Ulnar head replacement

Ulnar Head Replacement

What is it and when is it required?
Ulnar Head replacement surgery is undertaken when there is arthritis affecting the joint between the radius and ulnar bones at the wrist. This joint is referred to as the Distal Radio-Ulnar Joint (DRUJ). It is a very important joint in allowing twisting or rotational movements at the wrist. Most patients with arthritis here will present with pain, stiffness and a variable amount of swelling. Later on deformities may develop.

There will be a reduction in how much you are able to do with your wrist or hand, with pain often being made worse by twisting or loading type activities. (see also wrist arthritis) Ulnar Head Replacement seeks to replace the worn joint with an implant that will provide improvement in symptoms of pain. Stability of this implant is achieved by careful reconstruction of the soft tissues around the new ulnar head.

What are the symptoms?

Most patients will present with pain, stiffness and a variable amount of swelling. There will be a reduction in how much you are able to do with your hand. You may have to give up hobbies or sports because of pain, stiffness and lack of grip.


Diagnosis can often be made from the clinical history (the account of events and symptoms from the patient) and the clinical examination. X-rays will be undertaken to confirm the diagnosis.

Treatment options

Here are the treatment options for DRUJ arthritis

In Osteoarthritis the mainstay of treatment is activity modification, analgesics, anti-inflammatory medication, Hand Therapy and sometimes splints. These treatments are very useful in the early stages of the arthritis.

Steroid Injection – can be useful in selected cases and may give several weeks/months relief of symptoms. Most cases are DRUJ arthritis will be adequately controlled by these measures and surgery will never be required.

Ulnar Head Replacement is a good option in selected cases where symptoms remain intrusive. Your surgeon will assess the severity of your symptoms and arthritis and discuss with you whether this type of surgery is right for you

Post-operative care

The operation is performed under Regional and/or General Anaesthetic. It is normally undertaken as a day case patient, but you may be admitted overnight following your surgery. A bulky dressing, which includes a Plaster of Paris, is applied to the hand and wrist. The arm should be kept elevated as much as possible to reduce swelling. Movement of all the joints that are not immobilised is essential to prevent stiffness.

You will be seen in the outpatient department approximately two weeks following your operation. The wound will be checked and your dressing changed. Our Hand Therapy team will review you at this stage to commence rehabilitation. You will be fitted with a removable splint to wear for several weeks.
At six weeks, you should be able to undertake light activities with the wrist.

Permanent Limitations:

The use of the arm for physical tasks should be restricted following ulnar head replacement surgery. It is recommended that you avoid lifting more than 4.5Kg (or 10lbs) of weight with the affected arm.

It is expected that an ulnar head replacement will last between 10-15 years with careful use. You will be reviewed on a regular basis to identify any developing conditions or problems.

Other treatment options

Are there any alternatives?

Wrist denervation:

This operation involves removing the small nerves that supply sensation to the wrist joint. This will have no detrimental effect to the sensation to the hand/fingers. This procedure can provide benefit, relieving pain, in patients for several years.

Partial ulnar head excision

This operation involves removing the arthritic part of the ulnar head only but leaving the outside part intact. This has the advantage of keeping most of the important soft tissue attachments of the ulnar head attached.

Total ulnar head excision

This surgery involves removing the end of the ulnar bone, which effectively removes the painful joint. It is also known as a ‘Darrach’s procedure’ after the person who originally described it. The remaining stump of ulna takes over the function of forearm rotation after this operation.

Suave-Kapandji procedure

This surgery addresses the problem of the arthritic DRUJ in a very different way. The arthritic joint is fused together, but a portion of the ulnar bone is removed on the near part of the joint. This allows rotational movements of the forearm to occur but takes away the pain from the arthritic joint.
Both Darrach’s procedures and the Sauve-Kapandji procedures do have limitations or potential complications, which will be discussed with you at the consultation if required.

Finally, it may be that you have arthritis affecting the main wrist joint in addition to the DRUJ. This may require additional treatment. Your surgeon will discuss the options for your individual case with you.

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