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Maling LC, Smith AM, Williamson M. Long-term survivorship of the Herbert ulnar head prosthesis: a multicentre retrospective cohort study. J Hand Surg Eur Vol 2024:17531934241238938. [PMID: 38534146 DOI: 10.1177/17531934241238938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Lucy C Maling
- Department of Trauma & Orthopaedics, East Kent Hospitals University NHS Foundation Trust, Queen Elizabeth the Queen Mother Hospital, Margate, Kent, UK
| | - Andrew M Smith
- Department of Trauma & Orthopaedics, East Kent Hospitals University NHS Foundation Trust, Queen Elizabeth the Queen Mother Hospital, Margate, Kent, UK
| | - Mark Williamson
- Department of Trauma & Orthopaedics, East Kent Hospitals University NHS Foundation Trust, Queen Elizabeth the Queen Mother Hospital, Margate, Kent, UK
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2
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Archual AJ, DeGeorge BR, Shin AY. Distal Radioulnar Achilles Allograft Interposition Arthroplasty: Does It Solve the Problem of Persistent Pain? J Hand Surg Am 2022:S0363-5023(22)00003-X. [PMID: 35210144 DOI: 10.1016/j.jhsa.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 11/02/2021] [Accepted: 12/21/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Pain and instability following distal ulnar resection for distal radioulnar joint (DRUJ) arthritis is a problem without a clear solution. We investigated the outcomes of DRUJ interposition arthroplasty for the management of symptomatic radioulnar convergence. METHODS A retrospective review was performed for all patients who underwent Achilles tendon allograft interposition arthroplasty following the failure of distal ulna resection between October 2009 and January 2015. Records were reviewed for demographics, comorbidities, surgical history, pre- and postoperative pain, range of motion, grip strength, and complications. Radiographs and computed tomography scans were evaluated for distal radioulnar instability, distal ulnar absorption, ulnar scalloping, radioulnar convergence, and allograft subluxation. Reconstructive failure was defined as the presence of moderate-to-severe persistent distal radioulnar pain, instability with radiographic evidence of radioulnar convergence or allograft subluxation on radiographs or computed tomography scans, or the need for revision arthroplasty procedure. RESULTS Ten patients met the inclusion criteria. The mean age was 49 ± 10 years. The average follow-up after interposition arthroplasty was 76 ± 23 months. The preoperative means of grip strength, arc of pronosupination, flexion, and extension were similar after surgery. The mean arc of pronosupination improved by 26.5°, and the wrist flexion-extension arc in patients without arthrodesis improved by 22.6°. The grip strength increased by 1.7 kg. Seven of 10 patients had continued symptoms of pain and instability related to symptomatic allograft subluxation and/or radioulnar convergence. Five patients underwent revision surgery; the mean time to revision was 26 months. CONCLUSIONS Mid- to long-term follow-up of patients after salvage allograft interposition arthroplasty of the DRUJ resulted in minimal functional improvement in terms of arc of motion and grip strength. Persistent radioulnar pain was common, with half of the patients requiring revision operations following allograft interposition. Given this high failure rate, alternative procedures should be considered for the management of chronic pain and instability of the DRUJ. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
| | - Brent R DeGeorge
- Departments of Plastic and Orthopedic Surgery, University of Virginia, Charlottesville, VA
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3
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Sahito B, Ali SME, Qamar J, Katto MS, Ahmed MW, Jamil M. A Comparison of Outcomes of 'Extensor Carpi Ulnaris Tenodesis' versus 'No Tenodesis' after Resection of the Distal Ulna in Patients with Giant Cell Tumor. J Hand Surg Asian Pac Vol 2022; 27:110-116. [PMID: 35037577 DOI: 10.1142/s2424835522500102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: One of the methods of stabilizing the stump of the ulna following resection of the distal ulna is tenodesis of the extensor carpi ulnaris (ECU). Some studies have recommended stabilization, whereas others have not found it useful. Most of these studies have a mix of different pathologies and often do not have a control group. The aim of this study is to compare the outcomes of ECU tenodesis versus no tenodesis after resection of the distal ulna in patients with grade III giant cell tumor (GCT) of the distal ulna. Methods: The retrospective study included 10 patients with Campanacci grade III GCT of the distal ulna treated by resection of the distal ulna between 2014 and 2019. Patients were stratified into two groups based on whether they underwent ECU tenodesis (n = 5) or no tenodesis (n = 5). The patients were assessed at 6 weeks, 6 months, and 12 months for complications and outcomes using the Mayo wrist score (MWS) and the revised musculoskeletal tumor society score (MSTS). Results: The MWS and the MSTS were significantly better in the ECU tenodesis group at 6 weeks. At 6 months, MWS was similar in both groups, but MSTS continued to be significantly better in ECU tenodesis group. At 12 months, both groups reported similar MWS and MSTS. There were no recurrences in either groups. One patient in the ECU tenodesis group developed ECU tendonitis that resolved with conservative treatment. Conclusions: The outcomes of ECU tenodesis were better in the short term (6 months), although both groups reported similar outcomes at 12 months. Level of Evidence: Level III (Therapeutic).
