Salvage of Failed Resection Arthroplasties of the Distal Radioulnar Joint Using an Ulnar Head Prosthesis: Long-term Results

Schoonhoven, Jörg van; Mühldorfer-Fodor, Marion; Fernández, Diego L.; Herbert, Timothy J.

doi:10.1016/j.jhsa.2012.04.028

Cited by 74 publications

(14 citation statements)

References 23 publications

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“…In four papers, grip strength was significantly improved, 14,18,29-30 whilst in another four papers, grip strength was not reported.…”

Section: Clinical Resultsmentioning

confidence: 92%

“…13-14,17-18,24,26-30 Two of these papers showed a statistical improvement in pain in 80% of cases. 26,27 The other eight papers did show improvement in the VAS for pain, but it was either not statistically significant, or a statistical analysis was not performed.…”

Section: Clinical Resultsmentioning

confidence: 98%

“…17 It is also mentioned that initial radiological changes at the ulna level and in the sigmoid notch have a tendency not to progress in the long-term. 18 Finally, it is reported that only around half of the radiologically-unstable implants required further surgery. We found only two cases from over 350 reported procedures of deep post-operative infection (0.5%).…”

Section: Clinical Resultsmentioning

confidence: 99%

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Distal radioulnar joint arthroplasty with implants: a systematic review

Calcagni

Giesen

2016

EFORT Open Reviews

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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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“…In four papers, grip strength was significantly improved, 14,18,29-30 whilst in another four papers, grip strength was not reported.…”

Section: Clinical Resultsmentioning

confidence: 92%

Section: Clinical Resultsmentioning

confidence: 98%

Section: Clinical Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Distal radioulnar joint arthroplasty with implants: a systematic review

Calcagni

Giesen

2016

EFORT Open Reviews

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“…41 Twentythree patients were treated with the Herbert UHP in three international hand centers. Sixteen of the 22 patients could be assessed at 2 follow-up times: 28 months (range 10-43 months) and 11 years and 2 months (134 months; range, 97-158 months) after surgery.…”

Section: Discussionmentioning

confidence: 99%

Ulnar Head Replacement and Related Biomechanics

Sauerbier¹,

Arsalan-Werner

Enderle³

et al. 2013

Jnl Wrist Surg

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Up to 30% of patients after distal radius fractures suffer from ulnar-sided wrist pain. 1 This is manifested in the form of wrist pain, restricted movement, weakness, and instability, even after correct reduction of the fracture and bony union. The integrity of the distal radioulnar joint (DRUJ) is necessary for stability and load transfer from the forearm to the wrist. [2][3][4] Osteoarthritis of the DRUJ may occur after trauma due to a bony deformity, a ligamentous injury, or combination of both. 1,5,16 In the surgical treatment of osteoarthritis, "salvage operations" are often necessary, in which the ulnar head is resected partially or completely. 7-10 Numerous clinical studies have demonstrated a reduction of painful clinical symptoms for all these techniques. 11-14 Biomechanically, even a partial resection of the distal ulna destabilizes the wrist, and clinically, it may lead to instability of the distal ulnar stump and the radius. 15,16 Distal radioulnar impingement occurs because the distal support of the radius for rotation and the "cam effect" of the distal ulna have been ablated. As a result, instability of the DRUJ may again lead to restriction of motion and strength as well as to increased pain. [17][18][19] To reduce DRUJ instability, various "soft tissue stabilization operations" have been developed. The most common techniques are the pronator quadratus-interposition flap (Johnson procedure) 20 and the extensor carpi ulnaris (ECU)-flexor carpi ulnaris (FCU) tenodesis (Breen-Jupiter tenodesis). [21][22][23] Biomechanical studies, however, show that these procedures do not provide adequate stabilization of the distal ulna. 24 Ulnar head prostheses have also been developed to restore the integrity of the DRUJ, which has been shown experimentally 6 and clinically. [25][26][27][28] Keywords ► distal radioulnar joint (DRUJ) ► osteoarthritis ► arthroplasty ► ulnar head resection ► ulnar head prosthesis AbstractA 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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“…The UHR is a clinically proven means of re-establishing mechan ical contact between the distal radius and ulna to restore stability of the entire forearm [81,91,92]. The first UHR with previously performed Darrach or Sauvé-Kapandji procedures utilizing a metal head which articulates with a metal cup proximal to the sigmoid notch was introduced in 1992 by Kapandji, and followed by Herbert and van Schoonhoven using an UHR with a ceramic head they started with its use in 1995 [93,94].…”

