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

PURPOSE

Distal radioulnar joint (DRUJ) prostheses designed as semiconstrained devices aiming to replace the function of the ulnar head, sigmoid notch of the radius, and triangular fibrocartilage complex have demonstrated the capacity to restore the functional status of the DRUJ. However, soft tissue complications including tendons, nerves, and wounds, although documented, have not been the primary focus of prior reports. This study investigated short- to medium-term soft tissue complications after DRUJ semiconstrained implant arthroplasty.

METHODS

We performed a retrospective review of patients undergoing semiconstrained DRUJ implant arthroplasty with clinical and radiological follow-up greater than 1 year. Data were reviewed with a focus on soft tissue complications after arthroplasty.

RESULTS

Fifty DRUJ implant arthroplasties were performed over 10 years in 49 patients. Patients' average age was 47.8 years. Average duration of follow-up was 35.8 ± 3.7 months. A total of 46 patients underwent multiple operations before DRUJ arthroplasty. Postoperative pronosupination range of motion, grip strength, and visual analog scale pain scores were significantly improved after DRUJ arthroplasty. Wound-healing problems occurred in 11 arthroplasties; however, all wounds subsequently healed without operative intervention. Wound-related complications were significantly increased in patients with a history of rheumatoid arthritis or immunosuppression. Eighteen operations were required to address complications in 8 patients. Extensor tendinopathy was the most common indication for reoperation; 5 tenosynovectomy procedures were required in 4 wrists. A prominent screw requiring removal was identified in 3 cases of tenosynovitis. Periprosthetic fractures were identified in 3 wrists; 2 of these required reoperation for open treatment. Removal of hardware was required in 2 patients; these patients required 9 subsequent reoperations.

CONCLUSIONS

Distal radioulnar joint arthrosis is a major problem and patients commonly undergo multiple reconstructive surgeries before DRUJ implant arthroplasty. No instances of wound-related complications or tendinopathy occurred in patients without previous surgeries, and wound-related complications occurred at a higher frequency with a history of rheumatoid arthritis or immunosuppression.

TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.