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Review
. 2021 Jan;9(1):22-32.
doi: 10.22038/abjs.2020.53537.2659.

Distal Radioulnar oint Prosthesis

Ali Moradi  1 , Reza Binava  1 , Ehsan Vahedi  1 , Mohammad H Ebrahimzadeh  1 , Jesse B Jupiter  2
Affiliations
Review

Distal Radioulnar oint Prosthesis

Ali Moradi et al. Arch Bone Jt Surg. 2021 Jan.

Abstract

The distal radioulnar joint (DRUJ) prostheses have been available for many years and despite their superior outcomes compared to conventional DRUJ reconstructions in both short and long-term follow-ups, they have not become as popular as common hip and knee prostheses. In the current review article, at the first step, we discussed the applied anatomy and biomechanics of the DRUJ, and secondly, we classified DRUJ prostheses according to available literature, and reviewed different types of prostheses with their outcomes. Finally we proposed simple guidelines to help the surgeon to choose the appropriate DRUJ prosthesis.

Keywords: Distal radioulnar joint; Prosthesis; Review article.

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Figures

Figure 1
Figure 1
The Triangular Fibrocartilage Complex anatomy (TFCC): TFCC is composed of palmar and dorsal radioulnar ligaments, triangular fibrocartilage (articular disk), floor of the sixth extensor compartment, ulnocarpal meniscal homolog; and palmar ulnocarpal ligaments
Figure 2
Figure 2
In axial plane the radius of curvature of the sigmoid notch is greater than the ulnar head so the soft tissue stabilizes the joint
Figure 3
Figure 3
In axial plan, four different sigmoid notch shapes were diagnosed: A: Flat face sigmoid, B: Sky slop sigmoid, C: “C” type sigmoid and D: “S” type sigmoid. Among them the flat face (42%), and “C” type (30%) are more common
Figure 4
Figure 4
In sagittal plane the slopes of the articular surfaces of the sigmoid notch compared with the long axis of ulna may be: A: reverse oblique (divergence to long axis of ulna), B: parallel (55%), C: oblique (convergence to long axis of ulna)
Figure 5
Figure 5
Two main interosseous membrane structures which contribute to longitudinal forearm stiffness of the ulna are the central band (marked in purple) and distal oblique bundle (marked in green)
Figure 6
Figure 6
Kapandji extension DRUJ prosthesis (Moradi’s intra-osseous” prosthesis): This innovative prosthesis is the only “intra-osseous” prosthesis in the body. The prosthesis is located in the bone instead of the joint. One stem is in distal ulna and the other in proximal ulnar medullary canal. A ball with two sockets (in proximal and distal) simulates DRUJ movements
Figure 7
Figure 7
UHP, Martin GMBH, Germany DRUJ prosthesis: The prosthesis consists of a porous-coated titanium stem and a ceramic head. The head is spherical in the axial sections but at the distal end, it is designed concavely so that it can be matched with carpal bones and decrease pressure across the ulnocarpal joint
Figure 8
Figure 8
U-Head, Small Bone Innovation, USA DRUJ prosthesis: The U-Head prosthesis is a modular prosthesis that consists of a metal stem (cobalt–chrome) that can be press-fitted or cemented into the intramedullary canal of the ulna and a metal hemispheric ulnar head
Figure 9
Figure 9
Aptis DRUJ Prostheses, Aptis Medical, USA DRUJ prosthesis: This prosthesis is a semi-constrained ball and socket joint composed of a radial and an ulnar component to replace the function of sigmoid notch and ulnar head. The radial component is fixed to the radius by distal peg and cortical screws
Figure 10
Figure 10
Schuurman AH DRUJ prosthesis: This prosthesis is a two-component total DRUJ prosthesis formed by an ulnar and radial component. The proximal portion of the ulnar component (intramedullary portion) is coated with hydroxyapatite and the distal portion is coated with ceramic. The radial component has a ring and a rode where the ring joins with proximal portion of the ulnar component and allows axial rotation. The ring has a polyethylene lining
Figure 11
Figure 11
First Choice DRUJ System, Integra, Austin, TX partial head DRUJ prosthesis: This type of prosthesis is an implant which replaces only the articular surfaces of the ulnar head. The partial implant allows a conservative resurfacing of only the articular surface of the ulna, leaving the ulna styloid intact and maintaining the attachment of the TFCC and ulnocarpal ligament to the ulna
Figure 12
Figure 12
First Choice DRUJ System, Integra, Austin, TX total head DRUJ prosthesis: This type of prosthesis is an implant which replaces only the articular surfaces of the ulnar head
See this image and copyright information in PMC

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