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Affiliation(s)
- Badaruddin Sahito
- Dow University of Health Sciences, Karachi, Pakistan.,Dr. Ruth KM Pfau Civil Hospital Karachi, Karachi, Pakistan
| | | | - Javeria Qamar
- Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Soughat Katto
- Dow University of Health Sciences, Karachi, Pakistan.,Dr. Ruth KM Pfau Civil Hospital Karachi, Karachi, Pakistan
| | - Malik Wasim Ahmed
- Dow University of Health Sciences, Karachi, Pakistan.,Dr. Ruth KM Pfau Civil Hospital Karachi, Karachi, Pakistan
| | - Muhammad Jamil
- Dow University of Health Sciences, Karachi, Pakistan.,Dr. Ruth KM Pfau Civil Hospital Karachi, Karachi, Pakistan
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Reissner L, Schweizer A, Unterfrauner I, Estermann L, Nagy L. Long-term results of Sauvé-Kapandji procedure. J Hand Surg Eur Vol 2021; 46:626-631. [PMID: 33844599 PMCID: PMC8226425 DOI: 10.1177/17531934211004459] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/23/2021] [Accepted: 03/03/2021] [Indexed: 02/03/2023]
Abstract
The Sauvé-Kapandji procedure is an established treatment option for distal radioulnar joint dysfunction. We retrospectively analysed 36 patients following Sauvé-Kapandji procedure between 1997 and 2013. Fifteen patients were available for a follow-up after a mean of 13 years (range 6 to 23). Six patients needed revision surgery because of ulnar stump instability. Radiographs and sonography were performed to quantify the instability of the proximal ulnar stump. These showed a radioulnar convergence of 8 mm without weight and 2 mm while lifting 1 kg. Sonographically, the proximal ulnar stump dislocated by 8 mm to the volar side while applying pressure to the palm, compared with 4 mm on the contralateral side. Sonographically measured ulnar stump instability showed a positive strong correlation with the Disabilities of the Arm, Shoulder and Hand questionnaire and Patient-Reported Wrist Evaluations and a negative strong correlation with grip strength and supination torque. Because of the high incidence of revision surgery due to instability of the proximal ulnar stump, we restrict the use of the Sauvé-Kapandji procedure only to very selected cases.Level of evidence: IV.
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Affiliation(s)
- Lisa Reissner
- Department of Orthopedics, Hand Surgery Division, Balgrist
University Hospital Zurich, Switzerland
| | - Andreas Schweizer
- Department of Orthopedics, Hand Surgery Division, Balgrist
University Hospital Zurich, Switzerland
| | - Ines Unterfrauner
- Department of Orthopedics, Hand Surgery Division, Balgrist
University Hospital Zurich, Switzerland
| | - Lea Estermann
- Department of Orthopedics, Hand Surgery Division, Balgrist
University Hospital Zurich, Switzerland
| | - Ladislav Nagy
- Department of Orthopedics, Hand Surgery Division, Balgrist
University Hospital Zurich, Switzerland
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5
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Moradi A, Binava R, Vahedi E, Ebrahimzadeh MH, Jupiter JB. Distal Radioulnar oint Prosthesis. THE ARCHIVES OF BONE AND JOINT SURGERY 2021; 9:22-32. [PMID: 33778112 PMCID: PMC7957108 DOI: 10.22038/abjs.2020.53537.2659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 11/30/2020] [Indexed: 11/06/2022]
Abstract
The distal radioulnar joint (DRUJ) prostheses have been available for many years and despite their superior outcomes compared to conventional DRUJ reconstructions in both short and long-term follow-ups, they have not become as popular as common hip and knee prostheses. In the current review article, at the first step, we discussed the applied anatomy and biomechanics of the DRUJ, and secondly, we classified DRUJ prostheses according to available literature, and reviewed different types of prostheses with their outcomes. Finally we proposed simple guidelines to help the surgeon to choose the appropriate DRUJ prosthesis.
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Affiliation(s)
- Ali Moradi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Binava
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ehsan Vahedi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Jesse B. Jupiter
- Hand and Upper Extremity Service, Massachusetts General Hospital, Department of Orthopaedic Surgery, Yawkey Center for Outpatient Care, Boston, Massachusetts, USA
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6
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Fuchs N, Meier LA, Giesen T, Calcagni M, Reissner L. Long-term results after semiconstrained distal radioulnar joint arthroplasty: A focus on complications. HAND SURGERY & REHABILITATION 2020; 39:186-192. [PMID: 32126291 DOI: 10.1016/j.hansur.2020.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 12/31/2019] [Accepted: 01/24/2020] [Indexed: 11/19/2022]
Abstract
Arthroplasty of the distal radioulnar joint (DRUJ) using a semiconstrained DRUJ implant yields good outcomes according to the literature. The aim of this study was to investigate the subjective, clinical and radiographic outcomes with a special focus on complications in nine patients with a mean follow-up of 6years and to compare them with our previously published 3-year follow-up results. No subjective or objective changes were seen between the 3-year and the 6-year follow-up. In the previous study, one implant loosening and two irritations of the superficial branch of the radial nerve occurred. We saw three complications that needed surgery in addition to the three complications already found 3years after surgery. One patient with a large ulna had loosening of the cemented ulnar stem and therefore the prosthesis was explanted. One patient had an allergic reaction to the metal alloy of the prosthesis, which also led to removal. One patient had an ulnar impaction syndrome caused by too-distal placement of the implant that needed revision. Prior studies reported low complication rates. In our study, six complications occurred in four out of nine patients, requiring reoperation including two revisions and two implant removals. A precise surgical technique is mandatory to avoid the otherwise frequent complications and potential implant failures. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- N Fuchs
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
| | - L A Meier
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - T Giesen
- Centro Manoegomito, Clinica Ars Medica, Via Grumo 16, 6929 Gravesano, Switzerland.
