RSS-Feed abonnieren
DOI: 10.1055/s-0032-1324407
Preliminary Experience with a New Total Distal Radioulnar Joint Replacement
Publikationsverlauf
Publikationsdatum:
23. August 2012 (online)
![](https://www.thieme-connect.de/media/jws/201201/lookinside/thumbnails/10.1055-s-0032-1324407-1.jpg)
Abstract
This study reports the intermediate-term results of four patients from a series eight patients who have had an insertion of a new complete distal radioulnar joint (DRUJ) prosthesis.
A retrospective review was performed for all patients who underwent DRUJ joint replacement with the STABILITY Sigmoid Notch Total DRUJ System between the years of 2003 and 2008. To be included in this report, all patients had to have more than 24 months of follow-up and hand examination by the senior author. From the eight patients with this procedure, four patients met the inclusion criteria. These included one patient with painful posttraumatic arthritis, two patients with failed hemiarthroplasty, and one patient with a failed Sauvé–Kapandji procedure. Mean age at the time of surgery was 42.5 years (range: 35 to 51 years) and mean follow-up was 46 months (range: 36 to 66 months). Preoperative and postoperative assessment included range of motion, grip strength, visual analog pain scale, patient satisfaction, and radiographic evaluation.
There was a successful replacement of the DRUJ in all four patients. Final range of motion showed mean pronation of 80 degrees (range: 60 to 90 degrees) and mean supination of 64 degrees (range: 45 to 90 degrees). Final grip strength on the operated extremity was 25.5 kg and averaged 73% of contralateral side. This was an improvement from preoperative grip strength of 14.5 kg visual analog pain scale decreased from 8 to 2.5 following surgery (scale: 1 to 10). Patient satisfaction was 100%. One patient returned to manual labor, one patient returned to office work, and two patients remained off work. Postoperative radiographs depict appropriate alignment of the DRUJ, and there have been no cases of subluxation or dislocation. Implant survival has been 100%.
Total DRUJ joint replacement with sigmoid notch resurfacing and distal ulna replacement is an alternative to ulnar head resection in cases of DRUJ arthritis. Total DRUJ arthroplasty with this resurfacing design may provide a means of decreasing pain and restoring DRUJ stability and motion following severe trauma, failed hemiarthroplasty, or failed Sauvé–Kapandji procedure. More experience is needed with this implant to confirm these initial encouraging results. The level of evidence for this study is IV (therapeutic, case series).
-
References
- 1 Shaaban H, Giakas G, Bolton M , et al. The load-bearing characteristics of the forearm: pattern of axial and bending force transmitted through ulna and radius. J Hand Surg [Br] 2006; 31 (3) 274-279
- 2 Markolf KL, Lamey D, Yang S, Meals R, Hotchkiss R. Radioulnar load-sharing in the forearm. A study in cadavera. J Bone Joint Surg Am 1998; 80 (6) 879-888
- 3 Garcia-Elias M. Soft-tissue anatomy and relationships about the distal ulna. Hand Clin 1998; 14 (2) 165-176
- 4 Linscheid RL. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res 1992; (275) 46-55
- 5 Kauer JM. The distal radioulnar joint. Anatomic and functional considerations. Clin Orthop Relat Res 1992; (275) 37-45
- 6 Hagert CG. The distal radioulnar joint in relation to the whole forearm. Clin Orthop Relat Res 1992; (275) 56-64
- 7 Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res 1984; (187) 26-35
- 8 Adams BD, Berger RA. An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. J Hand Surg Am 2002; 27 (2) 243-251
- 9 Scheker LR, Belliappa PP, Acosta R, German DS. Reconstruction of the dorsal ligament of the triangular fibrocartilage complex. J Hand Surg [Br] 1994; 19 (3) 310-318
