gms | German Medical Science

Objectives: The use of implant arthroplasty in the hand and wrist is increasing, often with little evidence of outcomes in the literature. We therefore undertook a systematic review of the outcomes of distal radio-ulnar joint arthroplasties following the PRISMA guidelines.

Method: We performed this systematic review in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) state. The Pubmed, database were searched for papers returning the search terms distal radio-ulnar joint, distal radioulnar joint, ulna head or DRUJ and then matched with a further set of papers that contained either arthroplasty, implant, replacement or ulnar head replacement. Medline and Embase were searched matching papers returning arthroplasty with those returning distal radioulnar joint or ulna. The Cochrane database was also searched. Papers were assessed for outcomes, implant survival and methodological quality. Fourteen papers assessed ulna head replacements.

Results: The implant survival rate was 93% at a mean follow-up of 45 months. One paper assessed a partial ulna head replacement. Fourteen papers assessed total DRUJ replacements; all but two used the Aptis prosthesis. These implants had a survival rate of 97% at a mean of 56 months. Complications rates were 28% in both groups and significant complications can occur. Although these data are impressive there are many more implants implanted worldwide and not followed up. All studies were level IV and V studies with low Coleman scores.

Conclusion: This systematic review demonstrates that implant arthroplasty for the DRUJ has produced acceptable results in small numbers of patients. Whilst these short term outcomes are encouraging, the indications should be carefully considered and there should be proper consideration of the potential for later failure.