| | - M Calcagni
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
| | - L Reissner
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
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7
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Fok MWM, Fernandez DL, van Schoonhoven J. Midterm Outcomes of the Use of a Spherical Ulnar Head Prosthesis for Failed Sauvé-Kapandji Procedures. J Hand Surg Am 2019; 44:66.e1-66.e9. [PMID: 29934080 DOI: 10.1016/j.jhsa.2018.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 04/01/2018] [Accepted: 05/01/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The use of a spherical ulnar head prosthesis (UHP) for the treatment of symptomatic radioulnar convergence after Sauvé-Kapandji (SK) procedure has shown promising results in the short term. This study aims to evaluate the midterm outcome of the original cohort of patients treated with this technique. METHODS Seventeen patients with unstable ulnar stumps confirmed both clinically and radiographically were studied. The etiology for the initial SK procedure included posttraumatic distal radioulnar joint (DRUJ) incongruity, primary DRUJ arthrosis, and dysplastic DRUJ. Fourteen of the 17 patients had a minimum of 2, and a maximum of 6, operations prior to having a spherical UHP. All patients suffered from severe pain with difficulty in performing work and daily activities. Ceramic UHP was used for all patients, except 2 in whom a cobalt chrome head was used. RESULTS The average follow-up was 6 years (range, 4-17 years). A marked reduction in pain was observed with 11 patients reporting that they remained pain free. The range of motion of the wrist and power grip was maintained and showed a statistically significant improvement at the late follow-up. The Disabilities of the Arm, Shoulder, and Hand score also significantly improved from 77 to 41. There were no signs of prosthetic loosening at the midterm follow-up. The 2 patients with cobalt chrome prostheses had pain and osteolysis requiring revision to total DRUJ prosthesis. Two patients with dorsal prosthetic subluxation were successfully treated with distal radial osteotomy. CONCLUSIONS The midterm results of ceramic spherical UHP for failed SK procedures in this small patient series are encouraging. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
| | - Diego L Fernandez
- Department of Orthopaedic Surgery, Lindenhof Hospital, Bern, Switzerland
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8
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Ulnar head arthroplasty with posterior interosseous nerve neurectomy: A case report. Int J Surg Case Rep 2018; 51:340-343. [PMID: 30248626 PMCID: PMC6153192 DOI: 10.1016/j.ijscr.2018.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/27/2018] [Accepted: 09/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Distal Radioulnar joint (DRUJ) arthropathy can occur as a consequence of multiple mechanisms, including trauma, inflammatory or degenerative arthritis or even congenital anomalies. Ulnar head arthroplasty has been proposed as a viable therapeutic option, potentially restoring wrist function and improving pain control. This can also be achieved by complete wrist neurectomy but it has several risks associated with the procedure. A selective neurectomy may be more effective. CASE PRESENTATION We report the case of a 51-year-old man, Tool-Colector, who suffered from constant diffuse left wrist pain aggravated with activities and had a swollen and tender wrist at physical examination with limited range of motion on prono-supination. Radiographic and magnetic resonance imaging showed degenerative changes in the radiocarpal joint and distal radioulnar joint. In order to preserve the remaining mobility and reduce the wrist pain we proceeded with an ulnar head arthroplasty and a posterior interosseous nerve neurectomy, through a single skin incision in the dorso-ulnar side of the wrist. Afterwards, the patient followed a strict rehabilitation program with a hand therapist. Six months later he returned to his previous job with no limitations. CONCLUSIONS Ulnar head arthroplasty seems to be a very good option in the treatment of severe DRUJ arthrosis. It significantly improves pain control while maintains or even improves range of motion. Posterior interosseous nerve neurectomy is a simple technique and highly effective.
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9
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Poujade T, Balagué N, Beaulieu JY. Unipolar ulnar head replacement for treatment of post-Darrach procedure instability. HAND SURGERY & REHABILITATION 2018; 37:S2468-1229(18)30090-2. [PMID: 29880305 DOI: 10.1016/j.hansur.2018.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/17/2018] [Accepted: 05/17/2018] [Indexed: 06/08/2023]
Abstract
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.
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Affiliation(s)
- T Poujade
- Hand and Wrist Unit, hôpital de la Tour, avenue JD-Maillard 1, 1217 Meyrin Genève, Switzerland.
| | - N Balagué
- Hôpitaux universitaire de Genève, service d'orthopédie et traumatologie, unité de chirurgie de la main, rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, Switzerland; Hôpital du Valais, service de chirurgie plastique, reconstructive et de la main, rue St-Charles 14, 3960 Sierre, Switzerland
| | - J-Y Beaulieu
- Hôpitaux universitaire de Genève, service d'orthopédie et traumatologie, unité de chirurgie de la main, rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, Switzerland
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10
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[Endoprostheses of the distal radioulnar joint]. DER ORTHOPADE 2018; 47:677-683. [PMID: 29797017 DOI: 10.1007/s00132-018-3583-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND A stable distal radioulnar joint (DRUJ) is mandatory for the rotation and load transmission in the forearm and wrist. Salvage procedures such as the Darrach operation, Bowers arthroplasty, and the Kapandji-Sauvé procedure include the potential risk of dynamic radioulnar instability and impingement, despite stabilizing techniques addressing the soft tissues. PROSTHESES In an attempt to stabilize the distal forearm mechanically following ulnar head resection, various endoprostheses have been developed to replace the ulnar head. These prostheses can be used for secondary treatment of persistent complaints and unsatisfactory results after ulnar head resection, but also in the primary treatment of osteoarthritis of the DRUJ. Based on promising results concerning improvement in pain, range of motion, and grip strength, with proper indications ulnar head prostheses should be considered as a valuable treatment option for osteoarthritis of the DRUJ.
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Abstract
UNLABELLED The use of implant arthroplasty in the hand and wrist is increasing, often with little evidence of outcomes in the literature. We therefore undertook a systematic review of the outcomes of distal radio-ulnar joint arthroplasties following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Papers were assessed for outcomes, implant survival and methodological quality. Fourteen papers assessed ulna head replacements. The implant survival rate was 93% at a mean follow-up of 45 months. One paper assessed a partial ulna head replacement. Fourteen papers assessed total distal radio-ulnar joint replacements; all but two used the Aptis prosthesis. These implants had a survival rate of 97% at a mean of 56 months. Complications rates were 28% in both groups, and many were major. Although these data are impressive, worldwide there are many more implants placed and not followed up. All studies were level IV and V studies with low Coleman scores. This systematic review demonstrates that implant arthroplasty for the distal radio-ulnar joint has produced acceptable results in small numbers of patients. Whilst these short term outcomes are encouraging, the indications should be carefully considered and there should be proper consideration of the potential for later failure. LEVEL OF EVIDENCE III.
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Affiliation(s)
- L S Moulton
- 1 Hand and Upper Limb Unit, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - G E B Giddins
- 2 Department of Trauma and Orthopaedics, Royal United Hospital, Bath, UK
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12
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Liu S, Sun L, Chai Y, Fan C, Xu Y. [Clinical application progress of the Sauvé-Kapandji procedure]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:1131-1134. [PMID: 29798574 DOI: 10.7507/1002-1892.201702087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review the clinical application progress of the Sauvé-Kapandji procedure. Methods The indications, techniques, effectiveness, and modifications of the Sauvé-Kapandji procedure were analyzed and evaluated by an extensive review of the relevant literature. Results The Sauvé-Kapandji procedure can be applied for various disorders of the distal radioulnar joint. Risk of series of complications exist, which might be reduced by modification of the procedure. Conclusion The Sauvé-Kapandji procedure, as a salvage operation, can be a good alternative by meticulous manipulation for appropriate cases with distal radioulnar joint disorders.
