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IntroductionThis study examines patients’ outcomes and complications five years after receiving total distal radioulnar joint arthroplasty with a semi-constrained and modular implant, the second generation Aptis DRUJ prosthesis.

Methods Included in the study were 21 female and 14 male patients with a mean age of 44 years (range 23-74). 18 implants were inserted into the right wrist and 17 into the left. 19 patients had the operation in their dominant hand. 92% of the joints studied received the prosthesis as a salvage following previous DRUJ surgery including 8 Darrach, 2 Sauvé-Kapandji and 2 Bower’s procedures with the remaining cases having had ulna shortening and/or ligament reconstruction. Twenty-seven of the 35 patients receiving DRUJ prostheses underwent follow-up at a mean 5 years post-operatively (range, 4.4 yrs– 6.2 yrs). The study tested lifting capacity, grip strength and pronosupination.

Results At 5 year follow up, lifting capacity averaged 7.5 kg (16.4 pounds) in the DRUJ prosthesis arm, versus 7.7 kg (16.9 pounds) in the contralateral arm. Range of motion averaged 80 degrees pronation and 70 degrees supination. Grip strength increased to an average of 90% of the contralateral arm. Patients expressed an average satisfaction of 9.8 out of 10 (10=completely satisfied) with their prostheses (n=26, SD=0.49). Among the 27 patients who underwent 5-year follow up, the prosthesis had a 100% 5-year survival rate; no prostheses were infected. 69% (25) of the 36 prostheses implanted were complication-free. The remaining cases included complications of ECU tendinitis, ectopic calcification, one loose radial plate cover screw and two minor superficial soft tissue infections. All complications were treated successfully.

Discussion Our study shows no prosthesis breakage or failures. The 100% survival rate seen in our study and the low complication rate with manageable surgical revisions support the benefits of this prosthesis in surgical treatment of damaged DRUJs. Compared with other partial and total DRUJ prostheses available, our study shows excellent functional results and excellent survival of the prosthesis. This prosthesis is an excellent option for revision of dysfunctional distal radioulnar joints.