Efficacy and safety of prosthetic arthroplasty of the distal radioulnar joint: a systematic review.

Abstract

This systematic review evaluates the efficacy and safety of prosthetic arthroplasty of the ulnar head and distal radioulnar joint (DRUJ). A comprehensive literature search identified studies reporting functional and safety outcomes of DRUJ prosthetic arthroplasty for 10 or more cases. Primary outcomes included function, pain, and implant survival. Secondary outcomes were satisfaction, grip strength, range of pronation-supination, complications and reoperations. Forty-three case series were included; of those, 25 reported outcomes of semi-constrained bipolar DRUJ arthroplasty with the APTIS prosthesis (<i>n</i> = 706 cases) and 18 of unconstrained ulnar head replacement (DRUJ hemiarthroplasty; <i>n</i> = 819 cases). Both the APTIS prosthesis and the participating ulnar head prostheses resulted in functional improvements which were statistically significant and clinically meaningful in most studies in all included functional scales. For pain, mean postoperative improvement ranged from 1.2 to 8.0 (weighted mean 4.3 points) in APTIS and from 1.7 to 5 points (weighted mean 2.5 points) in ulnar head prostheses. Weighted mean long-term survival (>7 years) was 89% with the APTIS and 87% with ulnar head prostheses. Reoperations were required in a weighted mean of 25% of cases in the APTIS group and 23% in the ulnar head arthroplasty group. Both APTIS DRUJ arthroplasty and ulnar head replacement yield substantial functional improvements and good long-term survivorship. However, complication and incidence of reoperation remain high. These findings highlight the need for improved implant design and material innovation to enhance long-term safety and outcomes.