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Clinical outcome and survival rate of the Herbert ulnar head prosthesis for reconstruction of the distal radioulnar joint depending on co-morbidity and different indications

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Abstract

Introduction

Ulnar head prostheses have been developed to restore the integrity of the DRUJ and relieve pain. This study aims to evaluate the long-term outcome of the clinical and radiographic results as well as the survival rate of the Herbert ulnar head prosthesis (UHP) depending on co-morbidity and different indications.

Materials and methods

The Herbert ulnar head prosthesis was implanted in 62 patients. In the majority of the patients, the indication was given due to pain during forearm rotation. This was on account of painful instability of the distal ulna following Bowers (59.7%) or Kapandji procedure (16.1%), Darrach procedure (8.1%) or painful post-traumatic (12.9%) or primary osteoarthritis (3.2%). Of the 62 patients, 34 were men and 28 women. The mean age at the time of operation was 49 years (range 18–84 years). A clinical and radiographic evaluation was performed including pain scale, range of motion, grip strength and the DASH and modified Mayo wrist scores.

Results

The average follow-up was 84.5 months (range 8–206 months), and statistically significant reduction of pain was observed (p < 0.05). The range of motion of pro- and supination improved slightly, but not significantly, whereas the DASH score improved significantly from 56 to 43 (p < 0.05). Patients without an arthrodesis achieved better results in the DASH and in the modified Mayo wrist score.

In 39 cases, a small amount of bone resorption was seen at the collar of the prosthesis in the follow-up radiographs. A revision surgery was necessary in 14 patients. The Kaplan–Meier survival rate after 15 years was 90.3%.

Conclusion

The long-term results of the UHP are encouraging regardless of different indications with a survival rate of more than 90% 7 years following surgery, high patient satisfaction and good clinical and radiographic results.

Level of evidence

IV

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Authors and Affiliations

  1. Division for Hand Surgery, St. Vincent Hospital Hanau, Am Frankfurter Tor 19, 63450, Hanau, Germany

    I. M. Mehling

  2. Clinic for Surgery of the Hand, Bad Neustadt an der Saale, Germany

    R. F. Pronk & J. van Schoonhoven

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Correspondence to I. M. Mehling.

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Conflict of interest

The authors I.M. Mehling and R.F. Pronk declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. J. van Schoonhoven has a speaker`s contract with the KLS Martin, Tuttlingen, Germany. The clinical study is part of the doctoral thesis of R.F. Pronk. All authors were in varying proportions but equally involved. In the conception of the trial, in acquisition, analysis and interpretation of the data In drafting the work or revising it critically for its intellectual content. All authors were involved in final approval of the draft and gave their informed consent. All authors agree to be accountable for all aspects of the work and ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Mehling, I.M., Pronk, R.F. & van Schoonhoven, J. Clinical outcome and survival rate of the Herbert ulnar head prosthesis for reconstruction of the distal radioulnar joint depending on co-morbidity and different indications. Arch Orthop Trauma Surg 143, 2789–2795 (2023). https://doi.org/10.1007/s00402-022-04728-3

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