Achilles allograft interposition arthroplasty for the treatment of proximal radio-ulnar stump impingement pain.

Abstract

Proximal radio-ulnar stump impingement (PRUSI) describes a painful condition occurring following radial head loss. Pain occurs due to the proximal radial stump impinging against the ulna. This study aimed to evaluate the safety of a novel interposition arthroplasty method. A retrospective observational consecutive case series study was undertaken from case note review of patients with PRUSI, treated by Achilles allograft interposition arthroplasty. The technique utilised donor Achilles tendons to cushion the proximal radio-ulnar stump articulation. The primary outcome was a change in pain levels. Secondary outcomes included changes in: elbow and forearm range of movement, Mayo Elbow Performance Score (MEPS), patient satisfaction on an 11-point numerical rating scale (NRS) and adverse events. From baseline to six months post intervention, the mean NRS pain score was reduced from 9/10 to 2/10 with a mean difference in NRS pain scores of -7 (95% CI -4, -10; p = 0.004). Mean MEPS increased from 56/100 (s.d. 8) to 91 (s.d. 8), with a mean difference of 35/100 (95% CI 18, 52; p = 0.005). Achilles tendon allograft arthroplasty represents a safe procedure for treating PRUSI. This IDEAL phase 1 study shows promising results, indicating the need for further trials.