The use of implant arthroplasty in the distal radioulnar joint is increasing. Two main types of implants are commonly used, ulnar head prosthesis (UHP) and hemi or semi-constrained total distal radioulnar joint arthroplasty. The literature consists mainly of small patient series. The purpose of this study was to examine our long-term outcomes of distal radioulnar joint arthroplasty.
Patient data were collected in a patient registry from 2000 to 2019. The follow-up included radiographic examination, physical examination, Mayo Wrist Scores, pain level, range of motion, and grip strength. Reoperations were recorded. The implants were a semi-constrained prosthesis and a metallic UHP. The mean age at surgery was 50 years. Patient demographics were similar, but the semi-constrained group had a higher preoperative percentage of instability (85 vs 52 percent). The median follow-up time was 30 months for the semi-constrained implants group and 102 months for the UHP group.
A total of 53 primary semi-constrained total joint arthroplasties and 102 UHPs were included. The grip strength and Mayo Wrist Score improved for both the implant groups. Pain reduced in 76% of the patients. Supination improved for the semi-constrained total joint arthroplasty group. Lifting capacity was better in the semi-constrained total joint arthroplasty patients. The unadjusted reoperation rate was 23% for the semi-constrained implants group and 34% for the UHP group. Twenty-two implants were bilateral; these had comparable results to unilateral implants. Kaplan–Meier survival curves demonstrated 94% survival rate for the semi-constrained implants group and 87% survival for the UHP group after 5 years. The risk factors associated with reoperation for the combined implant group included younger age at surgery, previous wrist surgery, ulnar shortening, and wrist fusion.
Distal radioulnar joint arthroplasty improved functional outcomes in both the implant groups, but reoperations were frequent. The semi-constrained implants group had better lifting capacity. The bilateral implants had comparable outcomes to the unilateral implants.
Type of study/level of evidence
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Hand Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Functional and radiographic outcomes following distal ulna implant arthroplasty.J Hand Surg Am. 2012; 37: 1364-1371
- Ulnar head replacement: 21 cases; mean follow-up, 7.5 years.J Hand Surg Am. 2015; 40: 1731-1738
- Salvage of failed resection arthroplasties of the distal radioulnar joint using an ulnar head prosthesis: long-term results.J Hand Surg Am. 2012; 37: 1372-1380
- A study of functional outcomes following implantation of a total distal radioulnar joint prosthesis.J Hand Surg Eur Vol. 2008; 33: 18-28
- Ulnar head or total distal radioulnar joint replacement, isolated and combined with total wrist arthroplasty: midterm results.J Wrist Surg. 2020; 9: 411-416
- Indications and early to mid-term results of ulnar head replacement.Ann R Coll Surg Engl. 2013; 95: 427-432
- Short- to mid-term results of ulna head replacement as both a primary and revision implant.J Clin Orthop Trauma. 2016; 7: 292-295
- Outcome assessment after Aptis distal radioulnar Joint (DRUJ) Implant Arthroplasty.Arch Bone Jt Surg. 2014; 2: 180-184
- Total joint arthroplasty of the distal radioulnar joint for rheumatoid arthritis.J Hand Surg Am. 2014; 39: 1699-1704
- Salvage of failed Achilles tendon interposition arthroplasty for DRUJ instability after ulnar head resection with Aptis prosthesis.Hand (N Y). 2017; 12: 476-483
- Biomechanical evaluation of the dynamic radioulnar convergence after ulnar head resection, two soft tissue stabilization methods of the distal ulna and ulnar head prosthesis implantation.Arch Orthop Trauma Surg. 2011; 131: 15-26
- Biomechanical analysis of two ulnar head prostheses.J Hand Surg Am. 2002; 27: 845-853
- The biomechanical stability of salvage procedures for distal radioulnar joint arthritis.J Hand Surg Am. 2014; 39: 1274-1279
- The load-bearing characteristics of the forearm: pattern of axial and bending force transmitted through ulna and radius.J Hand Surg Br. 2006; 31: 274-279
- Distal radio-ulnar implant arthroplasty: a systematic review.J Hand Surg Eur Vol. 2017; 42: 827-838
- Distal radioulnar joint arthroplasty with implants: a systematic review.EFORT Open Rev. 2016; 1: 191-196
- Periprosthetic bone resorption and sigmoid notch erosion around ulnar head implants: a concern?.Hand Clin. 2010; 26: 573-577
- Semiconstrained distal radioulnar joint prosthesis.J Wrist Surg. 2013; 2: 41-48
- Constrained implant arthroplasty as a secondary procedure at the distal radioulnar joint: early outcomes.J Hand Surg Am. 2013; 38: 1111-1118
- Distal radioulnar joint replacement in the scarred wrist.J Wrist Surg. 2019; 8: 55-60
- Functional outcomes of the Aptis-Scheker distal radioulnar joint replacement in patients under 40 years old.J Hand Surg Am. 2015; 40: 1397-1403.e3
- Midterm outcomes of the use of a spherical ulnar head prosthesis for failed Sauvé-Kapandji procedures.J Hand Surg Am. 2019; 44: 66.e1-66.e9
- Midterm results of semiconstrained distal radioulnar joint arthroplasty and analysis of complications.J Wrist Surg. 2016; 5: 290-296
- Long-term results after semiconstrained distal radioulnar joint arthroplasty: a focus on complications.Hand Surg Rehabil. 2020; 39: 186-192
- Complications of semiconstrained distal radioulnar joint arthroplasty.J Hand Surg Am. 2018; 43: 566.e1-566.e9
- Salvage of painful porous coated stem ulnar head prosthesis with semiconstrained distal radioulnar joint arthroplasty.J Hand Surg Am. 2022; 47: 689.e1-689.e8
- Aseptic loosening of an APTIS distal radioulnar joint arthroplasty—case report.Trauma Case Rep. 2019; 21100196
- Distal radioulnar joint constrained arthroplasty.Hand Clin. 2013; 29: 113-121
- Arthroplasty of the distal radioulnar joint using a new ulnar head endoprosthesis: preliminary report.J Hand Surg Am. 2007; 32: 177-189
- Difficult wrist fractures. Perilunate fracture-dislocations of the wrist.Clin Orthop Relat Res. 1987; 214: 136-147
- Constrained implant arthroplasty for distal radioulnar joint arthrosis: evaluation and management of soft tissue complications.J Hand Surg Am. 2019; 44: 614.e1-614.e9
- Intermediate outcomes of ulnar head arthroplasty.J Hand Surg Am. 2014; 39: 2405-2411.e1
- Ulnar head implant arthroplasty: an intermediate term review of 1 surgeon’s experience.Tech Hand Up Extrem Surg. 2009; 13: 160-164
- Implant arthroplasty for treatment of ulnar head resection-related instability.Hand Clin. 2013; 29: 103-111
- Use of an ulnar head endoprosthesis for treatment of an unstable distal ulnar resection: review of mechanics, indications, and surgical technique.Hand Clin. 2005; 21: 603-620
- Salvage of failed resection arthroplasties of the distal radioulnar joint using a new ulnar head prosthesis.J Hand Surg Am. 2000; 25: 438-446
Published online: May 10, 2022
Accepted: February 11, 2022
Received: April 21, 2021
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
© 2023 by the American Society for Surgery of the Hand. All rights reserved.