Arthroplasty of the distal ulna distal in managing patients with post-traumatic disorders of the distal radioulnar joint: measurement of quality of life

Abstract

ObjectiveTo 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.MethodsTen 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.ResultsThe 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.ConclusionThis 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.

Distal Radioulnar Joint Osteoarthritis: An Update on Treatment Options

“…Aita et al evaluated a case series of 10 patients in which one patient was treated with partial ulnar head arthroplasty and 9 with total ulnar head arthroplasty. 37 Overall, the 10 patients in this study showed range of motion in pronosupination 174.5 AE 7.15 degrees. VAS of 2.13, and palmar grip strength at 90.7% of unaffected side after 1-year follow-up.…”

Ulnar head arthroplasty with posterior interosseous nerve neurectomy: A case report

“…Historically, advanced arthrosis of the DRUJ was commonly treated with complete or parcial resection of the ulnar head (Darrach procedure) or a combination of this and DRUJ arthrodesis, as in the Sauvé-Kapandji procedure [ [2] , [3] , [4] , [5] ]. Despite satisfactory results in some patients, especially older ones, these techniques are associated with high risk of wrist instability and pain.…”

“…Another method of treating these disorders is replacing the ulnar head with an artificial prosthesis. Although seen with some scepticism at the beginning, there is now a significant amount of published data regarding very satisfactory mid-term results of these implants [ [1] , [2] , [3] , 5 , 9 ].…”

“…Distal Radioulnar Joint (DRUJ) arthropathy can occur as a consequence of multiple mechanisms, including trauma, inflammatory or degenerative arthritis or even congenital anomalies in the joint [ 1 , 2 ].For severe injuries the most common treatment procedure has been ulnar head excision. This procedure leads frequently to radioulnar instability and does not always bring a significant pain relief [ 3 , 4 ]. Ulnar head arthroplasty has been proposed as a viable option, potentially restoring wrist function and improving pain control.…”

Avaliação funcional pós-operatória em pacientes submetidos à técnica de Sauvé-Kapandji

“…A sintomatologia também inclui dor, fraqueza e dificuldades na execução das atividades da vida diária, gerando grande impacto na qualidade de vida dos pacientes. Por esta razão, um tratamento adequado é necessário para restabelecer essas perdas de forma parcial ou total [1][2][3][4][5] .…”