Treatment of failed Sauvé-Kapandji procedures with a spherical ulnar head prosthesis

Abstract

Radioulnar convergence is a painful complication after a Sauvé-Kapandji procedure, with a reported incidence of 13% to 39%. We evaluated 10 patients with painful radioulnar convergence treated with a spherical ulnar head prosthesis proximal to the radioulnar fusion mass. At a mean follow-up of 2.6 years, patients were evaluated clinically and radiographically to determine whether an ulnar head replacement could restore forearm stability, prevent radioulnar convergence, and reduce pain. Postoperatively, no patient had subjective complaints of radioulnar convergence or clinical signs of distal ulnar instability. Pain had improved in all patients. Grip strength, expressed as a percentage of the uninjured hand, improved on average from 27% to 55%. Range of motion improved in seven patients, worsened in two and remained the same in one. Nine of 10 patients returned to their previous occupation with an average working capacity of 76%. The prosthesis was stable radiographically in all patients. Complications included two fractures of the radioulnar fusion mass and the development of painful periprosthetic calcifications in one patient. Placement of a spherical ulnar head prosthesis after a Sauvé-Kapandji procedure provides adequate early results for patients with painful radioulnar convergence.

Level of evidence: Therapeutic study, level IV (case series).