Section: Discussionmentioning

confidence: 99%

Who introduced the "quadrangular-construct" modification of the Sauvé Kapandji procedure first? Case presentation and brief overview of literature with regard to general, specific and practicable aspects to primary trauma-related surgical treatment including possible salvage options at the distal radioulnar joint

Schmidt¹,

Schmitz²,

Muradyan³

et al. 2017

Trauma Emerg Care

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A 26-year-old male sustained a left wrist injury after an occupational fall from height that was diagnosed as wrist sprain and treated conservatively by a plaster splint in another institution. Eight weeks after injury, the patient could be re-employed in his original occupation as a truck driver. Six years after injury, the patient came in our institution for the first time, and reported increasing pain in his left wrist accompanied with marked restriction of his left forearm's supination and pronation leading to the non-ability to carry out his occupational job 8 weeks previously. On clinical examination, there was pronounced dorsal subluxation of the ulnar head without any given possibilities for it manual closed reduction (i.e. static instability in transverse plane) ( Figure 1A). Posterior-anterior (PA) radiographs of both wrists showed no concomitant ulnar positiv variance (UPV) (i.e. no longitudinal instability) and no posttraumatic arthritic changes in the distal radioulnar joint (DRUJ), but the configuration of the ulnar styloid at the formerly injured left wrist could not be well assessed that suggested an additional rotation deformity of the ulnar head ( Figure 1B). Lateral radiographs of both wrist showed marked fixed subluxation of the ulnar head in dorsal direction (i.e. static instability in transverse plane) ( Figure 1C). Due to these findings, the Sauvé-Kapandji procedure, modified by creating a "quadrangularconstruct", was detected by us. At the preoperative radiographs of the left elbow in both planes there were no signs of any pre-existing degenerative changes with specific regard to the radiocapitellar joint.Intraoperatively, first, the 2 cm long ulna segment was excised typically proximal to the DRUJ, then a Kirschner-wire was drilled into the ulnar head parallel to the plane of the operation table on which the left forearm was positioned at terminal range of pronation (i.e. 90°) ( Figure 2A). After that, the ulnar head was rotated 90° perpendicular to the operation table's plane in dorsal direction using the formerly drilled Kirschner-wire, and so the neutral position of DRUJ could be achieved in which the arthrodesis had to be performed ( Figure 2B). Then, the cartilage of both corresponding surfaces in DRUJ was excised, and the DRUJ arthrodesis in neutral position was carried out using a 3.5 mm titanium malleolar screw, and the Kirschner-wire was removed. The next step included the several years later introduced "quadrangularconstruct" modification of the original Sauvé-Kapandji procedure: After decorticalization of the corresponding radius and ulna shafts proximal to the DRUJ arthrodesis and distal to resection plane of the ulna segment, the formerly excised ulna segment has been inserted transversely between both forearm bones and fixated with a second 3.5 mm titanium cortical screw through the ulna segment graft, and finally, complete restoration of rotation motion arc could be achieved ( Figures 2C-D). The correctly performed surgical procedure was confirmed intraoperatively by flu...

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Salvage of Failed Resection Arthroplasties of the Distal Radioulnar Joint Using an Ulnar Head Prosthesis: Long-term Results

Cited by 74 publications

References 23 publications

Distal radioulnar joint arthroplasty with implants: a systematic review

Distal radioulnar joint arthroplasty with implants: a systematic review

Ulnar Head Replacement and Related Biomechanics

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