Download PDF
CC BY-NC-ND 4.0 · J Wrist Surg 2024; 13(04): 318-327
DOI: 10.1055/s-0043-1774317
Scientific Article

Aptis Distal Radioulnar Joint Arthroplasty: A Multicenter Evaluation of Functional Outcomes, Complications, and Patient Satisfaction

Shirley D. Stougie 
1   Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, The Netherlands
2   Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, The Netherlands
,
Leonieke C. van Boekel 
4   Foundation for Orthopedic Research, Care and Education, Amphia Hospital, Breda, The Netherlands
,
Annechien Beumer
3   Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
,
Peter Hoogvliet
1   Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, The Netherlands
,
Simon D. Strackee
2   Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, The Netherlands
,
J. Henk Coert
1   Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, The Netherlands
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Background The Aptis distal radioulnar joint (DRUJ) implant has been commonly used to replace the DRUJ and restore wrist function in patients with a severely destroyed DRUJ.

Objective Promising results have been described in the literature. However, the clinical results in a multicenter setting are sparse and variable. This study evaluates the short- to midterm clinical results of 53 patients with a (mean) follow-up of 51 months.

Patients and Methods Fifty-three patients (59 implants) treated between 2011 and 2020 in three different institutions were retrospectively identified in a prospectively collected database. The main indication for Aptis DRUJ arthroplasty was a destroyed DRUJ and gross distal radioulnar instability and isolated DRUJ osteoarthritis. Functional outcome, complications, and patient satisfaction were evaluated. Patients completed the Patient-Rated Wrist Evaluation (PRWE) questionnaire and an additional questionnaire about patient satisfaction and return to hobby/work.

Results Implant survival was 92%, the surgical follow-up showed many complications (64,4%), and revision surgery was needed frequently (40.7%). In 13 cases, the follow-up was longer than 5 years. Three reimplantations had to be performed and two implants were permanently explanted. In spite of this all, wrist and forearm motion as well as pain reduction was adequate and patient satisfaction was reasonable (72.2%).

Conclusion The Aptis DRUJ arthroplasty is a viable option that can provide adequate wrist and forearm function after secure patient selection and surgical placement of the implant in the wrist with a good bone stock of the radius. The complication rate was found to be high, yet patient satisfaction was reasonable. In the case of secondary surgery, additional surgery seems to be needed. For primary surgery, the implant seems to be successful without complications. Different complications have been described, but further analysis is warranted to find the causes of complications and to objectify the performance of the Aptis DRUJ implant.

Level of Evidence IV.

Keywords

distal radioulnar joint - arthroplasty - functional outcomes - complications - joint replacement

Ethical Approval

The Medical Ethical Committee of the Amsterdam University Medical Centers, Amsterdam, declared that this study is not subject to the Dutch Medical Research with Human Subjects Law.


Informed Consent

Written informed consent was obtained from a legally authorized representative(s) for anonymized patient information to be published in this article.


Author Contributions

All the authors were actively involved in the planning and enactment of the study, and writing of the manuscript.




