Download PDF
CC BY-NC-ND 4.0 · J Wrist Surg 2022; 11(05): 425-432
DOI: 10.1055/s-0041-1742098
Scientific Article

Bone Remodeling after Ulna Head Replacement in Distal Radioulnar Joint Arthroplasty: A Radiographic Comparison between a Partial and a Total Ulna Head Concept

Elisabeth Brogren 
1   Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
2   Department of Translational Medicine, Lund University, Lund, Sweden
,
Antonio Abramo
1   Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
2   Department of Translational Medicine, Lund University, Lund, Sweden
,
Magnus Tägil 
3   Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
4   Department of Clinical Sciences, Lund University, Lund, Sweden
› Author Affiliations Funding This research was supported by R&D grant from Region Skåne, Sweden.
› Further Information
   Permissions and Reprints

Abstract

Background Ulna head arthroplasty has become an eligible solution for injury or disease in the distal radioulnar joint. Bone resorption beneath the prosthetic head is often reported, but mechanism poorly understood.

Purpose The aims were to evaluate bone remodeling and radiological instability in two conceptually different distal radioulnar joint arthroplasties: the total and the partial ulna head replacement.

Patients and Methods We conducted a retrospective radiographic assessment of 51 ulna head arthroplasties; 26 Herbert ulna (total ulna head replacement) and 25 First Choice (partial ulna head replacement), to analyze periprosthetic bone resorption and radiologic instability. Intraoperative/immediate postoperative and 1-year radiographs were reviewed by two independent assessors. The radiographic follow-up averaged 13 (10–17) months. The size of the stem in relation to the diameter of the ulna (filling ratio) was measured on the intraoperative/immediate postoperative radiographs. Bone resorption beneath the collar of the prothesis was measured on the 1-year radiographs and expressed as a bone resorption index (BRI) between the length of the resorption and the length of the implant stem. Radiological stability was measured on both the preoperative and the 1-year lateral radiographs.

Results The total ulna head prothesis presented with more extensive bone resorption beneath the prosthetic head than the partial ulna head prothesis at 1-year post surgery (p <0.001). The filling ratio did not influence the 1-year bone resorption and there was no difference regarding radiological instability between the two prosthetic designs.

Conclusion The pattern of bone adaptions after an ulna head prothesis may differ due to design and concept of the prosthesis.

Keywords

ulna head arthroplasty - distal radioulnar joint - bone resorption - stress shielding

Ethical Review Committee Statement

The study was approved by Lund University Ethical Review Board, Sweden No. 2015/110 and No. 2015/121.


Location

The work was performed at the Department of Translational Medicine and the Department of Clinical Sciences, both at Lund University, Lund, Sweden




