Distal Radioulnar Joint Arthroplasty Techniques

Distal radioulnar joint arthroplasty encompasses a range of surgical solutions devised to relieve pain, restore stability and preserve forearm rotation in patients with arthritis, trauma or tumour resection. Traditional salvage procedures such as the Darrach resection and the Sauvé–Kapandji procedure achieve symptom relief by removing or immobilising the distal ulna, but may lead to ulnar stump instability and extensor tendon irritation. Ulnar head hemiarthroplasty replaces only the ulnar head and relies on preserved soft-tissue restraints, offering enhanced load transfer yet posing challenges in alignment and long-term wear. Total joint arthroplasty employs semiconstrained or modular prostheses that reconstruct both articulating surfaces, aiming to reproduce native kinematics and distribute load more physiologically. Innovations in imaging and three-dimensional planning have informed developments in implant geometry, including variable stem offsets and torsional alignment tailored to individual anatomy. Biological techniques such as rib perichondrial transplantation or tendon tenodesis augment prosthetic constructs to reinforce residual stabilisers. Despite these advances, achieving an optimal balance between mechanical constraint and bone preservation remains central to reducing complications such as stress shielding, loosening and joint impingement.

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Distal Radioulnar Joint Arthroplasty Techniques publication trend

The graph below shows the total number of articles in distal radioulnar joint arthroplasty techniques across all publications each year (not limited to Nature Index journals).

Technical terms

Distal radioulnar joint (DRUJ): The articulation between the distal ends of the radius and ulna permitting forearm rotation.

Darrach procedure: A salvage operation involving resection of the distal ulna to relieve pain at the DRUJ.

Sauvé–Kapandji procedure: Fusion of the distal radioulnar articulation combined with an ulnar pseudarthrosis created proximally to maintain rotation.

Hemiarthroplasty: Partial joint replacement in which only the ulnar head is resurfaced or replaced, preserving the radial sigmoid notch.

Semiconstrained prosthesis: An implant design that permits controlled translation and rotation while providing stability between radius and ulna.

Finite element analysis: A computational method that simulates stress and strain in bone and implant structures under defined loading conditions.

References

1. Performance of the Aptis Distal Radioulnar Joint Implant: A Clinical Case Series Including Four-Dimensional Computed Tomography Kinematic Analysis. Journal of Clinical Medicine (2023).
2. Effect of the Sauvé–Kapandji method on the wrist contact surface for distal radial ulnar joint disorders. BMC Musculoskeletal Disorders (2024).
3. Reconstruction of the distal radioulnar joint with rib perichondrium – midterm follow-up. BMC Musculoskeletal Disorders (2022).
4. Finite element analysis of intraosseous distal radioulnar joint prosthesis. BMC Musculoskeletal Disorders (2022).
5. 3D analysis of the distal ulna with regard to the design of a new ulnar head prosthesis. BMC Musculoskeletal Disorders (2022).