Prosthetic arthroplasty of the distal radioulnar joint: historical perspective and 24-year follow-up

Distal Radio-Ulnar Joint Reconstruction after failed Darrach operation using free autogenous second toe Metatarso-phalangeal joint transfer. Development of the technique and a long-term (over 25 year) follow-up

During the development of microvascular surgery in 1980-95 many new methods to overcome different traumatic disorders were studied. Previously unsolved problems could be treated using free tissue transfer. Typical problems in wrist surgery were the painful complications from ulna head resection. No sound or acceptable artificial protheses for ulna head were available. Author did study the possibilities of reversal of resected ulna head using an autogenous microvascular joint transfer. First it was done using cadaver models and evaluating the possibilities of a toe MTP-II joint in replacing the distal radio-ulnar joint. Then same principle was used in three clinical cases. All patients had suffered a poor result after ulna head resection or Darrach procedure. First two cases had complications but third case from year 1994 resulted in a good outcome. This paper introduces the development of a surgical technique for the replacement of the resected ulna head. Also, it will describe the excellent long-term result achieved in the last case with 26-year follow-up. Although today many sophisticated prosthetic replacement techniques have become developed for this purpose, this kind of autogenous reconstruction might have a place in treating similar problems in young posttraumatic patients. Also it demonstrates the potential benefit of microsurgery in a difficult wrist problem.

Solutions for the Unstable and Arthritic Distal Radioulnar Joint

An unstable and osteoarthritic distal radioulnar joint presents with considerable functional impairment, pain, and weakness in gripping manipulation of objects. A wide variety of surgical alternatives have been described to address these concerns. Resection arthroplasties include different types of distal ulna resection and soft tissue procedures; good overall results have been described for these types of procedures, although they have shown limitations in achieving and maintaining pain relief and stability, especially in more active patients. Since the late 1980s, partial and total joint arthroplasties have emerged as good alternatives for treatment in young and more active patients.

Distal radioulnar joint arthroplasty with implants: a systematic review

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.