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Affiliation(s)
- Shenghe Liu
- Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai, 200233, P.R.China
| | - Luyuan Sun
- Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai, 200233, P.R.China
| | - Yimin Chai
- Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai, 200233, P.R.China
| | - Cunyi Fan
- Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai, 200233, P.R.China
| | - Yaozeng Xu
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215006,
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Abstract
A severely painful, dysfunctional, or destroyed distal radio-ulnar joint (DRUJ) can be reconstructed by fusion, interposition of soft tissue, or by arthroplasty using prostheses. The objective of this study was to review the literature on implants and evaluate their effectiveness in terms of pain relief, range of motion and longevity. A search was carried out using protocols and well-defined criteria in PubMed, the Cochrane Library and by screening reference lists. The review was conducted according to PRISMA guidelines. Of the 27 publications reporting on nine different implants, we excluded reports with less than five cases and silastic replacements of the ulna head. Eighteen publications describing a total of five implants were selected for analysis. Nine of the publications were useful for the evaluation of implant longevity. Despite methodological shortcomings in many of the source documents, a summary estimate was possible. It seems that DRUJ implants have good potential to improve function through pain reduction; an improvement was observed in 17 series, although it was significant in only seven series. Instability is not uncommon with ulna head-only implants, but they cause fewer clinical problems and re-interventions than might be expected. The risk of deep infection is small with the available implants. Overall implant survival in papers with at least five years’ follow-up is 95%, with a slightly better longevity of 98% for the constrained implants. Periprosthetic osteolysis/radiolucency is frequently reported. Its causes and consequences are not clarified.
Cite this article: Calcagni M, Giesen T. Distal radioulnar joint arthroplasty with implants: a systematic review. EFORT Open Rev 2016;1:191-196. DOI: 10.1302/2058-5241.1.160008.
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Yeo CJ, Morse LP, Krishnan J, Bain GI. Salvage Procedures for Distal Radioulnar Joint Complications. J Hand Surg Asian Pac Vol 2016; 21:173-86. [DOI: 10.1142/s2424835516500168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The distal radioulnar joint (DRUJ) allows forearm rotation and load transmission across the wrist. Post-traumatic and degenerative joint disease of DRUJ may cause pain and disability. Deficiency of the soft tissue or bony supports may result in DRUJ instability. Various techniques have been developed to address arthritis and / or instability of the DRUJ. A comprehensive review of the spectrum of surgical techniques and arthroplasty options is presented. The concepts of these procedures are discussed in detail, with a focus on special points of interest to optimise outcomes and to avoid complications. The salvage of the complications of arthroplasties is also presented in detail.
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Affiliation(s)
- Chong Jin Yeo
- Hand & Microsurgery Section, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Levi Philip Morse
- Flinders University, Adelaide, South Australia, Australia
- Department of Orthopaedics and Trauma, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Jeganath Krishnan
- Flinders University, Adelaide, South Australia, Australia
- Department of Orthopaedics and Trauma, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Gregory Ian Bain
- Flinders University, Adelaide, South Australia, Australia
- Department of Orthopaedics and Trauma, Flinders Medical Centre, Adelaide, South Australia, Australia
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Short- to mid-term results of ulna head replacement as both a primary and revision implant. J Clin Orthop Trauma 2016; 7:292-295. [PMID: 27857506 PMCID: PMC5106519 DOI: 10.1016/j.jcot.2016.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/14/2016] [Accepted: 04/21/2016] [Indexed: 11/21/2022] Open
Abstract
UNLABELLED We present the results of short- to medium-term follow-up of 10 patients following ulna head replacement. The mean age of patients was 63.2 years (range 48-81 years), with the mean duration of follow-up being 48 months (12-88 months). The indications for the procedure were primary osteoarthritis (n = 3), post-traumatic osteoarthritis (n = 4), failed Darrach's procedure (n = 2) and rheumatoid arthritis (n = 1). Two patients required revision (20%), one for gross aseptic loosening of the stem and another for an initially oversized head. At final follow-up, the satisfactory rate was 90%. The mean VAS score was 2.4 (range 0-8). The average DASH score was 37 (range 0-72.5). Our study suggests that ulna head replacement can give satisfactory forearm function; however, concerns exist regarding bone resorption and tapering around the prosthesis, which may affect the long-term performance of the prosthesis. LEVEL OF EVIDENCE IV.
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16
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Artroplastia de ulna distal no manejo dos pacientes com distúrbios pós‐traumáticos da articulação radioulnar distal: mensuração da qualidade de vida. Rev Bras Ortop 2015. [DOI: 10.1016/j.rbo.2015.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Aita MA, Ibanez DS, Saheb GCB, Alves RS. Arthroplasty of the distal ulna distal in managing patients with post-traumatic disorders of the distal radioulnar joint: measurement of quality of life. Rev Bras Ortop 2015; 50:666-72. [PMID: 27218078 PMCID: PMC4867913 DOI: 10.1016/j.rboe.2015.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 10/21/2014] [Indexed: 11/22/2022] Open
Abstract
Objective To measure the quality of life and clinical–functional results from patients diagnosed with osteoarthrosis of the distal radioulnar joint who underwent surgical treatment using the technique of total arthroplasty of the ulna, with a total or partial Ascension® prosthesis of the distal ulna. Methods Ten patients were evaluated after 12 months of follow-up subsequent to total or partial arthroplasty of the distal ulna. All of them presented post-traumatic osteoarthrosis and/or chronic symptomatic instability of the distal radioulnar joint. The study was prospective. Seven patients had previously undergone wrist procedures (two cases with Darrach, three with Sauvé–Kapandji and two with ligament reconstruction of the fibrocartilage complex) and three presented fractures of the distal ulna that evolved with pain, instability and osteoarthrosis of the distal radioulnar joint. The following were assessed: quality of life (DASH scale); percentage degree of palm grip strength (kgf) and pronosupination range of motion in relation to the unaffected side; pain (VAS); return to work; subjective evaluation of radiography; and complications. Results The patients presented a mean range of motion of 174.5° (normal side: 180°). Quality of life was analyzed by applying the DASH questionnaire and the mean value found was 5.9. The mean pain score using the VAS was 2.3. The mean degree of palm grip strength (kgf) was 50.7, which represented 90.7% of the strength on the unaffected side. The complication rate was 10%: this patient presented slight dorsal instability of the ulna and persistent pain, and did not return to work. This patient is still being followed up in the outpatient clinic and occupational therapy sector, with little improvement. He does not wish to undergo a new procedure. The mean length of follow-up was 16.8 months, with a minimum of 10 and maximum of 36 months. Conclusion This concept is subject to the test of time. Implantation of a prosthesis is a very interesting addition to the surgical arsenal for those who are specialists in hand surgery. Arthroplasty of the distal ulna is a safe and effective method with clinical–functional and quality-of-life improvements for patients and presents a low complication rate.