Publication History

Received: 22 February 2023

Accepted: 10 August 2023

Article published online:
13 September 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Gates DH, Walters LS, Cowley J, Wilken JM, Resnik L. Range of motion requirements for upper-limb activities of daily living. Am J Occup Ther 2016; 70 (01) p1 , p10
    CrossrefPubMedSearch in Google Scholar
  • 2 Lambrecht D, Vanhove W, Hollevoet N. Clinical and radiological results of distal radioulnar joint arthroplasty with the Aptis prosthesis. J Hand Surg Eur Vol 2022; 47 (04) 379-386
    CrossrefPubMedSearch in Google Scholar
  • 3 Kachooei AR, Chase SM, Jupiter JB. Outcome assessment after Aptis distal radioulnar joint (DRUJ) implant arthroplasty. Arch Bone Jt Surg 2014; 2 (03) 180-184
    PubMedSearch in Google Scholar
  • 4 Martínez Villén G, García Martínez B, Aso Vizán A. Total distal radioulnar joint prosthesis as salvage surgery in multioperated patients. Chir Main 2014; 33 (06) 390-395
    CrossrefPubMedSearch in Google Scholar
  • 5 Willis AA, Berger RA, Cooney III WP. Arthroplasty of the distal radioulnar joint using a new ulnar head endoprosthesis: preliminary report. J Hand Surg Am 2007; 32 (02) 177-189
    CrossrefPubMedSearch in Google Scholar
  • 6 Herbert TJ, van Schoonhoven J. Ulnar head replacement. Tech Hand Up Extrem Surg 2007; 11 (01) 98-108
    CrossrefPubMedSearch in Google Scholar
  • 7 Sauerbier M, Hahn ME, Fujita M, Neale PG, Berglund LJ, Berger RA. Analysis of dynamic distal radioulnar convergence after ulnar head resection and endoprosthesis implantation. J Hand Surg Am 2002; 27 (03) 425-434
    CrossrefPubMedSearch in Google Scholar
  • 8 Darrach W. Partial excision of lower shaft of ulna for deformity following Colles's fracture. 1913. Clin Orthop Relat Res 1992; (275) 3-4
    PubMedSearch in Google Scholar
  • 9 Bell MJ, Hill RJ, McMurtry RY. Ulnar impingement syndrome. J Bone Joint Surg Br 1985; 67 (01) 126-129
    CrossrefPubMedSearch in Google Scholar
  • 10 Watson HK, Ryu JY, Burgess RC. Matched distal ulnar resection. J Hand Surg Am 1986; 11 (06) 812-817
    CrossrefPubMedSearch in Google Scholar
  • 11 Swanson AB. 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 (02) 373-382
    CrossrefPubMedSearch in Google Scholar
  • 12 Scheker LR, Babb BA, Killion PE. Distal ulnar prosthetic replacement. Orthop Clin North Am 2001; 32 (02) 365-376 , x
    CrossrefPubMedSearch in Google Scholar
  • 13 Warlop J, Nuffel MV, Smet L, Degreef I. Midterm functional outcomes of the linked semiconstrained distal radioulnar joint prosthesis. J Wrist Surg 2021; 11 (04) 335-343
    PubMedSearch in Google Scholar
  • 14 Moulton LS, Giddins GEB. Distal radio-ulnar implant arthroplasty: a systematic review. J Hand Surg Eur Vol 2017; 42 (08) 827-838
    CrossrefPubMedSearch in Google Scholar
  • 15 Reissner L, Böttger K, Klein HJ, Calcagni M, Giesen T. Midterm results of semiconstrained distal radioulnar joint arthroplasty and analysis of complications. J Wrist Surg 2016; 5 (04) 290-296
    Thieme ConnectPubMedSearch in Google Scholar
  • 16 Kakar S, Fox T, Wagner E, Berger R. Linked distal radioulnar joint arthroplasty: an analysis of the APTIS prosthesis. J Hand Surg Eur Vol 2014; 39 (07) 739-744
    CrossrefPubMedSearch in Google Scholar
  • 17 Bizimungu RS, Dodds SD. Objective outcomes following semi-constrained total distal radioulnar joint arthroplasty. J Wrist Surg 2013; 2 (04) 319-323
    Thieme ConnectPubMedSearch in Google Scholar
  • 18 Savvidou C, Murphy E, Mailhot E, Jacob S, Scheker LR. Semiconstrained distal radioulnar joint prosthesis. J Wrist Surg 2013; 2 (01) 41-48
    Thieme ConnectPubMedSearch in Google Scholar
  • 19 Laurentin-Pérez LA, Goodwin AN, Babb BA, Scheker LR. A study of functional outcomes following implantation of a total distal radioulnar joint prosthesis. J Hand Surg Eur Vol 2008; 33 (01) 18-28
    CrossrefPubMedSearch in Google Scholar
  • 20 Zimmerman RM, Jupiter JB. Outcomes of a self-constrained distal radioulnar joint arthroplasty: a case series of six patients. Hand (N Y) 2011; 6 (04) 460-465
    CrossrefPubMedSearch in Google Scholar
  • 21 Scheker LR. Implant arthroplasty for the distal radioulnar joint. J Hand Surg Am 2008; 33 (09) 1639-1644
    CrossrefPubMedSearch in Google Scholar
  • 22 Amundsen A, Rizzo M, Berger RA, Houdek MT, Frihagen F, Moran SL. Twenty-year experience with primary distal radioulnar joint arthroplasty from a single institution. J Hand Surg Am 2023; 48 (01) 53-67
    CrossrefPubMedSearch in Google Scholar
  • 23 Brannan PS, Ward WA, Gaston RG, Chadderdon RC, Woodside JC, Connell B. Two-year clinical and radiographic evaluation of Scheker prosthesis (Aptis) distal radioulnar joint arthroplasty. J Hand Surg Am 2022; 47 (03) 290.e1-290.e11
    CrossrefPubMedSearch in Google Scholar
  • 24 Pääkkönen M. Complications of Scheker semiconstrained distal radioulnar joint arthroplasty in a low-volume unit. Hand Surg Rehabil 2022; 41 (04) 441-444
    CrossrefPubMedSearch in Google Scholar
  • 25 Fuchs N, Meier LA, Giesen T, Calcagni M, Reissner L. Long-term results after semiconstrained distal radioulnar joint arthroplasty: a focus on complications. Hand Surg Rehabil 2020; 39 (03) 186-192
    CrossrefPubMedSearch in Google Scholar
  • 26 Lans J, Chen SH, Jupiter JB, Scheker LR. Distal radioulnar joint replacement in the scarred wrist. J Wrist Surg 2019; 8 (01) 55-60
    Thieme ConnectPubMedSearch in Google Scholar
  • 27 DeGeorge Jr BR, Berger RA, Shin AY. Constrained implant arthroplasty for distal radioulnar joint arthrosis: evaluation and management of soft tissue complications. J Hand Surg Am 2019; 44 (07) 614.e1-614.e9
    CrossrefPubMedSearch in Google Scholar
  • 28 Bellevue KD, Thayer MK, Pouliot M, Huang JI, Hanel DP. Complications of semi constrained distal radioulnar Joint arthroplasty. J Hand Surg Am 2018; 43 (06) 566.e1-566.e9
    CrossrefPubMedSearch in Google Scholar
  • 29 Oonk JGM, Dobbe JGG, Strijkers GJ, Van Rijn SK, Streekstra GJ. Kinematic analysis of forearm rotation using four-dimensional computed tomography. J Hand Surg Eur Vol 2022; 12: 17 531934221142520
    PubMedSearch in Google Scholar
  • 30 MacDermid JC, Tottenham V. Responsiveness of the disability of the arm, shoulder, and hand (DASH) and patient-rated wrist/hand evaluation (PRWHE) in evaluating change after hand therapy. J Hand Ther 2004; 17 (01) 18-23
    CrossrefPubMedSearch in Google Scholar
  • 31 Clavien PA, Barkun J, de Oliveira ML. et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009; 250 (02) 187-196
    CrossrefPubMedSearch in Google Scholar
  • 32 Nakamura T. Surgeons' level of expertise. J Wrist Surg 2020; 9 (03) 185-185
    Thieme ConnectPubMedSearch in Google Scholar