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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

Moloney, Maria ; Larsson, Sara LU orcid and Brogren, Elisabeth LU (2025) In Acta Orthopaedica 96. p.684-691
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... (More)
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. (Less)
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author
; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Acta Orthopaedica
volume
96
pages
684 - 691
publisher
Taylor & Francis
external identifiers
  • pmid:40961374
  • scopus:105017623095
ISSN
1745-3682
DOI
10.2340/17453674.2025.44595
language
English
LU publication?
yes
id
6cc634da-676b-4738-af9e-623da42b3056
date added to LUP
2025-09-19 15:37:20
date last changed
2025-12-08 04:01:18
@article{6cc634da-676b-4738-af9e-623da42b3056,
  abstract     = {{Background and purpose — Traditional surgery for<br/>arthritis of the distal radioulnar joint (DRUJ), which typically<br/>involves resecting the ulnar head, is being increasingly challenged<br/>by newer techniques, such as prosthetic ulnar head<br/>replacement. The aim of our prospective cohort study was to<br/>investigate the clinical and patient-reported functional results,<br/>up to 2 years postoperatively, among patients with DRUJ<br/>arthritis treated with ulnar head replacement or resection.<br/><br/>Methods — 40 patients were included and underwent<br/>either ulnar head replacement (n = 22) or ulnar head resections<br/>(n = 18), due to DRUJ pathology between 2015 and<br/>2020. Patients were followed up at 3, 6, 12, and 24 months<br/>postoperatively by the means of Patient-Rated Wrist Evaluation<br/>(PRWE) (primary outcome), and Disability of the Arm,<br/>Shoulder and Hand (DASH) questionnaires, pain, range of<br/>forearm rotation, and grip strength (secondary outcomes).<br/>Postoperative complications were recorded. 19 and 16<br/>patients, respectively, responded at the 24-months follow-up.<br/>Female sex and inflammatory arthritis were more common in<br/>the resection group. General linear regression analyses adjusting<br/>for diagnosis and baseline PRWE score were performed<br/>for our primary outcome.<br/><br/>Results — The median and interquartile range (IQR)<br/>improvement in PRWE from baseline to 24 months was 69<br/>(IQR 49–87) to 27 (IQR 6–48) in the replacement group and<br/>60 (IQR 50–86) to 23 (IQR 5–44) in the resection group,<br/>indicating that both groups improved from baseline. There<br/>were no differences in unadjusted estimates at any time<br/>point. The adjusted means in PRWE at 24 months were<br/>35 and 26 points in the replacement and resection groups,<br/>respectively, corresponding to a statistically insignificant<br/>mean difference of 8.6 (95% confidence interval –11.7 to<br/>28.2). We found no statistically significant group differences<br/>in any of the secondary outcomes at any time point. Postoperative<br/>complications affected 6 patients with ulnar head<br/>replacement, whereas none were reported for patients with<br/>ulnar head resection.<br/><br/>Conclusion — We found that the outcome after ulnar<br/>head replacement is not superior to ulnar head resection in<br/>the short term.}},
  author       = {{Moloney, Maria and Larsson, Sara and Brogren, Elisabeth}},
  issn         = {{1745-3682}},
  language     = {{eng}},
  month        = {{09}},
  pages        = {{684--691}},
  publisher    = {{Taylor & Francis}},
  series       = {{Acta Orthopaedica}},
  title        = {{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}},
  url          = {{http://dx.doi.org/10.2340/17453674.2025.44595}},
  doi          = {{10.2340/17453674.2025.44595}},
  volume       = {{96}},
  year         = {{2025}},
}