Clinical outcomes of wrist and aptis distal radioulnar joint arthroplasty

This thesis explores clinical outcomes and implications of wrist and Aptis distal radioulnar joint arthroplasty.

Clinical Outcomes:

The first study assessed six patients who underwent combined radiocarpal and DRUJ arthroplasty to alleviate pain and preserve motion. While rotation improved in half of the patients, flexion-extension decreased in the others. Pain relief was observed in four patients, and despite limited return to work, all patients were satisfied with the surgical outcome. Implant survival reached up to nine years in one case. Due to small sample size and clinical variation, no firm surgical recommendations can be made.

The second study evaluated ten patients with post-traumatic osteochondral wrist defects treated with a nonvascular metatarsal osteochondral graft. At a five-year follow-up, successful osseointegration was observed in all cases, although three required additional surgery for minor complications. While most patients experienced acceptable donor site morbidity and satisfactory wrist motion, some reported persistent pain or inability to resume daily activities. These findings suggest the graft may be a viable treatment option in selected cases.

The third study investigated 53 patients (59 implants) who received a second-generation Aptis DRUJ implant. Indications included DRUJ destruction with instability and isolated osteoarthritis. The implant showed a 92% survival rate, but a high complication rate (64.4%) and frequent revisions (40.7%). Patient satisfaction was moderate (72.2%). Outcomes were better in cases of isolated DRUJ osteoarthritis than in complex destruction with instability. Proper surgical placement and good radial bone quality were key for success, especially in primary surgeries.

Clinical Implications:

The fourth study used 3DCT and 4DCT scans to analyze forearm kinematics in 12 patients with a unilateral Aptis implant. Findings showed significant changes in the forearm’s rotation axis and reduced translation of the radius along the ulna (−45%) compared to the healthy side. Wrist flexion-extension also decreased. These changes suggest that the implant alters normal kinematics, and optimal placement, preferably distally, may help improve outcomes.

The fifth study further explored potential causes of complications using the same imaging data. In 75% of patients, translation of the radius along the ulna was reduced or absent. Although no direct link was found between complications and specific kinematic deviations, relative dorsal implant placement and radial deformities were common in affected cases. These findings highlight the need for improved implant design and placement accuracy.

The sixth study described early complications and revision outcomes in five patients with rare wrist pathologies (e.g., rheumatoid arthritis, tumor resection, Madelung deformity). Complications included poor osseointegration, fractures, and carpal tunnel syndrome. Implants were removed in three patients. Despite satisfactory pain relief in four cases, aesthetic dissatisfaction was common. These results underscore the importance of stricter patient selection criteria, particularly regarding radial bone quality and anatomical deformities.

Conclusion

Across all studies, 3DCT and 4DCT imaging proved valuable for assessing motion patterns and implant positioning. This thesis supports the cautious and tailored use of wrist and DRUJ arthroplasties and highlights the importance of patient selection, surgical precision, and advanced imaging for improving outcomes in complex ulnar-sided wrist conditions.