[Salvage operations and their differential indication for the distal radioulnar joint]

Clinical outcome and survival rate of the Herbert ulnar head prosthesis for reconstruction of the distal radioulnar joint depending on co-morbidity and different indications

INTRODUCTION

Ulnar head prostheses have been developed to restore the integrity of the DRUJ and relieve pain. This study aims to evaluate the long-term outcome of the clinical and radiographic results as well as the survival rate of the Herbert ulnar head prosthesis (UHP) depending on co-morbidity and different indications.

MATERIALS AND METHODS

The Herbert ulnar head prosthesis was implanted in 62 patients. In the majority of the patients, the indication was given due to pain during forearm rotation. This was on account of painful instability of the distal ulna following Bowers (59.7%) or Kapandji procedure (16.1%), Darrach procedure (8.1%) or painful post-traumatic (12.9%) or primary osteoarthritis (3.2%). Of the 62 patients, 34 were men and 28 women. The mean age at the time of operation was 49 years (range 18-84 years). A clinical and radiographic evaluation was performed including pain scale, range of motion, grip strength and the DASH and modified Mayo wrist scores.

RESULTS

The average follow-up was 84.5 months (range 8-206 months), and statistically significant reduction of pain was observed (p < 0.05). The range of motion of pro- and supination improved slightly, but not significantly, whereas the DASH score improved significantly from 56 to 43 (p < 0.05). Patients without an arthrodesis achieved better results in the DASH and in the modified Mayo wrist score. In 39 cases, a small amount of bone resorption was seen at the collar of the prosthesis in the follow-up radiographs. A revision surgery was necessary in 14 patients. The Kaplan-Meier survival rate after 15 years was 90.3%.

CONCLUSION

The long-term results of the UHP are encouraging regardless of different indications with a survival rate of more than 90% 7 years following surgery, high patient satisfaction and good clinical and radiographic results.

LEVEL OF EVIDENCE

IV.

Clinical and radiological results of distal radioulnar joint arthroplasty with the Aptis prosthesis

We report the results of the treatment of disorders of the distal radioulnar joint with the semi-constrained Aptis prosthesis. Nineteen patients were assessed at a mean follow-up of 7 years. All patients had been operated on previously at the wrist, forearm or elbow. The Disabilities of Arm, Shoulder and Hand score had a mean value of 40, the Patient-Rated Wrist Evaluation score had a mean of 49 and the visual analogue scale for pain had a mean of 3.9. The mean ranges of pronation, supination, wrist flexion and wrist extension were 78°, 76°, 60° and 51°, respectively. The mean grip strength was 23 kg. Complications were noted in ten patients. Eighteen patients would undergo the operation again. The 10-year cumulative survival rate was 84%. The Aptis prosthesis may be a solution to treat patients in whom previous surgery at the distal radioulnar joint has failed.Level of evidence: IV.

[Mid- to long-term functional results after Bowers' hemiresection interposition arthroplasty of the distal radio-ulnar joint]

BACKGROUND

Bowers' hemiresection interposition arthroplasty of the distal radio-ulnar joint has been performed for decades, mainly for the treatment of osteoarthritis of the distal radio-ulnar joint. However, long-term test results are sparse.

OBJECTIVE

Evaluation of a homogeneous patient population following a mid- to long-term postoperative follow-up interval after hemiresection interposition arthroplasty.

PATIENTS AND METHODS

Twenty-five patients were evaluated 77.2 (±34.6) months after surgical therapy with regard to range of motion, grip strength and pain level. The subjective and objective scores DASH (Disabilities of Arm, Shoulder, and Hand) and MMWS (modified Mayo Wrist Score) were collected.

RESULTS

Wrist mobility is not worse than 10.4° in relation to all directions of wrist movement compared with the healthy opposite side. Coarse grip strength is reduced by an average of 5.8 kg compared with the opposite side. The pain level decreased on average from 8.2 preoperatively to 1.8 postoperatively. Postoperatively, 22 patients (88 %) had a stable distal radio-ulnar joint. At the time of follow-up DASH averaged 26.7 (±21.4) and the MMWS averaged 78 (±15.7).