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Sotereanos DG, Papatheodorou LK, Williams BG. Tendon allograft interposition for failed distal ulnar resection: 2- to 14-year follow-up. J Hand Surg Am 2014; 39:443-448.e1. [PMID: 24359796 DOI: 10.1016/j.jhsa.2013.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 11/06/2013] [Accepted: 11/06/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the mid- to long-term outcome of distal radioulnar interposition arthroplasty using an Achilles allograft for salvage of painful instability after distal ulnar resection. METHODS Twenty-six patients with an average age of 43 years were treated with Achilles tendon allograft interposition for failed distal ulnar resection. The average follow-up period was 79 months (range, 25-174 mo). Patients had an average of 2 previous procedures. All patients were evaluated clinically and radiographically. At the final follow-up, pain level, satisfaction, forearm rotation, grip strength, and Mayo Modified Wrist Score were assessed. RESULTS All clinical parameters demonstrated statistically significant improvement at the final follow-up. Mean patient pain scores improved from 8.1 to 1.3, and patient satisfaction scores improved by an average of 6.8 points. Preoperative and postoperative forearm rotation and grip strength measurements improved by an average of 28° in pronation, 41° in supination, and 72% in grip strength. The mean Mayo Modified Wrist Score improved from 42 to 85. Postoperative radiographs showed preservation of an adequate space between the distal radius and the resected distal ulna. No postoperative infections and no foreign body reactions relating to the allograft were observed. CONCLUSIONS Interposition arthroplasty with an Achilles allograft was an effective salvage procedure for the treatment of failed distal ulnar resection, preventing impingement of the ulnar stump on the radius. This procedure potentially provides a safe and reliable treatment, especially for patients who may not be candidates for implant arthroplasty. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Dean G Sotereanos
- Department of Orthopaedic Surgery, University of Pittsburgh, Orthopaedic Specialists-UPMC, Pittsburgh, Pennsylvania.
| | - Loukia K Papatheodorou
- Department of Orthopaedic Surgery, University of Pittsburgh, Orthopaedic Specialists-UPMC, Pittsburgh, Pennsylvania
| | - Benjamin G Williams
- Department of Orthopaedic Surgery, University of Pittsburgh, Orthopaedic Specialists-UPMC, Pittsburgh, Pennsylvania
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Wang W, Liu S, Liu J, Ruan H, Cai Z, Fan C. Modified Sauvé-Kapandji procedure for restoration of forearm rotation in devascularized hands. Ir J Med Sci 2014; 183:643-7. [PMID: 24470183 DOI: 10.1007/s11845-014-1067-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 01/06/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The purpose of this study is to evaluate the clinical outcomes in patients with forearm rotation limitation after successful wrist-level revascularization who underwent a modified Sauvé-Kapandji (S-K) procedure. METHODS This was a retrospective review of the clinical records of nine patients (three women, six men) after successful wrist-level revascularization who underwent late restoration of forearm rotation. All patients were evaluated using a Mayo Modified Wrist Score. The mean patient age was 35 (range 19-45) years. Mean time to reconstruction was 2.5 (range 0.5-4) years. RESULTS Mean postoperative pronation was 74°; mean postoperative supination was 80°. Overall results were excellent/good in seven patients, fair in one, and poor in one. No bone bridge was formed between the pseudarthrosis in any patient. Two patients had neurapraxia. Moderate pain and snapping occurred in one patient during movement at the ulnar amputation site. CONCLUSION This modification of the S-K procedure can restore rotation of the forearm after hand revascularization; as such, it provides an alternative salvage procedure.
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Affiliation(s)
- W Wang
- Department of Orthopaedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 600 Yi Shan Road, Shanghai, 200233, People's Republic of China
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Warwick D, Shyamalan G, Balabanidou E. Indications and early to mid-term results of ulnar head replacement. Ann R Coll Surg Engl 2013; 95:427-32. [PMID: 24025293 DOI: 10.1308/003588413x13629960048235] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this study was to explore the indications and show the early to mid-term results of ulnar head replacement for the treatment of pathological conditions of the distal radioulnar joint. METHODS Our study group comprised 52 patients with a mean age of 64 years who had 56 ulnar head replacements. Seven were implanted to salvage an unstable deletive procedure; the rest were for primary treatment of osteoarthritis, rheumatoid arthritis and trauma. Concomitant procedures along with the ulnar head replacement included wrist arthrodesis, joint replacement and tendon transfers. RESULTS The follow-up duration ranged from 1 year to 11 years (mean: 60 months, median: 60 months). In almost all of the patients, pain improved with a median visual analogue scale score of 2 (mean: 2.2, range: 0-8) and a median DASH (Disabilities of the Arm, Shoulder and Hand) score of 12.5 (mean: 17.9, range: 0-56). Of the 52 patients, 47 reported they would have the same procedure again. CONCLUSIONS Ulnar head replacement appears to be a reliable and effective procedure solving several pathological problems of the distal radioulnar joint. We present a large patient group with a short to medium-term follow-up duration.
