Name of the Procedure:

Arthroplasty with prosthetic replacement; distal ulna
Common Names: Ulnar Head Replacement, Distal Ulnar Arthroplasty

Summary

Arthroplasty with prosthetic replacement of the distal ulna is a surgical procedure to replace the damaged end of the ulna bone in the wrist with an artificial prosthesis. This helps restore the function and mobility of the wrist and forearm.

Purpose

Medical Condition Addressed:

• Severe arthritis
• Traumatic injury
• Instability or deformity of the distal ulna

Goals and Expected Outcomes:

• Pain relief
• Improved wrist motion
• Enhanced grip strength
• Restoration of normal arm function

Indications

Symptoms and Conditions:

• Chronic wrist pain unresponsive to conservative treatments
• Severe osteoarthritis or rheumatoid arthritis affecting the distal ulna
• Recurrent dislocations or subluxations of the distal ulna
• Previous trauma leading to distal ulna damage

Patient Criteria:

• Poor response to non-surgical treatments like medications, physical therapy, or splinting
• Presence of joint deformity or functional impairment
• Good overall health to withstand surgery

Preparation

Pre-Procedure Instructions:

• Fasting for at least 8 hours prior to surgery
• Adjustments to medications (e.g., stopping blood thinners)
• Arrange for transportation and post-surgery assistance at home

Diagnostic Tests:

• X-rays or MRI to assess the extent of bone damage
• Blood tests to check overall health and readiness for surgery

Procedure Description

1. Anesthesia: General anesthesia or regional anesthesia (nerve block) is administered.
2. Incision: A surgical incision is made over the wrist to expose the distal ulna.
3. Bone Preparation: The damaged portion of the distal ulna is carefully removed.
4. Prosthetic Placement: A prosthetic implant is inserted into the place of the removed bone.
5. Closure: The incision is closed with sutures, and the area is bandaged.

Tools and Equipment:

• Surgical instruments for bone removal
• Prosthetic implant specific to distal ulna

Duration

The procedure typically takes about 1-2 hours.

Setting

Performed in a hospital or specialized outpatient surgical center.

Personnel

• Orthopedic surgeon
• Surgical nurses
• Anesthesiologist
• Surgical technician

Risks and Complications

Common Risks:

• Infection
• Bleeding
• Pain at the surgery site

Rare Risks:

• Prosthesis loosening or failure
• Nerve damage
• Blood clots

Complications Management:

• Antibiotics for infections
• Pain management strategies
• Monitoring for nerve function and blood flow

Benefits

Expected Benefits:

• Pain relief usually noticed within weeks post-surgery
• Improved function and mobility of the wrist and hand
• Long-term durability of the prosthetic implant

Recovery

Post-Procedure Care:

• Elevation of the arm to reduce swelling
• Pain medications as prescribed
• Physical therapy to restore strength and mobility

Expected Recovery Time:

• Generally, 6-12 weeks for complete recovery
• Temporary restrictions on heavy lifting or strenuous activities

Follow-Up:

• Regular check-ups to monitor healing and prosthetic function

Alternatives

Other Treatment Options:

• Non-surgical options like medications, physical therapy, or braces
• Wrist fusion surgery
• Interpositional arthroplasty (using biological material instead of a prosthesis)

Pros and Cons:

• Non-surgical options may not provide long-term relief.
• Wrist fusion results in loss of wrist motion but provides stability and pain relief.
• Interpositional arthroplasty can be complex and may not be suitable for all patients.

Patient Experience

During the Procedure:

• Under anesthesia, the patient will not feel pain or be aware of the procedure.

After the Procedure:

• Some pain and swelling managed by medications and ice packs
• Physical therapy to aid in recovery and regain function
• Motivation and adherence to rehabilitation are crucial for optimal outcomes