Current evidence on the safety and efficacy of total distal radioulnar joint replacement for symptomatic joint instability or arthritis is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
Clinicians wishing to do total distal radioulnar joint replacement for symptomatic joint instability or arthritis should:
Inform the clinical governance leads in their NHS trusts.
Ensure that patients understand the uncertainty about the procedure's safety and efficacy and provide them with clear written information. In addition, the use of NICE's information for the public is recommended.
Audit and review clinical outcomes of all patients having total distal radioulnar joint replacement for symptomatic joint instability or arthritis (see section 7.1).
Patient selection and the procedure should only be done by clinicians with special expertise in hand and wrist surgery.
Further research should provide information on patient selection, and continue to collect long-term outcomes. NICE may update the guidance on publication of further evidence.