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Affiliation(s)
- D Warwick
- University Hospital, Tremona Road, Southampton SO16 6YD, UK.
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21
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Jacoby SM, Bachoura A, Diprinzio EV, Culp RW, Osterman AL. Complications following one-bone forearm surgery for posttraumatic forearm and distal radioulnar joint instability. J Hand Surg Am 2013; 38:976-982.e1. [PMID: 23566725 DOI: 10.1016/j.jhsa.2013.02.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 02/02/2013] [Accepted: 02/05/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To present the outcomes after one-bone forearm (OBF) surgery for chronic posttraumatic forearm and distal radioulnar joint instability. METHODS We conducted a retrospective chart review to study patients who underwent OBF surgery because of a traumatic etiology. We collected patient demographics, surgical technique, preoperative and postoperative range of motion, final grip strength, and complications from the medical records. Patients were asked to complete the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire, a 0- to 10-point pain scale, and a 0- to 10-point treatment satisfaction scale. RESULTS There were 5 male and 5 female patients, with a mean age of 32 years at the time of OBF surgery (range, 17-44 y). The mean number of procedures before OBF surgery was 3.6 (range, 2-7); 4 patients had undergone a Darrach procedure and 3 patients had undergone a Sauvé-Kapandji procedure. The median clinical follow-up duration was 6 years (range, 1-17 y). Wrist and elbow range of motion did not change remarkably before and after surgery. Of 8 primary OBF surgeries, 3 resulted in nonunion. Of 10 patients, 4 experienced painful impingement of the remaining proximal radius on adjacent bone and soft tissue and required a total of 7 procedures after OBF surgery. The median follow-up duration for patient-rated outcomes was 10 years (range, 5-21 y; n = 7). The median Quick Disabilities of the Arm, Shoulder, and Hand questionnaire score was 77, the median pain score was 7, and the median satisfaction score was 7. CONCLUSIONS In our experience, complications after OBF surgery are common. Although wrist and elbow range of motion were spared, pain persisted and functional outcomes were poor. One-bone forearm surgery is our last resort for a chronically painful and unstable forearm. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Sidney M Jacoby
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
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22
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Papatheodorou LK, Rubright JH, Kokkalis ZT, Sotereanos DG. Resection interposition arthroplasty for failed distal ulna resections. J Wrist Surg 2013; 2:13-8. [PMID: 24436784 PMCID: PMC3656583 DOI: 10.1055/s-0032-1333062] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The major complications of distal ulna resection, the Darrach procedure, are radioulnar impingement and instability. High failure rates have been reported despite published modifications of the Darrach procedure. Several surgical techniques have been developed to treat this difficult problem and to mitigate the symptoms associated with painful convergence and impingement. No technique has demonstrated clinical superiority. Recently, implant arthroplasty of the distal ulna has been endorsed as an option for the management of the symptomatic patient with a failed distal ulna resection. However, there are concerns for implant longevity, especially in young, active adults. Resection interposition arthroplasty relies on interposition of an Achilles tendon allograft between the distal radius and the resected distal ulna. Although this technique does not restore normal mechanics of the distal radioulnar joint, it can prevent painful convergence of the radius on the ulna. Achilles allograft interposition arthroplasty is a safe and highly effective alternative for failed distal ulna resections, especially for young, active patients, in whom an implant or alternative procedure may not be appropriate.
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Affiliation(s)
| | - James H. Rubright
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Zinon T. Kokkalis
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dean G. Sotereanos
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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23
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Abstract
A stable distal radioulnar joint (DRUJ) is mandatory for the function and load transmission in the wrist and forearm. Resectional salvage procedures such as the Darrach procedure, Bowers arthroplasty, and Sauvé-Kapandji procedure include the potential risk of radioulnar instability and impingement, which can lead to pain and weakness. Soft tissue stabilizing techniques have only limited success rates in solving these problems. In an attempt to stabilize the distal forearm mechanically following ulnar head resection, various endoprostheses have been developed to replace the ulnar head. The prostheses can be used for secondary treatment of failed ulnar head resection, but they can also achieve good results in the primary treatment of osteoarthritis of the DRUJ. Our experience consists of twenty-five patients (follow-up 30 months) with DRUJ osteoarthritis who were treated with an ulnar head prosthesis, with improvement in pain, range of motion, and grip strength. An ulnar head prosthesis should be considered as a treatment option for a painful DRUJ.
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Affiliation(s)
- Michael Sauerbier
- Department for Plastic, Hand and Reconstructive Surgery, Main-Taunus-Hospitals GmbHCooperation Hospital of the University Hospital Frankfurt, Academic Hospital of the University of Frankfurt am Main, Bad Soden am TaunusGermany
| | - Annika Arsalan-Werner
- Department for Plastic, Hand and Reconstructive Surgery, Main-Taunus-Hospitals GmbHCooperation Hospital of the University Hospital Frankfurt, Academic Hospital of the University of Frankfurt am Main, Bad Soden am TaunusGermany
| | - Elena Enderle
- Departement for Orthopedic Trauma and Reconstructive Surgery, Asklepios Hospital St. Georg, Hamburg, Germany
| | | | - Daniel Vonier
- Department for Plastic, Hand and Reconstructive Surgery, Main-Taunus-Hospitals GmbHCooperation Hospital of the University Hospital Frankfurt, Academic Hospital of the University of Frankfurt am Main, Bad Soden am TaunusGermany
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Wehbé MA. Prosthetic arthroplasty of the distal radioulnar joint: historical perspective and 24-year follow-up. Hand Clin 2013; 29:91-101. [PMID: 23168031 DOI: 10.1016/j.hcl.2012.08.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This is a report of the first prosthetic hemiarthroplasty and full arthroplasty, designed and implanted for the distal radioulnar joint in 1988. Two case reports are presented, with follow-up of 24 years. Experience and problems in the design of both a hemiarthroplasty and total prosthetic arthroplasty are described, in the hope that future developments may avoid past failures.
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25
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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).
