Perez L.A.
        • Goodwin A.N.
        • Babb B.A.
        • Scheker L.R.
        A study of functional outcomes following implantation of a total distal radioulnar joint prostheses.
        J Hand Surg. 2008; 33: 18-28
        • Savvidou C.
        • Murphy E.
        • Mailhot E.
        • Jacob S.
        • Scheker L.R.
        Semiconstrained distal radioulnar joint prosthesis.
        J Wrist Surg. 2013; 2: 41-48
        • Scheker L.R.
        • Martineau D.W.
        Distal radioulnar joint constrained arthroplasty.
        Hand Clinics. 2013; 29: 113-121
        • Galvis E.J.
        • Pessa J.
        • Scheker L.R.
        Total joint arthroplasty of the distal radioulnar joint for rheumatoid arthritis.
        J Hand Surg. 2014; 39: 1699-1704
        • Rampazzo A.
        • Gharb B.B.
        • Brock G.
        • Scheker L.R.
        Functional outcomes of the Aptis-Scheker distal radioulnar joint replacement in patients under 40 years old.
        J Hand Surg. 2015; 40: 1397-1403
        • Zimmerman R.M.
        • Jupiter J.B.
        Outcomes of a self constrained distal radioulnar joint arthroplasty: a case series of six patients.
        Hand. 2011; 6: 460-465
        • Axelsson P.
        • Sollerman C.
        Constrained implant arthroplasty as a secondary procedure at the distal radioulnar joint: early outcomes.
        J Hand Surg. 2013; 38: 1111-1118
        • Kachooei A.R.
        • Chase S.M.
        • Jupiter J.B.
        Outcome assessment after Aptis distal radioulnar joint (DRUJ) implant arthroplasty.
        Arch Bone Jt Surg. 2014; 2: 180-184
        • Villen G.M.
        • Martinez B.G.
        • Vizan A.A.
        Total distal joint prosthesis as salvage surgery in multioperated patients.
        Chirurgie de la Main. 2014; 33: 390-395
        • Bizimungo R.S.
        • Dodds S.D.
        Objective outcomes following semi-constrained distal radioulnar joint arthroplasty.
        J Wrist Surg. 2013; 2: 319
        • Bellevue K.D.
        • Thayer M.K.
        • Pouliot M.
        • Huang J.I.
        • Hanel D.
        Complications of Aptis DRUJ arthroplasty: level 4 evidence.
        J Hand Surg. 2017; 42: S14-S15
        • DeGeorge Jr., B.R.
        • Berger R.A.
        • Shin A.Y.
        Constrained implant arthroplasty for distal radioulnar joint arthrosis: evaluation and management of soft tissue complications.
        J Hand Surg. 2019; 44: 614.e1-614.e9
        • Moulton L.S.
        • Giddens G.E.
        Distal radio-ulnar implant arthroplasty: a systematic review.
        J Hand Surg. 2017; 42: 827-838
        • Hagert C.G.
        Distal radius fracture and the distal radioulnar joint—anatomic considerations.
        Handchir Mikrochir Plast Chir. 1994; 26: 22-26
        • Bieber E.J.
        • Linscheid R.L.
        • Dobyns J.H.
        • Beckenbaugh J.D.
        Failed distal ulna resections.
        J Hand Surg. 1988; 13: 193-200
        • Breen T.F.
        • Jupiter J.B.
        Extensor carpi ulnaris and flexor carpi ulnaris tenodesis of the unstable distal ulna.
        J Hand Surg. 1989; 14: 612-618
        • Leslie B.M.
        • Carlson G.
        • Ruby L.K.
        Results of extensor carpi ulnaris tenodesis in the rheumatoid wrist undergoing a distal ulnar excision.
        J Hand Surg. 1990; 15: 547-551
        • Kleinman J.B.
        • Greenberg J.A.
        Salvage of the failed Darrach procedure.
        J Hand Surg. 1995; 20: 951-958
        • Peterson II, C.A.
        • Maki S.
        • Wood M.B.
        Clinical results of the one-bone forearm.
        J Hand Surg. 1995; 20: 609-618
        • Herzberg G.
        Periprosthetic bone resorption and sigmoid notch erosion around ulnar head implants: a concern?.
        Hand Clinics. 2010; 26: 573-577