Purpose
To determine the functional outcome and complications after conversion from a painful
and unstable ulnar head prosthesis to a semiconstrained distal radioulnar joint arthroplasty.
Methods
We conducted a retrospective review of 11 ulnar head prostheses in 10 patients with
porous coated stems that were revised to semiconstrained prostheses. The median age
of the patients was 47 years. The median number of wrist surgeries prior to conversion
was 4 (range, 1–9). The median time from the ulnar head implant to the revision surgery
was 47 months. Pre- and postoperative pain levels were recorded. Mayo Wrist Scores
were calculated. Grip strength, range of motion, and complications and reoperations
were recorded.
Results
All patients reported moderate or severe pain before surgery, whereas 3 patients reported
moderate pain after surgery. The Mayo Wrist Score improved considerably from a median
of 50 before surgery to 65 after surgery. The grip strength and forearm pronation-supination
showed no change following surgery. The median wrist flexion-extension range improved
considerably. Follow-up was a median of 64 (range, 15–132) months after revision surgery.
Removal of the ulnar head implant was described as difficult by the surgeons, except
in 1 case where the implant was loose. Resection of bone from the distal ulna was
often necessary. One patient needed a reoperation requiring prosthesis removal for
aseptic loosening of the stem 5 years after revision. There were 2 nondisplaced periprosthetic
fractures successfully treated with cast immobilization and 2 additional minor complications,
1 postoperative stitch abscess, and 1 extensor carpi ulnaris tendinitis.
Conclusions
Conversion from an ulnar head implant to a semiconstrained prosthesis provided improved
pain scores and function with a low reoperation rate in this patient series. Removal
of an ulnar head prosthesis can be technically challenging, but it can be performed
leaving enough bone stock for immediate implantation of a semiconstrained implant.
Type of study/level of evidence
Therapeutic V.
Key words
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Article info
Publication history
Published online: August 23, 2021
Accepted:
July 16,
2021
Received:
June 15,
2020
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
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© 2022 by the American Society for Surgery of the Hand. All rights reserved.
