Comparison of the Native Ulnar Head and a Partial Ulnar Head Resurfacing Implant

Conaway, Danielle A.; Kuhl, Taften L.; Adams, Brian D.

doi:10.1016/j.jhsa.2009.03.014

Cited by 15 publications

(7 citation statements)

References 6 publications

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“…This implant is contraindicated in patients with substantial ulnar positive variance in which proper DRU joint congruity cannot be obtained and in those with a previous complete ulnar head resection. In a cadaveric study, the implant provided a close match to the native ulnar head as well as good joint alignment and stability (Conaway et al, 2009). This implant is probably preferable to a total ulnar head when preoperative joint alignment is good, but because of its monoblock design it cannot be used when the DRU joint is substantially dysplastic.…”

Section: Implant Designsmentioning

confidence: 99%

Non-constrained implant arthroplasty for the distal radioulnar joint

Adams

Gaffey

2017

J Hand Surg Eur Vol

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A variety of surgical techniques are used to treat the arthritic distal radioulnar joint, which is influenced by aetiology and previous procedures. Four types of ulnar head arthroplasty exist: total ulnar head, partial ulnar head, unlinked total distal radioulnar joint, and linked distal radioulnar joint. Although long-term outcome studies are sparse, short-term clinical and biomechanical studies have shown encouraging results, leading to expanded indications. Based on our experience and a literature review, patients are advised that pain is improved but minor pain is common after strenuous activity. Ulnar neck resorption is common, however, implant loosening is rare. Sigmoid notch erosion is concerning, but appears to stabilize and not affect outcome. A partial ulnar head replacement that retains bony architecture and soft tissue restraints may have benefit over a total ulnar head in appropriate patients. If appropriate selection criteria are met, ulnar head replacement typically produces reliable results, with low revision.

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Section: Implant Designsmentioning

confidence: 99%

Non-constrained implant arthroplasty for the distal radioulnar joint

Adams

Gaffey

2017

J Hand Surg Eur Vol

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“…The authors recommended incorporating modularity and an adjustable eccentricity to the ulnar head. Similarly, Conaway et al 11 performed a study comparing a native ulnar head and a partial ulnar head implant. The authors suggested that with the partial head replacement, offset has a critical role in providing tension in the joint capsule and TFCC and possibly increases joint contact forces, all aiding stability in the DRUJ.…”

Section: Discussionmentioning

confidence: 99%

“…There is no offset. The partial head replacement, with sparing of the ulnar styloid, provides better stability than the complete head replacement, but it is indicated only if the TFCC insertion is well-preserved, 11 which is a relatively uncommon clinical finding.…”

mentioning

confidence: 99%

Effect of Ulnar Head Offset on Distal Radioulnar Joint Stability

Orbay

Vernon

Poirier

et al. 2021

The Journal of Hand Surgery

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Purpose A complete ulnar head replacement may be indicated in cases of distal radial ulnar joint (DRUJ) dysfunction to address bony pathology in lieu of using a constrained total DRUJ prosthesis. Complete ulnar head implants are simple, but they may be unstable if soft tissue tension is not adequately restored. We hypothesized that incorporating an increased offset in the complete ulnar head replacement would lead to increased tension on the distal oblique interosseous ligament, increased contact force at the DRUJ, and improved joint stability.Methods Using a specially designed jig, we measured instability by comparing displacement under load (stiffness) of the DRUJ in 10 cadaveric specimens under 4 different conditions: (1) intact, (2) native head after excision of the triangular fibrocartilage complex, (3) replacement of the ulnar head with a standard offset ulnar head, and (4) replacement of the ulnar head with an increased offset ulnar head. No soft tissue repair was done. We measured anteroposterior displacement under load with maximum translation of 10 mm or maximum loads of 50 N. We tested all specimens with the forearm positioned in neutral, supination, and pronation.Results Excising the triangular fibrocartilage complex decreased the average stiffness of the DRUJ to 46% of the intact state, creating a simulated state of DRUJ instability. Replacing the ulnar head with the standard offset head increased average stiffness to 54% of the intact state. Increasing the ulnar head offset with the simulated total ulnar head replacement increased average stiffness to 77% of the intact state.Conclusions An increased offset ulnar head replacement improves DRUJ stability compared with a standard anatomic offset ulnar head replacement.Clinical relevance Understanding DRUJ morphology and offset is important in the treatment of DRUJ arthritis and instability.

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“…In an effort to correct these deficiencies, current basic and clinical research has focused on the development of an ulnar head prosthesis. [37][38][39] In comparison with the Darrach procedure, ulnar head replacement has been shown to restore the normal axis of forearm rotation and resist compressive forced at the DRUJ. 35,40 Recent reports examining ulnar head replacement have noted a high incidence of sigmoid notch erosion following ulnar head replacement.…”

mentioning

confidence: 99%

Preliminary Experience with a New Total Distal Radioulnar Joint Replacement

2012

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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 Sauv??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 Sauv??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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Comparison of the Native Ulnar Head and a Partial Ulnar Head Resurfacing Implant

Cited by 15 publications

References 6 publications

Non-constrained implant arthroplasty for the distal radioulnar joint

Non-constrained implant arthroplasty for the distal radioulnar joint

Effect of Ulnar Head Offset on Distal Radioulnar Joint Stability

Preliminary Experience with a New Total Distal Radioulnar Joint Replacement

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