Distal Radioulnar Joint Interposition Arthroplasty for Primary Distal Radioulnar Joint Arthritis

Abstract

Background Surgical management of the painful, arthritic distal radioulnar joint (DRUJ) remains challenging, particularly in young, active patients.

Description of Technique Following exposure of the DRUJ through a dorsal longitudinal incision over the DRUJ, suture anchors are evenly placed around the sigmoid notch. The sutures are threaded through the dermal allograft to secure the graft into the sigmoid notch. The volar edges of the allograft are passed from radial to ulnar underneath the distal ulna and secured to the remaining allograft dorsally, reducing the DRUJ and creating a stable interposition arthroplasty.

Patients, Methods, and Results We present a case report of a young, manual laborer who had significant improvement in pain, range of motion, and grip strength 6 months following interposition arthroplasty at the DRUJ. He was able to return to work after completing his rehabilitation following surgery.

Conclusions Dermal allograft interposition arthroplasty may provide reliable pain relief while maintaining pronosupination and stability of the DRUJ in the appropriately selected patient, without the need for lifting restrictions.

Keywords

allograft - interposition arthroplasty - DRUJ - arthritis

Publication History

Received: 24 April 2023

Accepted: 10 August 2023

Article published online:
11 September 2023

• References

• 1 Kakar S, Garcia-Elias M. The “four-leaf clover” treatment algorithm: a practical approach to manage disorders of the distal radioulnar joint. J Hand Surg Am 2016; 41 (04) 551-564
• 2 Slater Jr RR. The Sauvé-Kapandji procedure. J Hand Surg Am 2008; 33 (09) 1632-1638
• 3 Scheker LR. Implant arthroplasty for the distal radioulnar joint. J Hand Surg Am 2008; 33 (09) 1639-1644
• 4 Archual AJ, DeGeorge Jr BR, Shin AY. Distal radioulnar Achilles allograft interposition arthroplasty: does it solve the problem of persistent pain?. J Hand Surg Am 2022; 48 (06) 623.e1-623.e8
• 5 Bellevue KD, Thayer MK, Pouliot M, Huang JI, Hanel DP. Complications of semiconstrained distal radioulnar joint arthroplasty. J Hand Surg Am 2018; 43 (06) 566.e1-566.e9
• 6 DeGeorge Jr BR, Berger RA, Shin AY. Constrained implant arthroplasty for distal radioulnar joint arthrosis: evaluation and management of soft tissue complications. J Hand Surg Am 2019; 44 (07) 614.e1-614.e9
• 7 Greenberg JA. Reconstruction of the distal ulna: instability, impaction, impingement, and arthrosis. J Hand Surg Am 2009; 34 (02) 351-356
• 8 Greenberg JA, Sotereanos D. Achilles allograft interposition for failed Darrach distal ulna resections. Tech Hand Up Extrem Surg 2008; 12 (02) 121-125
• 9 Nawijn F, Verhiel SHWL, Jupiter JB, Chen NC. Hemiresection interposition arthroplasty of the distal radioulnar joint: a long-term outcome study. Hand (N Y) 2021; 16 (05) 664-673
• 10 Papatheodorou LK, Rubright JH, Kokkalis ZT, Sotereanos DG. Resection interposition arthroplasty for failed distal ulna resections. J Wrist Surg 2013; 2 (01) 13-18
• 11 Rampazzo A, Gharb BB, Brock G, Scheker LR. Functional outcomes of the Aptis-Scheker distal radioulnar joint replacement in patients under 40 years old. J Hand Surg Am 2015; 40 (07) 1397-1403.e3
• 12 Sotereanos DG, Göbel F, Vardakas DG, Sarris I. An allograft salvage technique for failure of the Darrach procedure: a report of four cases. J Hand Surg [Br] 2002; 27 (04) 317-321
• 13 Sotereanos DG, Papatheodorou LK, Williams BG. Tendon allograft interposition for failed distal ulnar resection: 2- to 14-year follow-up. J Hand Surg Am 2014; 39 (03) 443-448.e1
• 14 Sauerbier M, Hahn ME, Berglund LJ, An KN, Berger RA. Biomechanical evaluation of the dynamic radioulnar convergence after ulnar head resection, two soft tissue stabilization methods of the distal ulna and ulnar head prosthesis implantation. Arch Orthop Trauma Surg 2011; 131 (01) 15-26
• 15 Sauerbier M, Hahn ME, Fujita M, Neale PG, Berglund LJ, Berger RA. Analysis of dynamic distal radioulnar convergence after ulnar head resection and endoprosthesis implantation. J Hand Surg Am 2002; 27 (03) 425-434
• 16 Lamont S, Debkowska M, Johnsen P, Froehle A, Cotterell IH, Isaacs J. Outcomes of Darrach and Sauvé-Kapandji Procedures: A Systematic Review. Hand (N Y) 2022; Jul 9:15589447221107697 . Epub ahead of print. PMID: 35815646
• 17 Giberson-Chen CC, Leland HA, Benavent KA, Harper CM, Earp BE, Rozental TD. Functional outcomes after Sauve-Kapandji arthrodesis. J Hand Surg Am 2020; 45 (05) 408-416
• 18 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
• 19 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
• 20 Herbert TJ, van Schoonhoven J. Ulnar head replacement. Tech Hand Up Extrem Surg 2007; 11 (01) 98-108
• 21 van Schoonhoven J, Mühldorfer-Fodor M, Fernandez DL, Herbert TJ. Salvage of failed resection arthroplasties of the distal radioulnar joint using an ulnar head prosthesis: long-term results. J Hand Surg Am 2012; 37 (07) 1372-1380
• 22 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
• 23 Amundsen A, Rizzo M, Berger R, Moran SL. Salvage of painful porous coated stem ulnar head prosthesis with semiconstrained distal radioulnar joint arthroplasty. J Hand Surg Am 2022; 47 (07) 689.e1-689.e8
• 24 Ahmed SK, Cheung JP, Fung BK, Ip WY. Long term results of matched hemiresection interposition arthroplasty for DRUJ arthritis in rheumatoid patients. Hand Surg 2011; 16 (02) 119-125
• 25 Rabinovich RV, Lee SJ. Proximal row carpectomy using decellularized dermal allograft. J Hand Surg Am 2018; 43 (04) 392.e1-392.e9