Ulnar head replacement or head resection in patients with distal radioulnar arthritis: a prospective cohort study of clinical and patient-reported outcomes up to 2 years after surgery.

Abstract

Background and purpose:  Traditional surgery for arthritis of the distal radioulnar joint (DRUJ), which typically involves resecting the ulnar head, is being increasingly challenged by newer techniques, such as prosthetic ulnar head replacement. The aim of our prospective cohort study was to investigate the clinical and patient-reported functional results, up to 2 years postoperatively, among patients with DRUJ arthritis treated with ulnar head replacement or resection.

Methods:  40 patients were included and underwent either ulnar head replacement (n = 22) or ulnar head resections (n = 18), due to DRUJ pathology between 2015 and 2020. Patients were followed up at 3, 6, 12, and 24 months postoperatively by the means of Patient-Rated Wrist Evaluation (PRWE) (primary outcome), and Disability of the Arm, Shoulder and Hand (DASH) questionnaires, pain, range of forearm rotation, and grip strength (secondary outcomes). Postoperative complications were recorded. 19 and 16 patients, respectively, responded at the 24-months follow-up. Female sex and inflammatory arthritis were more common in the resection group. General linear regression analyses adjusting for diagnosis and baseline PRWE score were performed for our primary outcome.

Results:  The median and interquartile range (IQR) improvement in PRWE from baseline to 24 months was 69 (IQR 49-87) to 27 (IQR 6-48) in the replacement group and 60 (IQR 50-86) to 23 (IQR 5-44) in the resection group, indicating that both groups improved from baseline. There were no differences in unadjusted estimates at any time point. The adjusted means in PRWE at 24 months were 35 and 26 points in the replacement and resection groups, respectively, corresponding to a statistically insignificant mean difference of 8.6 (95% confidence interval -11.7 to 28.2). We found no statistically significant group differences in any of the secondary outcomes at any time point. Postoperative complications affected 6 patients with ulnar head replacement, whereas none were reported for patients with ulnar head resection.

Conclusion:  We found that the outcome after ulnar head replacement is not superior to ulnar head resection in the short term.