Outcomes following Total Distal Radioulnar Joint Replacement

Purpose: To assess clinical, functional, and radiographic outcomes following total distal radioulnar joint (DRUJ) arthroplasty 6 patients (7 wrists) treated for chonic ulnar sided wrist pain

Method: Retrospective review of 6 patients (7 wrists) following total Distal Radiounlar joint (DRUJ) replacement with the Aptis-Scheker prosthesis (Aptis Medical, Louisville, KY) at our academic hand center. Three of the seven wrists were treated for Madelung’s deformity and four for chronic distal ulna instability following prior surgery. At a mean follow-up of 45 months (range, 3.5 -83 months), Patient Rated Wrist Evaluation (PRWE), Disabilities of Arm Shoulder and Hand (DASH), Visual Analogue Scale (VAS) scores, subjective satisfaction questionnaires, grip strength and lifting were recorded at final follow-up. All of the surgeries were performed by two fellowship-trained hand surgeons.

Results: Within the cohort of 7 total DRUJ arthroplasties (6 patients), five patients underwent multiple ulnocarpal surgical procedures prior to total DRUJ replacement. Overall there was a mean of 3 prior procedures (range, 0-12). Mean grip strength was 92% of contralateral side (range, 71% - 140%). Mean weight lifting was 13 lbs. Mean extension/flexion arc was 99⁰ (range, 50⁰-153⁰) with mean flexion 50⁰ (8⁰-81⁰) and mean extension 48⁰ flexion (range, 30⁰- 72⁰). Mean pronation-supination arc was 165⁰(range, 140⁰-180⁰) with mean supination 80⁰ (range, 65⁰-90⁰), and mean pronation 84⁰ (range, 60⁰-90⁰). Mean DASH score and PRWE were 23 and 37, respectively. Mean VAS score before surgery was 7 and 2 post-operatively. There were two major complications ((1) re-rupture of reconstructed extensor tendons; (2) periprosthetic radius fracture) and one minor (symptomatic retained suture).

Conclusions: Total DRUJ arthroplasty is an acceptable salvage option in selected patients who have recalcitrant disabling wrist pain following prior distal ulna and ulnocarpal procedures. Clinical, functional, and patient-reported outcomes are similar to those reported in other small cohort series. Prospective long term data is needed to accurately assess outcomes and prosthesis longevity.

Level of evidence Therapeutic IV.


Key words Arthritis, distal radioulnar joint, implant, prosthesis, replacement.