Objective: The total distal radioulnar joint (DRUJ) arthroplasty is an alternative of treatment of patients with symptomatic DRUJ due to advanced chondral damage, chronic ligamenteous instability, and failed resection arthroplasty (Sauvé-Kapandji, Darrach, etc.). The objective of this study is to assess the outcomes of total DRUJ arthroplasty in a case-series at mid-term follow-up. Methods: We performed a prospective evaluation of 5 patients, mean age 43.3 years (range, 32-56), with more than 4 years (mean 6.6 years, median 6 years) after a total DRUJ prosthesis (Aptis Medical). The indication was in 3 cases due to a posttraumatic arthritis (2 chronic instability and 1 postfracture arthritis), 1 primary arthritis in an ulna minus wrist, and 1 failed symptomatic Sauvé-Kapandji. Patients were symptomatic for a mean of 47.6 months prior the DRUJ prosthesis, all had chronic pain with daily pain medication and had a median of 2 wrist surgeries previous to the prosthesis (range, 0-4). We assessed the outcomes of range of motion, pain, Disabilities of the Arm, Shoulder and Hand (DASH), and Patient Rated Wrist Evaluation (PRWE) scores at short-term and mid-term follow-up. Results: All patients had a significant improvement after the arthroplasty, at short-term (3-6 months) and mid-term. At the last evaluation, the mean arc of flexo-extension was 143° and prono-supination 148°. DASH score was 6.2 (range, 0-21.6) and PRWE score 17.2 (range, 0-53). Only 1 patient had mild to moderate pain, with occasional need of pain medications. Four patients required additional procedures, all of them at short-term (mean 12.3 months). One patient had an acute local infection treated with surgical debridement and implant preservation. Two patients had extensor tenosinovitis requiring tenolysis and 1 patient had excision of distal ulna calcifications. No patients have required implant removal and there have no sign of radiographic loosening. Conclusion: In this series of patients treated with a total DRUJ prosthesis, we observed a substantial clinical improvement, with preservation of motion, pain relief, and high functional levels, at short-term and mid-term follow-up. We consider the total DRUJ arthroplasty an excellent treatment option in selected patients with severely DRUJ damage.
