Salvage of Failed Sauvé–Kapandji Procedure with an Ulnar Head Prosthesis: Report of Three Cases

Smet, Luc De; Peeters, Tom

doi:10.1016/s0266-7681(02)00309-1

Cited by 23 publications

(10 citation statements)

References 17 publications

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“…Other research groups 40,43 as well as our published data 44 show similar short-term and mid-term results using an ulnar head prosthesis in different disorders.…”

Section: Discussionsupporting

confidence: 79%

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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“…Other research groups 40,43 as well as our published data 44 show similar short-term and mid-term results using an ulnar head prosthesis in different disorders.…”

Section: Discussionsupporting

confidence: 79%

Ulnar Head Replacement and Related Biomechanics

Sauerbier¹,

Arsalan-Werner

Enderle³

et al. 2013

Jnl Wrist Surg

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“…24 Independent of this study group, good short-term to mid-term results in the treatment of various disorders of the DRUJ using this prosthesis have been reported. [25][26][27] This follow-up study now finalizes the original study intention to assess the long-term results as a revision procedure in patients with painful instability following previous resection arthroplasties of the DRUJ and demonstrates that this prosthesis and this procedure are durable. Considering the shortcomings of other revision procedures, 3,10,11 the biomechanical evidence, 9,18,19 and our long-term clinical and radiological results, we now consider reconstruction of the DRUJ with the UHP the first treatment option to overcome the symptoms associated with the painful instability of the forearm and wrist following previous resection arthroplasties of the DRUJ.…”

Section: Discussionmentioning

confidence: 99%

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

Schoonhoven

Mühldorfer-Fodor²,

Fernández³

et al. 2012

The Journal of Hand Surgery

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“…Total ulnar head arthroplasty involves a complete resection of the ulnar head with the insertion of a stemmed implant and is intended to treat instability in addition to pain (39,40). In cases of complete DRUJ disruption, there are total DRUJ arthroplasty implants available.…”

Section: Implant Arthroplastymentioning

confidence: 99%

“…In addition to the soft-tissue stabilization procedures just mentioned, both ulnar head and DRUJ replacement implants can be used as salvage for failed resection arthroplasty of the distal ulna (40,(87)(88)(89). Long-term outcomes following ulnar head replacement for treatment of failed distal ulnar resection have shown promise even greater than ten years after the initial surgery (88).…”

Section: Complications and Management: Arthroplastymentioning

confidence: 99%