Distal radioulnar joint arthroplasty with implants: a systematic review

Abstract

A severely painful, dysfunctional, or destroyed distal radio-ulnar joint (DRUJ) can be reconstructed by fusion, interposition of soft tissue, or by arthroplasty using prostheses.The objective of this study was to review the literature on implants and evaluate their effectiveness in terms of pain relief, range of motion and longevity.A search was carried out using protocols and well-defined criteria in PubMed, the Cochrane Library and by screening reference lists. The review was conducted according to PRISMA guidelines.Of the 27 publications reporting on nine different implants, we excluded reports with less than five cases and silastic replacements of the ulna head. Eighteen publications describing a total of five implants were selected for analysis. Nine of the publications were useful for the evaluation of implant longevity. Despite methodological shortcomings in many of the source documents, a summary estimate was possible.It seems that DRUJ implants have good potential to improve function through pain reduction; an improvement was observed in 17 series, although it was significant in only seven series.Instability is not uncommon with ulna head-only implants, but they cause fewer clinical problems and re-interventions than might be expected.The risk of deep infection is small with the available implants.Overall implant survival in papers with at least five years’ follow-up is 95%, with a slightly better longevity of 98% for the constrained implants.Periprosthetic osteolysis/radiolucency is frequently reported. Its causes and consequences are not clarified.Cite this article: Calcagni M, Giesen T. Distal radioulnar joint arthroplasty with implants: a systematic review. EFORT Open Rev 2016;1:191-196. DOI: 10.1302/2058-5241.1.160008.

Ulnar head arthroplasty with posterior interosseous nerve neurectomy: A case report

“…Supination was the only type of movement significantly improved and there was a trend for less residual pain and better functional scores if it was a primary arthroplasty. These results are consistent with the majority of published data, as verified in a Systematic Review by Calgani et al [ 4 ].…”

“…Historically, advanced arthrosis of the DRUJ was commonly treated with complete or parcial resection of the ulnar head (Darrach procedure) or a combination of this and DRUJ arthrodesis, as in the Sauvé-Kapandji procedure [ [2] , [3] , [4] , [5] ]. Despite satisfactory results in some patients, especially older ones, these techniques are associated with high risk of wrist instability and pain.…”

“…Distal Radioulnar Joint (DRUJ) arthropathy can occur as a consequence of multiple mechanisms, including trauma, inflammatory or degenerative arthritis or even congenital anomalies in the joint [ 1 , 2 ].For severe injuries the most common treatment procedure has been ulnar head excision. This procedure leads frequently to radioulnar instability and does not always bring a significant pain relief [ 3 , 4 ]. Ulnar head arthroplasty has been proposed as a viable option, potentially restoring wrist function and improving pain control.…”

Ulnar Head or Total Distal Radioulnar Joint Replacement, Isolated and Combined with Total Wrist Arthroplasty: Midterm Results

“…However, our cumulated implant survival and complication rate correspond well with what is generally reported. 21,22 In the recent systematic review presented by Moulton and Giddins, 22 the authors found the total complication and revision rate of 28 % (100 out of total 355 cases) in the reports of UHRs and correspondingly, in 28% (88 out of 315 cases) in reports of total DRUJ arthroplasties. Only the complicated cases that need surgery were counted.…”

Acortamiento cubital: resultados del tratamiento de la patología de la articulación radio cubital distal y su conversión a una Artroplastia

“…18 Traditionally, «salvage procedures» have been used for end stage DRUJ OA, 18 but none of them restore DRUJ stability and function except joint replacement. 19,20,21 Fifteen years ago, a series of 32 patients treated with US for early osteoarthritis (OA) was published by the senior author, showing good and excellent results reported in 56% of the cases. 9 Even though some information regarding US results has been produced since then, to our understanding there is no previous study regarding the risk and rate of having a secondary DRUJ procedure, particularly DRUJ implant arthroplasty replacement after US osteotomy.…”