- 10 Darrach W. Partial excision of lower shaft of ulna for deformity following Colles' fracture. Ann Surg 1913; 57: 764-765
- 11 Hartz CR, Beckenbaugh RD. Long-term results of resection of the distal ulna for post-traumatic conditions. J Trauma 1979; 19 (4) 219-226
- 12 Dingman PVC. Resection of the distal end of the ulna (Darrach operation); an end result study of twenty four cases. J Bone Joint Surg Am 1952; 34A (4) 893-900
- 13 McKee MD, Richards RR. Dynamic radio-ulnar convergence after the Darrach procedure. J Bone Joint Surg Br 1996; 78 (3) 413-418
- 14 Field J, Majkowski RJ, Leslie IJ. Poor results of Darrach's procedure after wrist injuries. J Bone Joint Surg Br 1993; 75 (1) 53-57
- 15 Bieber EJ, Linscheid RL, Dobyns JH, Beckenbaugh RD. Failed distal ulna resections. J Hand Surg Am 1988; 13 (2) 193-200
- 16 Bell MJ, Hill RJ, McMurtry RY. Ulnar impingement syndrome. J Bone Joint Surg Br 1985; 67 (1) 126-129
- 17 Garcia-Elias M. Failed ulnar head resection: prevention and treatment. J Hand Surg [Br] 2002; 27 (5) 470-480
- 18 Sauve L, Kapandji M. Nouvelle technique des traitement chirurgical des luxations redidivantes isolees de l'extremite intericubitus. J Chir (Paris) 1936; 47: 589-594
- 19 Jacobsen TW, Leicht P. The Sauvé-Kapandji procedure for posttraumatic disorders of the distal radioulnar joint. Acta Orthop Belg 2004; 70 (3) 226-230
- 20 Low CK, Chew WYC. Results of Sauve-kapandji procedure. Singapore Med J 2002; 43 (3) 135-137
- 21 Lamey DM, Fernandez DL. Results of the modified Sauvé-Kapandji procedure in the treatment of chronic posttraumatic derangement of the distal radioulnar joint. J Bone Joint Surg Am 1998; 80 (12) 1758-1769
- 22 Rothwell AG, O'Neill L, Cragg K. Sauvé-Kapandji procedure for disorders of the distal radioulnar joint: a simplified technique. J Hand Surg Am 1996; 21 (5) 771-777
- 23 Minami A, Suzuki K, Suenaga N, Ishikawa J. The Sauvé-Kapandji procedure for osteoarthritis of the distal radioulnar joint. J Hand Surg Am 1995; 20 (4) 602-608
- 24 Vincent KA, Szabo RM, Agee JM. The Sauve-Kapandji procedure for reconstruction of the rheumatoid distal radioulnar joint. J Hand Surg Am 1993; 18 (6) 978-983
- 25 Mikkelsen SS, Lindblad BE, Sommer J. Sauvè-Kapandji operation for disorders of the distal radioulnar joint. Contemp Orthop 1993; 26 (2) 151-155
- 26 Millroy P, Coleman S, Ivers R. The Sauvé-Kapandji operation. Technique and results. J Hand Surg [Br] 1992; 17 (4) 411-414
- 27 Sanders RA, Frederick HA, Hontas RB. The Sauvé-Kapandji procedure: a salvage operation for the distal radioulnar joint. J Hand Surg Am 1991; 16 (6) 1125-1129
- 28 Nakamura R, Tsunoda K, Watanabe K, Horii E, Miura T. The Sauvé-Kapandji procedure for chronic dislocation of the distal radio-ulnar joint with destruction of the articular surface. J Hand Surg [Br] 1992; 17 (2) 127-132
- 29 Taleisnik J. The Sauvé-Kapandji procedure. Clin Orthop Relat Res 1992; (275) 110-123
- 30 Bowers WH. Distal radioulnar joint arthroplasty: the hemiresection-interposition technique. J Hand Surg Am 1985; 10 (2) 169-178
- 31 Watson HK, Ryu JY, Burgess RC. Matched distal ulnar resection. J Hand Surg Am 1986; 11 (6) 812-817
- 32 Bain GI, Pugh DM, MacDermid JC, Roth JH. Matched hemiresection interposition arthroplasty of the distal radioulnar joint. J Hand Surg Am 1995; 20 (6) 944-950
- 33 Imbriglia JE, Matthews D. Treatment of chronic post-traumatic dorsal subluxation of the distal ulna by hemiresection-interposition arthroplasty. J Hand Surg Am 1993; 18 (5) 899-907
- 34 Minami A, Kaneda K, Itoga H. Hemiresection-interposition arthroplasty of the distal radioulnar joint associated with repair of triangular fibrocartilage complex lesions. J Hand Surg Am 1991; 16 (6) 1120-1125
