FIVE-YEAR RESULTS OF DISTAL RADIOULNAR JOINT RECONSTRUCTION WITH HERBERT ULNAR HEAD

Abstract

Introduction and Aims: Distal radioulnar joint surgery in the past have been dominated by different types of partial or complete ulnar head excision. However, in the long run this can create a number of problems; hence we have used Herbert modular prosthesis to tackle these very difficult situations. This prosthesis comprises of a press fit stem in three sizes and a ceramic head also available in three sizes.

Method: In Wrightington Hospital upper limb unit, 61 patients underwent Herbert ulnar head replacement. Fifty-eight were clinically and radiologically reviewed. This is the largest series from a single centre of this type of surgery.

Between December 1998 and December 2002, 21 male and 27 female patients were operated. The mean age was 49.8 (range 28–72 years). Twenty-two left, eighteen right and two bilateral replacements were performed. The mean follow-up was 20.02 months (range 3–60 months).

An independent observer, using range of motion, grip strength and satisfaction as outcome, reviewed all patients.

Results: Primary diagnoses included failed Darrach, Bower, Sauve Kapandji and traumatic ulnar head excision. Forty-five patients were satisfied with the outcome. Pain score showed a mean improvement of four, with a range of 0–10. The grip strength compared to normal side was decreased in 50% of the patients. The range of motion compared to normal side improved by a mean of 10 degrees (range 3–20) in supination and 13 (range 4–23) in pronation.

Conclusion: Radiological review showed new bone (eight) and notch formation (nine). Stress shielding of 0–19mm was observed in distal ulna with revision or emergency stem. Complication occurred in eight patients: instability (four), RSD (one), implant failure (one) and two others. Twelve patients required further surgery. No loosening was observed at revision. There are no long-term results available at present.