Aptis Distal Radioulnar Joint Implant: Management of Remarkable Complications

Background  The aim of an Aptis distal radioulnar joint (DRUJ) implant is to reconstruct the DRUJ in patients with a destroyed, painful DRUJ, and gross ulnar instability. The literature is scarce regarding the management of (severe) early complications related to the Aptis implant in wrists with more rare conditions, such as rheumatoid arthritis, congenital malformations, or leiomyosarcoma of the distal ulna. Purpose  This paper describes the clinical results, (severe) early complications related to the implant, revision surgery, patient satisfaction with the revision surgery, and esthetic appearance of the affected wrist in this specific cohort. Materials and Methods  Retrospective evaluation of five consecutive patients with a short-to-medium follow-up time of 32 months (range: 18-53 months) was carried out. Results  The follow-up revealed implant osseointegration failure in two cases, periprosthetic fractures in two cases, and acute carpal tunnel syndrome in one case. Three Aptis DRUJ arthroplasties were converted into a proximal Darrach. In four cases (80%), the patient was satisfied with the revision surgery due to pain reduction. In four cases (80%), the esthetic appearance of the affected wrist was found disappointing. Conclusion  This study describes remarkable complications related to the Aptis implants in wrists with more rare conditions. The implant is more likely to fail in wrists with poor bone stock, remodeling of the radius, deformation, and malformation of the radius. The range of indications for the usage of the implant to maintain wrist function may be strict. Level of Evidence  IV.