(VAS>5,0 cm) but only one patient was dissatisfied and regretted havingundergone arthroplasty.

Mean DASH averaged 27 points; PRWE 31 points and the MAYO wristscore 70.

Radiographic evaluation showed resorption at the distal part of the Ulnaand erosion of the radius for most patients. These changes had come to ahalt for all patients but one at the latest follow-up. No signs of asepticloosening were encountered.

One patient required a capsuloplasty, nine month after the arthroplasty,due to painful instability. Full stability was not achieved but the painreceded.Summary Points:� We conclude that mid-term results for the Herbert UHP were satisfactory.� We found the risk for aseptic loosening and other complications tobe low.

In selected cases, where soft tissues at the DRUJ are assessed as adequate,we believe that Herbert UHP should be considered as a primary option forrevision of resection arthroplasties. The Herbert implant also appears to be aviable option for primary procedures of DRUJ- arthritis but larger long-termstudies needs to confirm that.

REFERENCES

1. Van Shoonhoven J, Fernandez DL, Bowers WH, Herbert TJ. Salvage of failedresection arthroplasties of the distal radioulnar joint using a new ulnar headprosthesis. J Hand Surg. 2000;25(3):438e446.

2. Willis A, Berger RA, Cooney WP III. Arthroplasty of the distal radioulnar jointusing a new ulnar head endoprosthesis: preliminary report. J Hand Surg Am.2007;32(3):177e189.

3. Herzberg G. Periprosthetic bone resorption and sigmoid noth erosion aroundulnar head implants: a concern? Hand Clin. 2010;26(4):573e577.

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4. Van Schoonhoven J, et al. Salvage of failed resection arthroplasties of the distalradioulnar joint using an ulnar head prosthesis: long term results. J Hand Surg.2012;37(7):1372e1380.

5. Kakar S, Swann RP, Perry KI, Wood-Wentz CM, Shin AY, Moran SL. Functionaland radiographic outcomes following distal ulna implant arthroplasty. J HandSurg. 2012;37(7):1364e1371.

6. Warwick D. Indications and early to mid-term results of ulnar head re-placements. An R Coll Surg Engl. 2013;95(6):427e432.

PAPER 22

Clinical Paper Session 03: Wrist/ReconstructionFriday, September 19, 2014 � 10:26e10:33 AMCategory: Evaluation/Diagnosis, Prognosis/Outcomes, Basic ScienceKeyword: Hand and Wrist

Periprosthetic Osteolysis After Total Wrist Arthroplasty:Incidence, Evolution, and HistopathologyLevel 4 Evidence

� Michel E. H. Boeckstyns, MD© Guillaume Herzberg, MD, PhD© Anders Toxvaerd, MD© Lars S. Vadstrup, MD© Manjula Bansal, MD

Hypothesis: Periprosthetic osteolysis (PPO) after total wrist arthroplasty(TWA) is correlated to polyethylene and metallic wear.Methods:1. We obtained an estimate of the occurrence of PPO by analyzing data

from 7 centers in the International Remotion TWA-registry.2. We performed a systematic analysis of annual radiographs from 2

centers. Cases with at least 2 years follow-up were included. Two seniorhand surgeons in close collaboration measured the evolution of thewidth of PPO in defined zones on plain radiographs.

3. In view of evaluating the possible causes of PPO, we analyzed biopsiesfrom the bone-implant interphase in 13 consecutive wrists from one ofthe centers as well as blood samples collected from the patients. Thehistopathological findings were correlated to the radiographic findings.Interrater variance was assessed.

© Speaker has nothing of financial value to disclose

Results:1. In the registry, signs of implant loosening were reported in 6 of 52 cases

seen at follow-up 5-9 years after operation and PPO without implantloosening in another 11 cases.

2. In the systematic analysis, we found significant PPO (> 2mm) at theradial component side in 16 of 44 wrists and at the carpal side in 7. Inmost cases, it stabilized after 1-3 years, but in a few cases it progressedto a markedly larger area (figure 1). In general PPO was not related toevident loosening.

3. Some metallic debris was seen in 21 of 24 specimens by at least one oftwo pathologists and (sparse) polyethylene particles in 19. There was nopositive correlation between the amount of debris and the width of theradiolucent zones. Even in cases with pronounced radiolucency therecould be no polyethylene particles at all and in cases with a relativelyhigh amount of debris there could be no visible osteolysis (figure 2).Neither was there histopathological evidence of infectious or rheuma-toid activity in any of the specimens or blood samples. The level ofmetallic ions in blood was within normal ranges. PPO was not related toa specific diagnosis.

Summary Points: PPO was a common occurrence. In most cases, it was stableand of no concern in terms of implant loosening. In few cases it was pro-gressive. It was not correlated with the occurrence of particulate debris.

REFERENCES

1. Zhu YH, Chiu KY, Tang WM. Review article: polyethylene wear and osteolysis intotal hip arthroplasty. J Orthop Surg. 2001;9(1):91e99.

2. Kurtz SM, Gawel HA, Patel JD. History and systematic review of wear andosteolysis outcomes for first-generation highly crosslinked polyethylene. ClinOrthop Relat Res. 2011;469(8):2262e2277.

