A critical analysis of Swanson ulnar head replacement arthroplasty: rheumatoid versus nonrheumatoid

Clinical and radiographic assessment of the results of 40 Swanson silicone ulnar head prosthesis implants in three different patient groups is presented. Twenty-eight were done for treatment of rheumatoid arthritis, eight for ulnoradial impingement after the Darrach procedure, and four for ulnocarpal impingement resulting from malunited Colles' fractures. Patients were reviewed 12 to 48 months after operation (mean, 29 months). Seventy-eight percent of patients reported relief of pain and improved function. Radiologic examination showed that all patients exhibited resorption of the distal ulna (mean 4.4 mm) and that resorption was worst in the group with rheumatoid arthritis. Bone resorption about the implant predisposed the cap to both side-to-side tilt and pistoning of the prosthesis on supination and pronation. There was a 10% revision rate because of silicone synovitis. Although clinical results remain satisfactory for patients with rheumatoid arthritis and ulnocarpal impingement, the radiologic results suggest that Swanson ulnar head replacement should be restricted to elderly patients with rheumatoid arthritis.