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Affiliation(s)
| | - Kshamata Skeete
- Department of Orthopedics, Mayo Clinic, Rochester, Minnesota
| | - Steven L. Moran
- Department of Orthopedics, Mayo Clinic, Rochester, Minnesota
- Division of Hand Surgery, Department of Plastic Surgery, Mayo Clinic, Rochester, Minnesota
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26
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Atwal NS, Clark DA, Amirfeyz R, Bhatia R. SALVAGE OF A FAILED SAUVÉ-KAPANDJI PROCEDURE USING A TOTAL DISTAL RADIO-ULNAR JOINT REPLACEMENT. ACTA ACUST UNITED AC 2011; 15:119-22. [PMID: 20672401 DOI: 10.1142/s021881041000476x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 09/11/2009] [Accepted: 03/01/2010] [Indexed: 11/18/2022]
Abstract
This is the first report in the literature of a patient treated with a DRUJ replacement after Sauvé-Kapandji procedure failed due to pain and instability. The DRUJ replacement is an unconstrained, biomechanically more advantageous implant which can confer stability in cases where soft tissues are inadequate. We describe the treatment and outcome of persistent ulnar instability with a distal radio-ulnar joint replacement following failed salvage procedures for a malunion of a distal radius fracture.
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Affiliation(s)
- N. S. Atwal
- Department of Trauma and Orthopaedic Surgery, Bristol Royal Infirmary, Bristol, UK
| | - D. A. Clark
- Department of Trauma and Orthopaedic Surgery, Bristol Royal Infirmary, Bristol, UK
| | - R. Amirfeyz
- Department of Trauma and Orthopaedic Surgery, Bristol Royal Infirmary, Bristol, UK
| | - R. Bhatia
- Department of Trauma and Orthopaedic Surgery, Bristol Royal Infirmary, Bristol, UK
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27
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Rekonstruktion des distalen Radioulnargelenks mit der Herbert-Ulnakopfprothese. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2011; 23:86-97. [DOI: 10.1007/s00064-011-0018-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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28
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Abstract
Wrist involvement in rheumatoid arthritis (RA) is common. Within 2 years of diagnosis, more than half of patients will have wrist pain, and more than 90% will have wrist disease by 10 years. Although wrist involvement is generally thought to be less disabling than RA of the fingers and hand, it can be a significant cause of pain and disability. Severe disease with bony destruction and synovitis in the wrist can also result in soft-tissue problems including tendon ruptures. In addition to musculoskeletal involvement, systemic manifestations of RA can occur. Felty syndrome can result in a low white blood count and splenomegaly in association with RA. New generation, disease-modifying pharmacologic agents offer promise in controlling the disease progression. Surgical treatments for the diseased wrist are aimed at relieving pain and restoring function. Common procedures include: synovectomy and tenosynovectomy, tendon reconstruction, distal ulnar resection and/or distal radioulnar joint reconstruction, partial and full wrist arthrodesis, and total wrist arthroplasty.
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Affiliation(s)
- Marco Rizzo
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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29
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Abstract
Metallic ulnar head implants have been proposed not only to solve symptomatic radioulnar impingement after Darrach or Sauvé-Kapandji procedures, but also to prevent such an impingement when treating arthritic distal radioulnar joint. This article prospectively analyzes a series of ulnar head implants with special reference to bone resorption at the prosthesis collar and erosion of the sigmoid notch of the distal radius at an average follow-up of 32 months (minimum 24 months).
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Affiliation(s)
- Guillaume Herzberg
- Division of Hand and Upper Extremity Orthopaedic Surgery, Herriot Hospital and Claude Bernard University, 5 Place Arsonval, 69437 Lyon Cedex 03, France.
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30
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Abstract
In the patient in whom primary distal radioulnar joint surgery has failed, consideration must be given to the anatomy and biomechanics of the native joint; how this has been disrupted by injury, disease, and previous trauma; and what is required to reconstruct the joint. The forearm relies on a congruent condylar cam of the distal ulna, with intact soft tissue restraints for normal biomechanics. Surgical reconstruction using tendon graft, autologous bone graft, allograft interposition, and prosthetic reconstruction are discussed in this article. If these procedures fail, then salvage procedures including wide excision of the ulna or one-bone forearm can be performed.
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Affiliation(s)
- Adam C Watts
- Upper Limb Unit, Wrightington Hospital, Hall Lane, Appley Bridge, Wigan, WN6 9EP, UK.
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31
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Yen Shipley N, Dion GR, Bowers WH. Ulnar head implant arthroplasty: an intermediate term review of 1 surgeon's experience. Tech Hand Up Extrem Surg 2009; 13:160-164. [PMID: 19730047 DOI: 10.1097/bth.0b013e3181b4c52d] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Ulnar head arthroplasty has been an emerging alternative for salvage of resection arthroplasty at the distal radioulnar joint (DRUJ) since the early 1990s. Recently, it has been offered for initially treating painful arthrosis or instability of the DRUJ. This follow-up study reports a surgeon's experience treating DRUJ disorders with ulnar head arthroplasty. Twenty-two wrists in 20 patients (11 females, 9 males), 6 with no prior wrist procedures were treated between 1995 and 2006 for painful DRUJ disorders with either Herbert-Martin (Martin Medizin-Technik, Tuttingen, Germany) or Avanta (Small Bone Innovations, New York, NY) head prosthesis. Follow-up averaged 54.3 months. A standardized telephone survey determined preoperative /postoperative verbal analog pain scores and a modified Mayo Wrist Score (delineating poor, fair, good, or excellent outcomes). Data suggest that ulnar head implant arthroplasty is a reasonable treatment option for DRUJ-related pain, loss of function, or salvage of failed distal ulna resection procedures. The analog pain score statistically significant decreased by 1.68 points when comparing preoperative to postoperative scores. Average Modified Mayo Wrist Scores were good, independent of whether the procedure was primary or salvaged. No significant difference was seen between the primary or salvage group modified Mayo Wrist Scores. Whereas averaged modified Mayo scores for both the primary and salvage groups were in the good category, prostheses used as primary procedures may be associated with fewer poor or fair outcomes. Two good and 1 excellent outcome of 3 wrists requiring revision procedures suggest that even with revision of the implant arthroplasty, satisfactory results may be expected.
