Salvage of failed resection arthroplasties of the distal radioulnar joint using an ulnar head prosthesis: long-term results.
OBJECTIVE
The aim of this prospective multicenter study was to evaluate the long-term outcome of the Herbert ulnar head prosthesis for painful instability of the distal radioulnar joint (DRUJ) following resection of the ulnar head.


METHODS
Twenty-three patients were treated with a Herbert ulnar head prosthesis in 3 international hand centers. One patient was excluded from the study because a septic prosthesis had to be removed after 3 months. Sixteen of the remaining 22 patients could be assessed at 2 follow-up times, 28 months (range, 10-43 mo) and 11 years and 2 months (range, 97-158 mo) after surgery, for DRUJ stability, forearm rotation, grip strength, pain level (0-10), and satisfaction (0-10). Standardized radiographs of the wrist were evaluated for displacement of the ulnar head and loosening or bony reactions at the sigmoid notch or the ulna shaft.


RESULTS
All patients demonstrated a clinically stable DRUJ at the latest examination, and no patient required further surgery at the DRUJ since the short-term evaluation in 1999. Average pain measured 3.7 before surgery, 1.7 at the short-term follow-up, and 1.7 at the long-term follow-up; patients' satisfaction, 2.2, 8.2, and 8.9; pronation, 73°, 86°, and 83°; supination, 52°, 77°, and 81°; and grip strength, 42%, 72%, and 81% of the unaffected side. All clinical parameters improved significantly from before surgery to the short-term follow-up, with no further statistically significant change between the short-term and long-term follow-up. Radiographs demonstrated no signs of stem loosening or incongruity of the DRUJ.


CONCLUSIONS
The previously reported short-term results with the Herbert prosthesis did not deteriorate in the long term. Reconstruction of the DRUJ with this prosthesis in painful radioulnar impingement following ulnar head resection is a reliable and reproducible procedure with lasting results.
Klinik für Handchirurgie, Bad Neustadt, Germany. vanschoonhoven@hotmail.com
Jörg
J
van Schoonhoven
Marion
M
Mühldorfer-Fodor
Diego L
DL
Fernandez
Timothy J
TJ
Herbert
D000328:Adult; D000368:Aged; D019643:Arthroplasty, Replacement / Q000379:methods*; D005260:Female; D018737:Hand Strength; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery*; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011446:Prospective Studies; D011859:Radiography; D020127:Recovery of Function; D012399:Rotation; D016879:Salvage Therapy; D016896:Treatment Outcome; D014457:Ulna / Q000000981:diagnostic imaging / Q000601:surgery*; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000601:surgery*