Midterm Outcomes of the Use of a Spherical Ulnar Head Prosthesis for Failed Sauvé-Kapandji Procedures

doi:10.1016/j.jhsa.2018.05.005

The Journal of Hand Surgery

Volume 44, Issue 1, January 2019, Pages 66.e1-66.e9

https://doi.org/10.1016/j.jhsa.2018.05.005 Get rights and content

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.

Section snippets

Materials and Methods

Twenty patients who suffered from unstable ulnar stumps and radioulnar convergence following SK procedures were treated with spherical UHPs from January 1999 to January 2011 by the 2 senior authors (D.L.F. and J.v.S.). Three patients were lost to follow-up. Thus, 17 patients were available for analysis. This study sample consisted of 10 women and 7 men with an average age of 47 years (range, 29–70 years). The etiologies for the initial SK procedure were posttraumatic distal radioulnar joint

Results

The average follow-up was 6 years (range, 4–17 years). Pain relief was noted with 11 patients pain free, 5 reporting mild pain, and 1 moderate pain, eventually requiring wrist denervation. The average wrist motion showed an improvement in all ranges of movement: flexion: 42° (± 11) to 64° (± 16) (P = .05); extension: 60° (± 11) to 66° (± 15) (P < .05); pronation: 74° (± 17) to 74° (± 17); supination: 64° (± 20) to 76° (± 15); radial deviation: 15° (± 3) to 21° (± 4) (P < .05); and ulnar

Discussion

Distal radioulnar arthrosis may be managed by a variety of different techniques including ulnar head resection,24, 25, 26 hemiresection arthroplasties of the DRUJ,26, 27 and the SK procedure. The advocates of the SK procedure hold that fusing the DRUJ enables the maintenance of the structural anatomy by preserving the ulnar carpal ligament, the triangular fibrocartilage complex, and the ulnar head. This prevents the ulnar translation or dislocation of the wrist in patients with radiocarpal

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Twenty-Year Experience With Primary Distal Radioulnar Joint Arthroplasty From a Single Institution
2023, Journal of Hand Surgery
The use of implant arthroplasty in the distal radioulnar joint is increasing. Two main types of implants are commonly used, ulnar head prosthesis (UHP) and hemi or semi-constrained total distal radioulnar joint arthroplasty. The literature consists mainly of small patient series. The purpose of this study was to examine our long-term outcomes of distal radioulnar joint arthroplasty.
Patient data were collected in a patient registry from 2000 to 2019. The follow-up included radiographic examination, physical examination, Mayo Wrist Scores, pain level, range of motion, and grip strength. Reoperations were recorded. The implants were a semi-constrained prosthesis and a metallic UHP. The mean age at surgery was 50 years. Patient demographics were similar, but the semi-constrained group had a higher preoperative percentage of instability (85 vs 52 percent). The median follow-up time was 30 months for the semi-constrained implants group and 102 months for the UHP group.
A total of 53 primary semi-constrained total joint arthroplasties and 102 UHPs were included. The grip strength and Mayo Wrist Score improved for both the implant groups. Pain reduced in 76% of the patients. Supination improved for the semi-constrained total joint arthroplasty group. Lifting capacity was better in the semi-constrained total joint arthroplasty patients. The unadjusted reoperation rate was 23% for the semi-constrained implants group and 34% for the UHP group. Twenty-two implants were bilateral; these had comparable results to unilateral implants. Kaplan–Meier survival curves demonstrated 94% survival rate for the semi-constrained implants group and 87% survival for the UHP group after 5 years. The risk factors associated with reoperation for the combined implant group included younger age at surgery, previous wrist surgery, ulnar shortening, and wrist fusion.
Distal radioulnar joint arthroplasty improved functional outcomes in both the implant groups, but reoperations were frequent. The semi-constrained implants group had better lifting capacity. The bilateral implants had comparable outcomes to the unilateral implants.
Therapeutic IV.
Long-term results after semiconstrained distal radioulnar joint arthroplasty: A focus on complications
2020, Hand Surgery and Rehabilitation
Citation Excerpt :
A new arthroplasty was performed with a titanium and ceramic ulnar head prosthesis. Nine months later, the implant dislocated dorsally, and secondary stabilization was performed with so-called Fernandez procedure [22,23]. At the 7-year follow-up visit, the pain level was 8, flexion/extension was 0/0/45° (wrist was in a fixed 45° extended position without any fusion), pronation/supination 65/0/80°, grip strength 13 kg and lifting capacity 3 kg;
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 6 years 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 3 years 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.
IV.
L’arthroplastie semi-contrainte de l’articulation radio-ulnaire distale a démontré des résultats satisfaisants. Le but de cette étude était d’analyser les résultats subjectifs, cliniques et radiographiques en se concentrant sur les complications de neuf patients, 6 ans après l’opération et en comparant les résultats avec ceux obtenus 3 ans après l’opération. Les améliorations subjectives et objectives enregistrées au bout de 3 ans en moyenne ne présentaient pas de différences au bout de 6 ans. Lors de l’étude précédente, un descellement d’implant et deux irritations du rameau superficiel du nerf radial avaient été observées. Trois complications ont nécessité une opération en plus des trois déjà observées lors de la précédente étude. Un patient doté d’une large ulna a subi un descellement de la prothèse attribué au jeu de la tige cimentée dans le canal médullaire de l’ulna. Un autre patient a présenté une réaction allergique à l’alliage de la prothèse, qui a conduit à l’ablation de celle-ci. Un patient a présenté un syndrome de l’ulna longue en raison d’un implant positionné trop distalement nécessitant une révision de l’implant. Des études précédentes ont montré un faible taux de complications. Sur l’ensemble de cette étude, six complications ont été observées sur quatre des neuf patients, nécessitant des réinterventions dont deux révisions et deux retraits de l’implant. Une méthode opératoire précise est indispensable pour éviter les fréquentes complications et les échecs potentiels de la pose de l’implant.
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Distal Radioulnar Joint Osteoarthritis: An Update on Treatment Options
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Scientific articleMidterm Outcomes of the Use of a Spherical Ulnar Head Prosthesis for Failed Sauvé-Kapandji Procedures

Purpose

Methods

Results

Conclusions

Type of study/level of evidence

Section snippets

Materials and Methods

Results

Discussion

J Hand Surg Br

J Hand Surg Am

J Hand Surg Br

J Hand Surg Am

J Hand Surg Br

J Hand Surg Am

J Hand Surg Am

J Hand Surg Am

J Hand Surg Am

J Hand Surg Am

J Hand Surg Am

J Hand Surg Am

J Hand Surg Am

J Hand Surg Am

J Hand Surg Am

J Hand Surg Am

J Hand Surg Br

J Hand Surg Br

J Hand Surg Am

Scientific article
Midterm Outcomes of the Use of a Spherical Ulnar Head Prosthesis for Failed Sauvé-Kapandji Procedures