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Affiliation(s)
- Nancy Yen Shipley
- Department of Orthopaedics, Virginia Commonwealth University, Medical College of Virginia, Richmond, VA 23298-0153, USA.
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32
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Greenberg JA. Reconstruction of the distal ulna: instability, impaction, impingement, and arthrosis. J Hand Surg Am 2009; 34:351-6. [PMID: 19181238 DOI: 10.1016/j.jhsa.2008.11.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 11/09/2008] [Indexed: 02/02/2023]
Abstract
A number of afflictions may affect the distal radioulnar joint that can lead to severe pain, disuse, dysfunction, and disability. The disorders that affect this small anatomic region are complex, have multifactorial etiologies, and can sometimes present difficult diagnostic and treatment options. This article presents an overview of recent developments in the diagnosis and treatment of a variety of conditions that affect the joint and surrounding bone and soft tissues.
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Affiliation(s)
- Jeffrey A Greenberg
- Indiana Hand Center and Indiana University School of Medicine, Indianapolis, IN 46260, USA.
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33
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Greenberg JA, Sotereanos D. Achilles allograft interposition for failed Darrach distal ulna resections. Tech Hand Up Extrem Surg 2008; 12:121-125. [PMID: 18528240 DOI: 10.1097/bth.0b013e3181640346] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Many treatment options exist for the symptomatic patient with a failed Darrach distal ulna resection. Tendon transfers, osteoplasties, soft tissue interpositions, and combinations have been used to mitigate the symptoms of impingement. Recently, implant arthroplasty of the distal ulna has become a favorable option for treating the patient with a symptomatic distal ulna resection. This article presents an alternative treatment option using Achilles tendon allograft as a soft tissue interposition.
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Rotsaert P, Cermak K, Vancabeke M. Case report: revision of failed Sauvé-Kapandji procedure with an ulnar head prosthesis. CHIRURGIE DE LA MAIN 2008; 27:47-9. [PMID: 18314373 DOI: 10.1016/j.main.2007.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Revised: 12/06/2007] [Accepted: 12/15/2007] [Indexed: 11/19/2022]
Abstract
The Sauvé-Kapandji procedure has been developed in order to solve distal radioulnar joint (DRUJ) disorders. Postoperative results are variable. Complications such as painful ulnar stump, ulnar instability and loss of grip strength have often been described. We report the case of a painful ulnar stump instability resulting from a Sauvé-Kapandji procedure. After several attempted salvage procedures, a custom-made Herbert distal ulnar head prosthesis was implanted. Long-term results showed complete pain relief, improvement of the range of motion and satisfactory grip strength recovery. Our findings confirm that the Herbert custom-made ulnar head prosthesis appear to be a reliable salvage solution for failed Sauvé-Kapandji procedures.
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Affiliation(s)
- P Rotsaert
- Department of Orthopaedic Surgery, Erasme University Hospital, 808 route de Lennik, Brussels, Belgium
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35
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Ross M, Thomas J, Couzens G, Coleman S. Salvage of the unstable Sauvé-Kapandji procedure: a new technique. Tech Hand Up Extrem Surg 2007; 11:87-92. [PMID: 17536530 DOI: 10.1097/bth.0b013e318033b537] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Sauvé-Kapandji procedure has been commonly performed in the setting of posttraumatic osteoarthritis of the distal radioulnar joint. A recognized complication is instability of the proximal ulnar stump, which may occur in up to 33% of cases. Salvage of the failed Sauvé-Kapandji procedure in this setting is difficult and can sometimes involve sacrifice of forearm rotation. We report the results of 3 cases of a new salvage procedure in this setting. The radioulnar pseudarthrosis was taken down; ulnar continuity was restored with an intercalary graft; and forearm rotation was restored with matched hemiresection and interposition arthroplasty at the site of previous radioulnar fusion. Postoperatively, all patients achieved good forearm rotation (mean supination, 60 degrees; mean pronation, 65 degrees), had no symptoms of instability, and were satisfied with the results of the procedure. Disabilities of the Arm, Shoulder and Hand scores improved from preoperative mean of 55 to postoperative mean of 18.
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Affiliation(s)
- Mark Ross
- Hand and Upper Limb Unit, Department of Orthopaedic Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
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36
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Abstract
Recent years have seen an increasing awareness of the anatomical and biomechanical significance of the distal radioulnar joint (DRUJ). With this has come a more critical approach to surgical management of DRUJ disorders and a realization that all forms of "excision arthroplasty" can only restore forearm rotation at the expense of forearm stability. This, in turn, has led to renewed interest in prosthetic replacement of the ulnar head, a procedure that had previously fallen into disrepute because of material failures with early implants, in particular, the Swanson silicone ulnar head replacement. In response to these early failures, a new prosthesis was developed in the early 1990s, using materials designed to withstand the loads across the DRUJ associated with normal functional use of the upper limb. Released onto the market in 1995 (Herbert ulnar head prosthesis), clinical experience during the last 10 years has shown that this prosthesis is able to restore forearm function after ulnar head excision and that the materials (ceramic head and noncemented titanium stem), even with normal use of the limb, are showing no signs of failure in the medium to long term. As experience with the use of an ulnar head prosthesis grows, so does its acceptance as a viable and attractive alternative to more traditional operations, such as the Darrach and Sauve-Kapandji procedures. This article discusses the current indications and contraindications for ulnar head replacement and details the surgical procedure, rehabilitation, and likely outcomes.
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Abstract
Replacement arthroplasty of the ulnar head is indicated primarily for stiffness and pain as a consequence of rheumatoid, degenerative, and posttraumatic arthritis of the distal radioulnar joint. It is also successfully used in the setting of previous failed excisional arthroplasty of the distal ulna. A distal ulnar hemiarthroplasty, which anatomically recreates the native ulnar head by employing an eccentric design, is discussed. The surgical technique includes a dorsal approach and careful repair of the soft tissue stabilizers.
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Affiliation(s)
- David J Sauder
- Hand and Upper Limb Centre, University of Western Ontario, St Joseph's Health Care, London, Ontario, Canada
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