gms | German Medical Science

Objectives/Interrogation: Arthropathy of the distal radioulnar joint (DRUJ) occurs due to a variety of pathology, including congenital instability, as well as inflammatory, degenerative and post-traumatic arthritis.

Treatment consists of resection, fusion and arthroplasty. However in some cases, instability, pain or failure of primary procedure necessitate further intervention to regain improved function.

The Scheker (Aptis Medical) prosthesis allows for mechanical function with a semi-constrained mechanism in this group of patients, by use of a cobalt chromium radial plate containing a hemi-socket articulating with a UHMWP ball attached to a cobalt chromium fluted stem in the ulna.

Our aim is to assess the outcome of our patients, comparative to the positivity of other studies using the same implant.

Methods: We evaluated the outcome of surgery in a series of consecutive patients from 2013 onwards, in a NHS hospital performed by a single surgeon, providing a regional service. Indications for surgery were in keeping with NICE guidelines. Outcomes were measured using clinical and radiological assessment, with the added use of functional scores and questionnaires. All patients underwent standardised rehabilitation with splinting and hand therapy over a minimum of a 6 week period.

Results and Conclusions: 10 patients with mean age 56 yrs, at time of surgery, were followed for a mean time of 2.5 years (max 6 years).

5 patients had arthritis following trauma, 2 had congenital deformity leading to instability, 2 had osteoarthritis & 1 patient had rheumatoid inflammatory disease with instability.

2 patients had previous ulnar head replacements, one had a failed radio-ulnar fusion with stump impingement & 3 had degenerative instability after wrist trauma. The other 4 had pain & instability due to their primary pathology.

All patients reported improved forearm rotational ROM (supination and pronation), reduced pain (VAS) and improved functional outcome (DASH & PRWE scores).

Implant survival is 100%, with no evidence of infection or need for further surgery to the DRUJ.

Patient satisfaction was high, with early visible improvement seen within weeks of the procedure.

Early to mid-term results suggest that the semi-constrained Scheker prosthesis is a reliable implant in restoring functional stability for patients who have painful degenerative instability of the DRUJ. Further follow up is advised for long-term assessment to assess whether there may be potential for more widespread use.