Treatment Outcomes in Patients Undergoing Surgical Treatment for Arthritis of the Distal Radioulnar JointFunding None.
18 December 2019
07 January 2020
16 March 2020 (online)
Objective Surgical treatment options for distal radioulnar joint (DRUJ) arthritis include distal ulnar resection (DUR), DRUJ arthrodesis, and ulnar head replacement. Ulnar convergence leading to persistent pain and clicking is a relatively common complication of complete DUR and DRUJ arthrodesis with distal ulnar segment resection (DRUJA). This led to the development of the distal ulna hemiresection (DUHR) and distal ulnar stump stabilization techniques to reduce the risk of this complication. Patients may experience incomplete relief of pain and limited range of motion (ROM) with these procedures. We hypothesized that there would be no differences in outcomes between the treatment groups, but patients undergoing DUHR, tendon interposition, or distal ulnar stump stabilization would be at lower risk of complications.
Methods Records were retrospectively reviewed for 121 patients undergoing DRUJ procedures between 2000 and 2018 at a single institution to collect patient demographics, surgical details, preoperative diagnosis, and outcomes including complications, revision procedures, ROM, pain, and swelling. Patients were grouped for analysis by procedure type: DUR (Darrach procedure), DUHR (Bowers procedure), and DRUJA (Sauve–Kapandji procedure). Continuous variables were compared using an analysis of variance test and categorical variables using the Freeman–Halton extension of the Fisher's exact test. A multivariate logistic regression analysis was performed to identify significant predictors of outcomes.
Results Seventy-three patients underwent a DUR procedure, while 33 patients underwent a DUHR procedure and 11 underwent a DRUJA procedure. Mean follow-up was 70.6 months. Patients undergoing DRUJA were significantly younger than those undergoing DUR or DUHR procedure (42.4 vs. 60.0 vs. 62.1, p < 0.001). No significant differences between groups were demonstrated in measured outcomes. Posttraumatic arthritis was the most common preoperative diagnosis (43.4%). Persistent pain was the most common negative outcome (25.6%) followed by limited ROM (19.7%). Five patients (4.3%) suffered postoperative complications, most common being rupture of extensor tendons. Five patients (4.3%) underwent revision procedures. Body mass index (BMI) was a significant predictor of persistent pain (odds ratio = 1.09, p = 0.031).
Conclusion The results of our study suggest that outcomes are equivalent between the three distinct treatment groups. Despite the potential benefits, hemiresection, tendon interposition, and distal stump stabilization had no significant effect on outcomes in this study. More than a quarter (25.6%) of patients undergoing DRUJ procedures experience persistent pain postoperatively, while one-fifth (19.7%) experienced limited ROM. Patients with higher BMI are at a significantly greater risk of experiencing persistent postoperative pain.
Level of Evidence This is a Level III, retrospective comparative study.
- 1 Faucher GK, Zimmerman RM, Zimmerman NB. Instability and arthritis of the distal radioulnar joint: a critical analysis review. JBJS Rev 2016; 4 (12) 1
- 2 McKee MD, Richards RR. Dynamic radio-ulnar convergence after the Darrach procedure. J Bone Joint Surg Br 1996; 78 (03) 413-418
- 3 Tulipan DJ, Eaton RG, Eberhart RE. The Darrach procedure defended: technique redefined and long-term follow-up. J Hand Surg Am 1991; 16 (03) 438-444
- 4 Grawe B, Heincelman C, Stern P. Functional results of the Darrach procedure: a long-term outcome study. J Hand Surg Am 2012; 37 (12) 2475-80.e1 , 2
- 5 Bell MJ, Hill RJ, McMurtry RY. Ulnar impingement syndrome. J Bone Joint Surg Br 1985; 67 (01) 126-129
- 6 Minami A, Iwasaki N, Ishikawa J, Suenaga N, Yasuda K, Kato H. Treatments of osteoarthritis of the distal radioulnar joint: long-term results of three procedures. Hand Surg 2005; 10 (2-3): 243-248
- 7 Field J, Majkowski RJ, Leslie IJ. Poor results of Darrach's procedure after wrist injuries. J Bone Joint Surg Br 1993; 75 (01) 53-57
- 8 May MM, Lawton JN, Blazar PE. Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability. J Hand Surg Am 2002; 27 (06) 965-971
- 9 Lluch A. The Sauvé-Kapandji procedure. J Wrist Surg 2013; 2 (01) 33-40
- 10 Bowers WH. Distal radioulnar joint arthroplasty: the hemiresection-interposition technique. J Hand Surg Am 1985; 10 (02) 169-178
- 11 Glowacki KA. Hemiresection arthroplasty of the distal radioulnar joint. Hand Clin 2005; 21 (04) 591-601
- 12 Watson HK, Gabuzda GM. Matched distal ulna resection for posttraumatic disorders of the distal radioulnar joint. J Hand Surg Am 1992; 17 (04) 724-730
- 13 Ahmed SK, Cheung JPY, Fung BK-K, Ip W-Y. Long term results of matched hemiresection interposition arthroplasty for DRUJ arthritis in rheumatoid patients. Hand Surg 2011; 16 (02) 119-125
- 14 George MS, Kiefhaber TR, Stern PJ. The Sauve-Kapandji procedure and the Darrach procedure for distal radio-ulnar joint dysfunction after Colles' fracture. J Hand Surg [Br] 2004; 29 (06) 608-613
- 15 Minami A, Suzuki K, Suenaga N, Ishikawa J. The Sauvé-Kapandji procedure for osteoarthritis of the distal radioulnar joint. J Hand Surg Am 1995; 20 (04) 602-608
- 16 Nakamura R, Tsunoda K, Watanabe K, Horii E, Miura T. The Sauvé-Kapandji procedure for chronic dislocation of the distal radio-ulnar joint with destruction of the articular surface. J Hand Surg [Br] 1992; 17 (02) 127-132
- 17 Sanders RA, Frederick HA, Hontas RB. The Sauvé-Kapandji procedure: a salvage operation for the distal radioulnar joint. J Hand Surg Am 1991; 16 (06) 1125-1129
- 18 Taleisnik J. The Sauvé-Kapandji procedure. Clin Orthop Relat Res 1992; (275) 110-123
- 19 Moulton LS, Giddins GEB. Distal radio-ulnar implant arthroplasty: a systematic review. J Hand Surg Eur Vol 2017; 42 (08) 827-838