Publication History

Received: 05 October 2021

Accepted: 17 November 2021

Article published online:
20 January 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Moulton LS, Giddins GEB. Distal radio-ulnar implant arthroplasty: a systematic review. J Hand Surg Eur Vol 2017; 42 (08) 827-838
    CrossrefPubMedGoogle Scholar
  • 2 Warwick D, Shyamalan G, Balabanidou E. Indications and early to mid-term results of ulnar head replacement. Ann R Coll Surg Engl 2013; 95 (06) 427-432
    CrossrefPubMedGoogle Scholar
  • 3 Kakar S, Swann RP, Perry KI, Wood-Wentz CM, Shin AY, Moran SL. Functional and radiographic outcomes following distal ulna implant arthroplasty. J Hand Surg Am 2012; 37 (07) 1364-1371
    CrossrefPubMedGoogle Scholar
  • 4 Willis AA, Berger RA, Cooney III WP. Arthroplasty of the distal radioulnar joint using a new ulnar head endoprosthesis: preliminary report. J Hand Surg Am 2007; 32 (02) 177-189
    CrossrefPubMedGoogle Scholar
  • 5 Galvis EJ, Pessa J, Scheker LR. Total joint arthroplasty of the distal radioulnar joint for rheumatoid arthritis. J Hand Surg Am 2014; 39 (09) 1699-1704
    CrossrefPubMedGoogle Scholar
  • 6 Axelsson P, Sollerman C, Kärrholm J. Ulnar head replacement: 21 cases; mean follow-up, 7.5 years. J Hand Surg Am 2015; 40 (09) 1731-1738
    CrossrefPubMedGoogle Scholar
  • 7 Sabo MT, Talwalkar S, Hayton M, Watts A, Trail IA, Stanley JK. Intermediate outcomes of ulnar head arthroplasty. J Hand Surg Am 2014; 39 (12) 2405-11.e1 , e1
    CrossrefPubMedGoogle Scholar
  • 8 Baring TK, Popat R, Abdelwahab A, Ferris B. Short- to mid-term results of ulna head replacement as both a primary and revision implant. J Clin Orthop Trauma 2016; 7 (04) 292-295
    CrossrefPubMedGoogle Scholar
  • 9 Calcagni M, Giesen T. Distal radioulnar joint arthroplasty with implants: a systematic review. EFORT Open Rev 2017; 1 (05) 191-196
    CrossrefPubMedGoogle Scholar
  • 10 Garcia-Elias M. Failed ulnar head resection: prevention and treatment. J Hand Surg [Br] 2002; 27 (05) 470-480
    CrossrefPubMedGoogle Scholar
  • 11 Kopylov P, Tägil M. Distal radioulnar joint replacement. Tech Hand Up Extrem Surg 2007; 11 (01) 109-114
    CrossrefPubMedGoogle Scholar
  • 12 Garcia-Elias M. Eclypse: partial ulnar head replacement for the isolated distal radio-ulnar joint arthrosis. Tech Hand Up Extrem Surg 2007; 11 (01) 121-128
    CrossrefPubMedGoogle Scholar
  • 13 van Schoonhoven J, Fernandez DL, Bowers WH, Herbert TJ. Salvage of failed resection arthroplasties of the distal radioulnar joint using a new ulnar head prosthesis. J Hand Surg Am 2000; 25 (03) 438-446
    Google Scholar
  • 14 Masaoka S, Longsworth SH, Werner FW, Short WH, Green JK. Biomechanical analysis of two ulnar head prostheses. J Hand Surg Am 2002; 27 (05) 845-853
    CrossrefPubMedGoogle Scholar
  • 15 Hagert CG. Distal radius fracture and the distal radioulnar joint—anatomical considerations. Handchir Mikrochir Plast Chir 1994; 26 (01) 22-26
    PubMedGoogle Scholar
  • 16 Frost HM. Wolff's Law and bone's structural adaptations to mechanical usage: an overview for clinicians. Angle Orthod 1994; 64 (03) 175-188
    CrossrefPubMedGoogle Scholar
  • 17 Engh CA, McGovern TF, Bobyn JD, Harris WH. A quantitative evaluation of periprosthetic bone-remodeling after cementless total hip arthroplasty. J Bone Joint Surg Am 1992; 74 (07) 1009-1020
    CrossrefPubMedGoogle Scholar
  • 18 Frost HM. Bone “mass” and the “mechanostat”: a proposal. Anat Rec 1987; 219 (01) 1-9
    CrossrefPubMedGoogle Scholar
  • 19 Bauer TW, Schils J. The pathology of total joint arthroplasty.II. Mechanisms of implant failure. Skeletal Radiol 1999; 28 (09) 483-497
    CrossrefPubMedGoogle Scholar
  • 20 Denard PJ, Raiss P, Gobezie R, Edwards TB, Lederman E. Stress shielding of the humerus in press-fit anatomic shoulder arthroplasty: review and recommendations for evaluation. J Shoulder Elbow Surg 2018; 27 (06) 1139-1147
    CrossrefPubMedGoogle Scholar
  • 21 Nagels J, Stokdijk M, Rozing PM. Stress shielding and bone resorption in shoulder arthroplasty. J Shoulder Elbow Surg 2003; 12 (01) 35-39
    CrossrefPubMedGoogle Scholar
  • 22 Herbert TJ, van Schoonhoven J. Ulnar head replacement. Tech Hand Up Extrem Surg 2007; 11 (01) 98-108
    Google Scholar
  • 23 Herzberg G. Periprosthetic bone resorption and sigmoid notch erosion around ulnar head implants: a concern?. Hand Clin 2010; 26 (04) 573-577
    CrossrefPubMedGoogle Scholar
  • 24 Adams BD, Gaffey JL. Non-constrained implant arthroplasty for the distal radioulnar joint. J Hand Surg Eur Vol 2017; 42 (04) 415-421
    CrossrefPubMedGoogle Scholar
  • 25 Park KS, Jin SY, Lim JH, Yoon TR. Long-term outcomes of cementless femoral stem revision with the Wagner cone prosthesis. J Orthop Surg Res 2021; 16 (01) 375
    CrossrefPubMedGoogle Scholar
  • 26 DeVito P, Judd H, Malarkey A. et al. Medial calcar bone resorption after anatomic total shoulder arthroplasty: does it affect outcomes?. J Shoulder Elbow Surg 2019; 28 (11) 2128-2138
    CrossrefPubMedGoogle Scholar
  • 27 Aspenberg P, van der Vis H. Fluid pressure may cause periprosthetic osteolysis. Particles are not the only thing. Acta Orthop Scand 1998; 69 (01) 1-4
    CrossrefPubMedGoogle Scholar
  • 28 Jordan RW, Manoharan G, Van Liefland M. et al. Reliability of stemless shoulder arthroplasty in rheumatoid arthritis: observation of early lysis around the humeral component. Musculoskelet Surg 2021; Aug; 105 (02) 139-148
    CrossrefPubMedGoogle Scholar
  • 29 Shim JH, Stavre Z, Gravallese EM. Bone loss in rheumatoid arthritis: basic mechanisms and clinical implications. Calcif Tissue Int 2018; 102 (05) 533-546
    CrossrefPubMedGoogle Scholar