3. Boeckstyns ME, Herzberg G, Merser S. Favorable results after total wristarthroplasty: 65 wrists in 60 patients followed for 5e9 years. Acta Orthop.2013;84(4):415e419.

4. Herzberg G, Boeckstyns M, Sorensen AI, Axelsson P, Kroener K, Liverneaux P,et al. “Remotion” total wrist arthroplasty: preliminary results of a prospectiveinternational multicenter study of 215 cases. J Wrist Surg. 2012;1(1):17e22.

5. Ward CM, Kuhl T, Adams BD. Five to ten-year outcomes of the Universal totalwrist arthroplasty in patients with rheumatoid arthritis. J Bone Joint Surg Am.2011;93(10):914e919.

6. Cobb TK, Beckenbaugh RD. Biaxial total-wrist arthroplasty. J Hand Surg Am.1996;21(6):1011e1021.

7. Herzberg G. Periprosthetic bone resorption and sigmoid notch erosion aroundulnar head implants: a concern? Hand Clin. 2010;26(4):573e577.

8. Van Harlingen D, Heesterbeek PJC, De Vos MJ. High rate of complicationsand radiographic loosening of the biaxial total wrist arthroplasty in rheu-matoid arthritis: 32 wrists followed for 6 (5e8) years. Acta Orthop.2011;82(6):721e726.

© Speaker has nothing of financial value to disclose

9. Talwalkar SC, Hayton MJ, Trail IA, Stanley JK. Management of the failed biaxialwrist replacement. J Hand Surg Am. 2005;30(3):248e251.

10. Krukhaug Y, Lie SA, Havelin LI, Furnes O, Hove LM. Results of 189 wrist re-placements. A report from the Norwegian Arthroplasty Register. Acta Orthop.2011;82(4):405e409.

� Other (Please describe): Travel and hotel support from Universal Life-Sciences and SBI Inc (Boeckstyns)

PAPER 23

Clinical Paper Session 03: Wrist/ReconstructionFriday, September 19, 2014 � 10:33e10:40 AMCategory: Treatment, Surgical TechniqueKeyword: Hand and Wrist

Scapholunate Temporary Screw Fixation for the Treatmentof Chronic Scapholunate InstabilityLevel 4 Evidence

© Margaret Woon Man Fok, Dr© Diego L. Fernandez, MD

Hypothesis: For chronic scapholunate ligament instabilities, it is not uncom-mon to see the loss of reduction on radiological images at intermediate to longterm follow-up. We propose the use of scapho-lunate temporary screw fixa-tion to provide a more stable mechanical environment for soft tissue healingafter primary repair or late reconstruction of the scapholunate ligament.Methods: 36 patients who suffered from chronic scapho-lunate instabilitywere studied for the period of 1991 to 2012. Arthroscopic debridement wasperformed for non-dissociative complete tears of the scapho-lunate ligamentwhile primary repair or reconstruction of the scapho-lunate ligament wasperformed for dissociative tears. In all cases, scapho-lunate screw fixationwas then used for the protection of the repair or reconstruction. Active wristmotion was allowed after 3 weeks post-operatively. Clinical and radio-graphic parameters were being monitored at the out-patient clinic regularly.Screws were removed when loosening was noted on roentgenograms whichusually occurred at 4 to7 months after operation.

Statistical analysis of comparing means of pre-operative and post-operative radiologic and clinical parametric data of the operated and the un-affected wrist was performed by the Student’s t-test.Results: Of the 36 patients, there were 11 non-dissociative complete scapho-lunate ligament tears and 25 dissociated tears. The follow-up period was 7.9years. Clinically, 95% of the patients were either mild or no pain post-oper-atively. The range of movement of the wrist was satisfactory with an averageof 55 degrees of wrist extension, 51 degrees of wrist flexion, 26 degrees ofulnar-deviation and 15 degrees of radial deviation. Post-operative roentgen-ograms revealed a scapho-lunate angle of an average of 56 degrees (range, 40-75 degrees). The post-operative scapho-lunate interval decreased significantlyand was at an average of 2.5 mm (range, 1.6-3.8 mm). 2 patients were notedto have residual fixed DISI deformity post-operatively and underwent scapho-capito-lunate fusion.

At the latest follow-up, except for the 2 patients with the above mentionedcomplications, both the scapho-lunate angle and interval were maintained. Nofurther progression to intercarpal and radiocarpal degenerative changes wasnoted. Neither breakage of screw nor infection occurred in this series.Summary Points:� Temporary scapho-lunate screw fixation together with ligament repair, orreconstruction provide a stable closure of the SL interval.

� Both clinical and radiographical parameters can be maintained in the longterm.

� Routine Screw removal is recommended in order to prevent complicationlike screw breakage.

REFERENCES

1. Herbert TJ. Rotary subluxation of the scaphoid. In: Herbert TJ, ed. The FracturedScaphoid. Quality Medical Publishing; 1990:184e189.

2. Filan SL, Herbert T. Herbert screw fixation for the treatment of scapholunateligament rupture. Hand Surg. 1998;3:47e55.

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