Dr. Nur Nurbhai of Phoebe Orthopaedic Specialty Group gives a demonstration of the APTIS distal radio-ulnar joint prosthesis. The device is designed to work as a joint replacement in the wrist so that a patient can regain motion and have the ability to lift weight. (Staff Photo: Jennifer Parks)
ALBANY — Whether from trauma, arthritis or a congenital defect, loss of cartilage or stability in the wrist may ultimately require surgery — even a joint replacement — to correct the problem.
Dr. Nur Nurbhai of Phoebe Orthopaedic Specialty Group performed the first such procedure in Southwest Georgia a few weeks ago. It involves implanting an enclosed joint as a way to allow patients to experience a renewed range of wrist motion.
The treatment is known as a total distal radio-ulnar joint, or DRUJ, prosthesis.
“Think of it as a wrist replacement,” Nurbhai said.
Pain associated with damage to the DRUJ occurs at the end of the forearm, where the radius is supported by and rotates around the ulna. It left untreated, the result can be loss of cartilage.
Nurbhai, a fellowship-trained hand and upper extremity surgeon, completed his training from Dr. Luis Scheker, inventor of a device known as the APTIS DRUJ prosthesis. The treatment involves making an incision in the wrist and implanting a metal joint consisting of a low rod and stem in the long bone of the forearm connected to the joint that is pulled together in a ball and socket fashion. It is designed to have the benefit of the reduction or elimination of pain, regained motion in the wrist and forearm and improved ability to lift and bear weight.
Generally, it is meant as a last resort for those who have not found relief through other means.
“I’ve been in practice for eight years. We knew where the pain was (but many of the other treatments were not very effective),” Nurbhai said. ” … This is a very common problem (from wrist fractures to congenital defects). We usually recommend a more conservative type treatment before we think about replacement.”
Dorothy Banks, of Camilla, on Sept. 18 was the first from Southwest Georgia to have the procedure. She was referred to Nurbhai after complaining to her physician about a pain in her wrist and a loss of feeling in her right hand that prevented her from picking up objects.
She’s still got some recovery time left, but overall, her quality of life has improved significantly. She went so far as to say that her quality of life before the surgery was such that she would not have been able to get by without having the procedure done.
“I’ve got full motion in my hand, and I’ve got to go to therapy to get the stiffness (out of my wrist). Otherwise there is no problem at all,” Banks said. “It’s way better. I’ve got a little stiffness and not quite the full rotation (in my wrist) yet, but it’s getting there. I’ve been given exercises to do, and it’s helping — and I’m not on pain medication. It was just a great thing to happen to me.”
The outpatient procedure usually takes one-and-a-half to two hours. The results of the surgery typically allows a patient to use the wrist with unrestricted motion and some lifting, as advised, two weeks after implantation.
“When (the prosthesis is) put together, (the patient) has full rotation without pain,” Nurbhai said. “It is a rod, plate and ball socket joint.
“There is no similar procedure. People have done other types of surgery to the bone and tissue, but down the road that fails. It is the only thing that restores the joint to full motion.”
Six weeks after the operation, patients are normally fully recovered and able to lift up to 20 pounds.
“They are immobilized for two weeks, and they do therapy over the next few months,” Nurbhai said. “… The result is immediately restored function. There is a weight limit, but most patients are happy just to restore function. … I’ve seen a lot of patients with no good solution to this problem.”
The price for the procedure is comparable to that of a joint replacement, or roughly $7,000, for the average person. Patients may stay in the hospital overnight for pain, but are otherwise permitted to go home the same day, Nurbhai said.