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J Wrist Surg 2012; 01(01): 023-030
DOI: 10.1055/s-0032-1324407
Special Focus: Total Wrist Arthroplasty
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Preliminary Experience with a New Total Distal Radioulnar Joint Replacement

Timothy J. Ewald
1   Department of Orthopedics, Mayo Clinic, Rochester, Minnesota
,
Kshamata Skeete
1   Department of Orthopedics, Mayo Clinic, Rochester, Minnesota
,
Steven L. Moran
1   Department of Orthopedics, Mayo Clinic, Rochester, Minnesota
2   Division of Hand Surgery, Department of Plastic Surgery, Mayo Clinic, Rochester, Minnesota
› Author Affiliations
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Publication History

Publication Date:
23 August 2012 (online)

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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).

Keywords

arthroplasty - distal radioulnar joint - reconstruction - ulnar head - wrist
 

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