DISCUSSION

Hemiresection interposition arthroplasty is a reliable and safe surgical technique with good subjective and functional outcomes in the mid- to long-term.

Unipolar ulnar head replacement for treatment of post-Darrach procedure instability

The aim of this study was to assess distal radioulnar joint stability after unipolar ulnar head replacement for post-Darrach instability. All the patients who underwent ulnar head replacement between1999 and 2015 for post-Darrach procedure instability at our clinic were reviewed. Seven Hebert-type and two uHead (SBI/Stryker) prostheses were implanted. None of the implants were cemented. We assessed stability, pain, range of motion and strength pre- and postoperatively. The changes in the radiographic appearance between immediate postoperative and the last follow-up were determined. All patients (8 patients and 9 joint replacements) had a stable distal ulnar stump at the mean follow-up of 69 months. No complications occurred and no revisions were needed. Pain on a visual analog scale (VAS) was 0 at rest and 6 during maximum effort at the last follow-up; it was 1.5 at rest and 8.5 during effort preoperatively. Wrist flexion and extension, supination and grip strength were unchanged. Pronation increased from 45° to 70°. An area of bone resorption proximal to the ulnar head implant was found in 5 cases but no secondary displacement of the implant or increased pain was reported. Ulnar head replacement stabilizes the ulnar stump. The implant acts as a spacer to place the soft tissues under tension. Distal ulnar stump instability after the Darrach procedure can be solved by a unipolar ulnar head replacement procedure.

Long-term functional outcome and patient satisfaction after ulnar head resection

BACKGROUND AND AIM

Resection of the ulnar head (Darrach procedure) is still frequently performed in patients suffering from posttraumatic osteoarthritis of the distal radioulnar joint (DRUJ). Ulnar impingement syndrome is sometimes observed with subsequent poor functional outcome. Here, we present a long-term follow-up study after Darrach procedure to evaluate functional results, pain relief, and patient satisfaction.

METHODS

Thirty-seven patients after ulnar head resection who were treated in our clinic between 2006 and 2012 were invited for follow-up investigation. Follow-up included radiologic outcomes, objective measures (active range of motion (AROM) and grip strength), the patients' individual perception of disability (pain, visual analog scale (VAS), the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and patient-rated wrist evaluation score (PRWE)).

RESULTS

A total of 25 patients with 27 operated wrists were available for clinical evaluation and radiologic follow-up. The AROM of the treated wrists averaged 145.7° (89.7% of the contralateral side) for pronation and supination. The average VAS decreased from 6.5 to 2.3 postoperatively. Mean grip strength was 12.4 kg (57.1%). Patients showed satisfying results with an average PRWE of 42 and an average DASH of 25.5. Radiographic radioulnar convergence did not correlate with clinical symptoms. Overall, patient satisfaction was high and 22 patients (88%) would choose to undergo the operation again.

CONCLUSIONS

In patients with posttraumatic and chronic DRUJ osteoarthritis, the Darrach procedure leads to satisfactory long-term results especially concerning mobility and sustainable pain relief. Symptomatic ulnar impingement and persistent pain of the ulnar stump are rare sequelae of this procedure.

Corrective osteotomy for deformity of the distal radius using a volar locking plate

Dorsally angulated malunions of the distal radius have historically been corrected with an opening wedge osteotomy fixed with a dorsal plate. Volar locking plates may facilitate a less morbid approach to corrective osteotomies of the wrist. Eight consecutive patients with an average age of 40 years (range, 15-52 years) underwent correction of a distal radius deformity through a volar approach. Clinical follow-up averaged 17.4 months (range, 7-41 months). Preoperative radiographs revealed an average of 24 degrees of dorsal tilt in patients with dorsal deformity. Postoperatively, their average measurement was <3 degrees of volar tilt. Patients were initially ulnar-positive with an average of 4 mm ulnar-positive variance (range, 2-7 mm). This corrected to less than 1 mm postoperatively. Postoperative disabilities of the arm, shoulder, and hand (DASH), SF-12, and Mayo Wrist scores averaged 10.8, 40.5, and 82.5, respectively. There were no nonunions, and no plates required removal. Distal radius deformity can be effectively addressed through a volar approach with the use of a locking plate.