Total distal radioulnar joint replacement for symptomatic joint instability or arthritis

In a case series of 41 patients, there was a statistically significant decrease in the mean pain score (measured on a visual analogue scale [VAS] from 0 to 10) from 8 before the procedure to 2 at follow-up (mean 61 months, range 24 months to 99 months; p<0.001). In a case series of 19 patients, there was a statistically significant decrease in the mean pain score (measured on a VAS from 0 to 10) from 5.3 before the procedure to 3.5 at follow-up (mean 4 years and 1 month, range 1 year to 7 years; p=0.02). In a case series of 17 patients, there was a statistically significant decrease in the mean pain score (measured on a VAS from 0 to 10) from 7.4 before the procedure to 2.2 at follow-up (mean 39 months, range 12 months to 79 months; p=0.001).

In the case series of 41 patients, there was a statistically significant decrease in the disabilities of the arm, shoulder and hand (DASH) score (range 0 to 100; lower scores better) from 56 before the procedure to 27 at follow-up (p=0.008). There was also a statistically significant decrease in the patient-rated wrist evaluation (PRWE) score (range 0 to 100; lower scores better) from 64 before the procedure to 30 at follow-up (p=0.002). In the case series of 19 patients, there was a decrease in the DASH score from 39 before the procedure to 31 at follow-up (p=0.07). In a case series of 35 patients who had a second-generation prosthesis, the mean PRWE score at 5‑year follow-up was 14 (n=19) and the mean DASH score was 22 (n=18).

In the case series of 41 patients, mean pronation increased from 69° to 77° (p=0.48), supination from 62° to 73° (p=0.021), extension from 55° to 56° (p=0.28) and flexion from 53° to 56° (p=0.065) at follow-up. In the case series of 19 patients, mean pronation increased from 79° to 88° (p=0.01), supination from 70° to 72° (p=0.7), extension from 48° to 59° (p=0.01) and flexion from 39° to 46° (p=0.29) at follow-up. In the case series of 35 patients who had a second-generation prosthesis, the mean pronation increased from 62° to 83° and the mean supination increased from 51° to 75° at 5‑year follow-up (p values not reported). In the case series of 17 patients, mean pronation increased from 56° to 78° (p=0.30) and mean supination increased from 56° to 72° (p=0.04) at follow-up.

In the case series of 41 patients, there was a statistically significant increase in mean grip strength after the procedure from 31 kg to 49 kg (p<0.001) at follow-up. In the case series of 19 patients, there was a statistically significant increase in mean grip strength after the procedure from 10 kg to 16 kg (p=0.01) at follow-up. In the case series of 35 patients who had a second-generation prosthesis, the mean grip strength increased from 44% of the contralateral side to 94% of the contralateral side at 5‑year follow-up (p value not reported).

In a systematic review of 315 patients, for those papers using 1 particular type of implant, there were 7 revisions of 246 implants, giving an implant survival rate of 97% at a mean follow-up of 56 months (range 24 months to 75 months).

In the case series of 41 patients, 5% (2/41) of patients were not satisfied with the procedure and would not advise patients with the same pathology to have the procedure. In the case series of 35 patients who had a second-generation prosthesis, the mean satisfaction score after the procedure was 9.6 out of 10.0. In a case series of 13 patients with a median follow-up of 60 months, all patients were satisfied with their wrist motion and ability to perform activities of daily living. In a case series of 10 patients, all 7 patients who responded to a follow-up questionnaire were either satisfied or very satisfied with the outcome of their surgery.

The specialist advisers listed the following key efficacy outcomes: pain reduction, reduction in feeling of instability, improved function, grip and lifting strength, restoration of forearm range of motion, and return to work and pre-existing activity.

Four commentaries from patients who had experience of this procedure were received, which were discussed by the committee.