A-0354 The total distal radioulnar joint prosthesis (APTIS): functional outcome in seven patients.
Vanhove WMF, Vander Eecken S, Hollevoet N, Victor J.
Purpose: This study was designed to examine the early functional and subjective outcome after total distal radioulnar joint (DRUJ) replacement with the APTIS endoprosthesis, as designed by L. Scheker.
Methods: Since June 2006, 7 patients (3 men and 4 women) presenting either a posttraumatic or a congenital deformity with secondary degenerative disease of the DRUJ were operated on by one single surgeon. They all had previously undergone multiple surgical treatments, sometimes with severe adverse effects. Four patients were operated for failure of a Herbertulnar head prosthesis. The mean age at surgery was 43 years (24-57 years). Follow-up ranged from 1 to 5 years. The following questionnaires were completed: Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder and Hand (DASH), visual analogue (VAS) pain score, a query concerning complications, activities of daily living (ADL), and overall patient satisfaction. The clinical examination included measurement of range of motion, grip strength, and strength of key pinch. Torque during pronation and supination was measured with use of the Baltimore Therapeutic Equipment (BTE). All measurements were taken on both operated and the nonaffected side.
Results: DRUJ replacement surgery with the APTIS endoprosthesis and postoperative rehabilitation were uneventful in all patients. Two patients required further surgery for nerve or soft-tissue problems. Pronation and supination increased in all patients. Grip strength increased in all patients but to a variable extent. The weight-lifting capability showed only minor improvement. Four out of 7 patients still required chronic pain medication and had a VAS score for pain of 7 or more. Multi-operated patients who had a non-functional upper limb preoperatively did not have an excellent postoperative result but still considered the surgery as major improvement. Patients who had few previous surgical procedures achieved the best results. The scores for patient satisfaction with total DRUJ replacement were very high and all patients would have the surgery again, if needed. Three patients returned to their previous job and one previously unemployed patient was able to start working. Two patients were still unable to work because of their DRUJ problem and one patient was incapacitated because of severe back problems.
Conclusions: The total DRUJ prosthesis improves the functional outcome in salvage operations for previously failed surgery and patient satisfaction with this procedure is high. The effect on pain is less predictable and chronic pain may not be resolved. Patients need to be aware that this is a salvage procedure with pre-set limitations in the functional improvement. The surgeon needs to be prepared to tackle secondary problems. Larger studies are needed to access the clinical value of this procedure in salvage surgery of the DRUJ.