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

Abstract

There is no financial information to disclose. The Aptis distal radioulnar joint (DRUJ) is a semi-constrained implant designed to restore the function of the ulnar head, sigmoid notch of the radius, and the triangular fibrocartilage complex. Previous reports of this implant have demonstrated restoration of the functional status of the DRUJ, however soft tissue complications, including: tendonopathy and wound complications have not been reported. The aim of the study was to investigate the patient-related and implant-related factors associated with soft tissue complications following DRUJ implant arthroplasty. We performed a retrospective review of a prospectively maintained database of all patients undergoing constrained DRUJ implant arthroplasty with clinical and radiological follow-up greater than 1 year following institutional IRB approval. Data were reviewed, including: demographic variables, co-morbidities, previous operative procedures, and complications with a focus on soft tissue complications following arthroplasty. We performed 46 Aptis DRUJ implant arthroplasties in 45 patients. Average patient age was 47.9 years. Arthroplasties were performed for chronic pain and instability, post traumatic arthrosis, and DRUJ deformity in 28, 16, and 6 patients, respectively. Average duration of follow-up was 24.2 ± 3.1 months. 42 patients underwent multiple operations prior to DRUJ arthroplasty (mean 2.6 ± 0.4 previous operations). Multiple previous scars were noted in 88% of patients. Post-operative grip strength (P < 0.05) and VAS pain scores (P < 0.01) were significantly improved following DRUJ arthroplasty. 10 operations were required to address complications in 5 patients: 4 hardware complications, 4 extensor tenosynovectomy or tenolysis, 1 painful scar revision with fat grafting, and 1 implant removal. Wound healing problems, including soft tissue necrosis, hematoma, seroma, and wound dehiscence occurred in 8 patients. Extensor tendinitis or tendinopathy was reported in 5 patients. Paresthesias were noted in 4 patients. Wound-related complications were significantly increased in patients with a history of rheumatoid arthritis or immunosuppression. (Table 23-1) •Distal radioulnar joint arthrosis is a significant problem, and patients commonly undergo multiple reconstructive surgeries prior to DRUJ implant arthroplasty.•No instances of wound-related complications or tendinopathy occurred in patients without a history of previous surgeries or scars; and occurred in a higher frequency with a history of rheumatoid arthritis or immunosuppression.•Despite soft-tissue complications, overall satisfaction rates are high with DRUJ implant arthroplasty.Table 23-1Patient and Operative CharacteristicsDemographics Patients (#)45 Wrists (#)46 Age (Mean years ± SEM)47.9 ± 2.3 Male (%)32.0% Hand Dominance (% Right)50.2% Laterality (% Right)91.2% Duration of Symptoms (Mean years ± SEM)6.2 ± 1.0Co-Morbidities Diabetes (%)0.0% Rheumatoid Arthritis (%)17.6% Smoking (%)11.7% BMI > 30 (%)44.1% History of Previous Surgery88.2% Number of Previous Surgeries (Mean ± SEM)2.6 ± 0.4Pre-Operative Function Flexion45.5 ± 4.2 Extension46.8 ± 4.7 Pronation68.9 ± 3.6 Supination66.2 ± 3.8 Grip (kg)16.2 ± 1.8 VAS Pain Score6.7 ± 0.7Post-Operative Function Flexion52.7 ± 3.6 Extension52.3 ± 3.8 Pronation73.2 ± 2.4 Supination69.2 ± 2.8 Grip (kg)20.4 ± 3.1 VAS Pain Score1.3 ± 0.5 Open table in a new tab