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Ulnar Head Implant Arthroplasty as a Treatment for Arthritis of the DRUJ
Brian Adams, MD1; John Gaffey, MD2
1Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA; 2Orthopedics, Des Moines Orthopedic Surgeons- East, Des Moines, IA

Introduction/Hypothesis: Ulnar head implant arthroplasty is becoming an increasingly used option for the treatment of arthritis of the distal radioulnar joint (DRUJ) because it has the potential to avoid problems of radioulnar impingement associated with complete or partial resections.  It is our hypothesis that ulnar head arthroplasty results in a functional range of forearm motion, good patient satisfaction, and good radiographic findings. 

Methods: Following institutional review board (IRB) approval, the initial consecutive 28 patients (28 wrists) who had undergone distal ulnar arthroplasty (three different manufacturers' implants were used) by a single surgeon were reviewed.  Following surgery, patients were evaluated clinically for range of forearm motion, grip strength, and complications.  Radiographs were obtained preoperatively and at follow-up.  Postoperatively, the Patient Rated Wrist Evaluation (PRWE) survey was applied. 

Results: Mean age at surgery was 54 years (range: 23-82 years).  Most common preoperative diagnoses were primary DRUJ arthritis (14), arthritis secondary to fracture or malunion (10), and rheumatoid arthritis (3).  Ten patients had undergone previous operations on the distal ulna.  Postoperatively, four patients were lost to follow-up, two patients died prior to final follow-up, and one patient had their prosthesis removed for loosening and pain.

Mean follow-up for the twenty patients completing our series was 2.6 years (range: 9 months-9.7 years).  Of these twenty, one patient required additional surgery for instability that responded to conversion to a smaller head and soft tissue reconstruction.

Postoperative range of motion averaged 71 degrees and 55 degrees for pronation and supination respectively.  Flexion averaged 55 degrees, while extension averaged 52 degrees.  Average ulnar deviation and radial deviation were 23.1 and 14.7 degrees respectively.

Grip strength at final follow-up averaged 77 lbs on the patientsí operative side compared to 91 lbs for the unaffected side.  At final follow-up, average PRWE scores were 18.5 for pain and 15.7 for function, with a total score of 34.2.

Summary Points: Ulnar head implant arthroplasty is becoming an increasingly used option for the treatment of arthritis of the DRUJ because it has the potential to avoid problems of radioulnar impingement associated with complete or partial resections.  At mean followup of 2.6 years, ulnar head implant arthroplasty results in a functional range of forearm motion, good patient satisfaction, and good radiographic findings.



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