Comparative Analysis of Two Hemiarthroplasty Techniques for Symptomatic Distal Radial Ulnar Joint
Nathan Hebel, BS1; Elizabeth Helsper, MD2; Kitty Wu, MD, FRCSC2; Bassem T Elhassan, MD3; Sanjeev Kakar, MD, FAOA4; Moran L Steven, MD5
1Mayo Clinic SoM, Rochester, MN; 2Mayo Clinic, Rochester, MN; 3Orthopedic depatrment/hand devision, Mayo Clinic, Rochester, MN; 4Orthopaedics, Mayo Clinic, Rochester, MN; 5Division of Plastic Surgery, Mayo Clinic, Rochester, MN
Purpose Young patients are not impervious to distal radioulnar joint (DRUJ) instability, deformities, and pain. The purpose of this study was to compare and assess the superiority of two techniques of hemiarthroplasty for the treatment of symptomatic DRUJ in a young cohort.
Methods Thirty-four hemiarthroplasties were performed between 2010 and 2020 by three surgeons at one tertiary medical center. Patients were identified retrospectively and stratified into two groups by implant type: partial ulnar head (A), and Pyrocarbon MCP (B) (off label) (Image 1). Demographics and outcomes were extracted from the electronic medical record (Tables 1, 2, and 3).
Results Between the two groups, objective measures of wrist range of motion, grip strength, and pain showed similar findings with improvement across all categories (Table 2). Statistically significant findings were observed with respect to reduction in pain in both groups as well as improvement in wrist flexion in the pyrocarbon group. Post-operative complications warranting surgical intervention occurred in 10 patients (Table 3). Of these ten were 2 in the ulnar head implant group; pain and reduced range of motion necessitated one revision to an Aptis implant and one revision to a pyrocarbon implant. In the Pyrocarbon group, 8 surgical interventions were required: 3 pinning in supination for reduced range of motion, 1 exchange with a smaller size implant due to pain, 1 addition of meniscal allografting for pain, and three conversions to Aptis implants for pain and instability.
Conclusions Painful DRUJs in young patients warrant a surgical intervention which preserves stability and provides longevity with possibility for revision during their lifetime. Hemiarthroplasty allows for preservation of stability, seen in 33/34 patients in this study, with improved symptom management which was seen in 29/34 patients. This study found equal efficacy of the standard ulnar head implant to that of the off-label use of the MCP Pyrocarbon implant. However, the osteointegration of the partial ulnar head implant means future revision would have increased risk of complication. As well, the metallic head of the partial ulnar head implant is known to cause osteolysis of the radial fossa making it less ideal for young patients with future decades of implant wear. Due to these limitations and the similar efficacy, we recommend the use of this prothesis in young patients with symptomatic DRUJ.
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