MATCHED HEMIRESECTION INTERPOSITION ARTHROPLASTY OF THE DISTAL RADIOULNAR JOINT

Since 1986 the senior author has performed a matched hemiresection wit h retinacular/capsular interposition for patients with painful disorde rs of the distal radioulnar joint. A retrospective review of 55 wrists was performed by an independent hand surgeon and hand therapist. Fort y-nine of 54 wrists in the surviving patients were clinically and radi ographically reviewed with an average follow-up interval of 36 months. Subjective assessment included a visual analog rating of pain improve ment and satisfaction with treatment. Objective assessment included ex amination of range of motion, strength, stability, and standardized fu nctional testing with the Jebsen and Minnesota Rate of Manipulation te sts. Thirty-five patients reported pain improvement and 41 patients we re satisfied. The range of supination and pronation increased from 54 degrees and 67 degrees, respectively, to 72 degrees and 72 degrees. Fu nctional ability as measured by the Jebsen test was similar to the con tralateral wrist. Patients had most difficulty turning large objects. The clinical, objective, functional, and x-ray films results correlate d poorly with pain improvement and patient satisfaction. Complications included one infection, one reflex sympathetic dystrophy, one neuroma of the dorsal sensory branch of the ulnar nerve, and four cases of ul nar-carpal impaction. Pain relief was the primary determinant of patie nt satisfaction and should be considered the indication for surgery.