- 35 Sauerbier M, Fujita M, Hahn ME, Neale PG, Berger RA. The dynamic radioulnar convergence of the Darrach procedure and the ulnar head hemiresection interposition arthroplasty: a biomechanical study. J Hand Surg [Br] 2002; 27 (4) 307-316
- 36 Watson HK, Gabuzda GM. Matched distal ulna resection for posttraumatic disorders of the distal radioulnar joint. J Hand Surg Am 1992; 17 (4) 724-730
- 37 Herbert TJ, van Schoonhoven J. Ulnar head replacement. Tech Hand Up Extrem Surg 2007; 11 (1) 98-108
- 38 Kopylov P, Tägil M. Distal radioulnar joint replacement. Tech Hand Up Extrem Surg 2007; 11 (1) 109-114
- 39 Conaway DA, Kuhl TL, Adams BD. Comparison of the native ulnar head and a partial ulnar head resurfacing implant. J Hand Surg Am 2009; 34 (6) 1056-1062
- 40 Gordon KD, Dunning CE, Johnson JA, King GJW. Kinematics of ulnar head arthroplasty. J Hand Surg [Br] 2003; 28 (6) 551-558
- 41 Kakar S, Swann RP, Perry KI, Wood-Wentz CM, Shin AY, Moran SL. Functional and radiogrpahic outcomes following distal ulna implant arthroplasty. J Hand Surg Am 2012; 37: 1364-1371
- 42 Herzberg G. Periprosthetic bone resorption and sigmoid notch erosion around ulnar head implants: a concern?. Hand Clin 2010; 26 (4) 573-577
- 43 Scheker LR. Implant arthroplasty for the distal radioulnar joint. J Hand Surg Am 2008; 33 (9) 1639-1644
- 44 Scheker LR, Babb BA, Killion PE. Distal ulnar prosthetic replacement. Orthop Clin North Am 2001; 32 (2) 365-376
- 45 Willis AA, Berger RA, Cooney III WP. Arthroplasty of the distal radioulnar joint using a new ulnar head endoprosthesis: preliminary report. J Hand Surg Am 2007; 32 (2) 177-189
- 46 Garcia-Elias M, Hagert E. Surgical approaches to the distal radioulnar joint. Hand Clin 2010; 26 (4) 477-483
- 47 Swanson AB. Implant arthroplasty for disabilities of the distal radioulnar joint. Use of a silicone rubber capping implant following resection of the ulnar head. Orthop Clin North Am 1973; 4 (2) 373-382
- 48 Stanley D, Herbert TJ. The Swanson ulnar head prosthesis for post-traumatic disorders of the distal radio-ulnar joint. J Hand Surg [Br] 1992; 17 (6) 682-688
- 49 Sagerman SD, Seiler JG, Fleming LL, Lockerman E. Silicone rubber distal ulnar replacement arthroplasty. J Hand Surg [Br] 1992; 17 (6) 689-693
- 50 McMurtry RY, Paley D, Marks P, Axelrod T. A critical analysis of Swanson ulnar head replacement arthroplasty: rheumatoid versus nonrheumatoid. J Hand Surg Am 1990; 15 (2) 224-231
- 51 van Schoonhoven J, Fernandez DL, Bowers WH, Herbert TJ. Salvage of failed resection arthroplasties of the distal radioulnar joint using a new ulnar head prosthesis. J Hand Surg Am 2000; 25 (3) 438-446
- 52 Fernandez DL, Joneschild ES, Abella DM. Treatment of failed Sauvé-Kapandji procedures with a spherical ulnar head prosthesis. Clin Orthop Relat Res 2006; 445: 100-107
- 53 Sauder DJ, King GJ. Hemiarthroplasty of the distal ulna with an eccentric prosthesis. Tech Hand Up Extrem Surg 2007; 11 (1) 115-120
- 54 Garcia-Elias M. Eclypse: partial ulnar head replacement for the isolated distal radio-ulnar joint arthrosis. Tech Hand Up Extrem Surg 2007; 11 (1) 121-128
- 55 Atwal NS, Clark DA, Amirfeyz R, Bhatia R. Salvage of a failed Sauve-Kapandji procedure using a total distal radio-ulnar joint replacement. Hand Surg 2010; 15 (2) 119-122
- 56 O'Flynn HM, Rosen A, Weiland AJ. Failure of the hinge mechanism of a trispherical total wrist arthroplasty: a case report and review of the literature. J Hand Surg Am 1999; 24 (1) 156-160
- 57 Groot D, Gosens T, Leeuwen NC, Rhee MV, Teepen HJ. Wear-induced osteolysis and synovial swelling in a patient with a metal-polyethylene wrist prosthesis. J Hand Surg Am 2006; 31 (10) 1615-1618
- 58 Stuart PR, Berger RA, Linscheid RL, An KN. The dorsopalmar stability of the distal radioulnar joint. J Hand Surg Am 2000; 25 (4) 689-699