Distal radioulnar joint arthroplasty with implants: a systematic review
Calcagni M, Giesen TWrist
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A severely painful, dysfunctional, or destroyed distal radio-ulnar joint (DRUJ) can be reconstructed by fusion, interposition of soft tissue, or by arthroplasty using prostheses.
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The objective of this study was to review the literature on implants and evaluate their effectiveness in terms of pain relief, range of motion and longevity.
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A search was carried out using protocols and well-defined criteria in PubMed, the Cochrane Library and by screening reference lists. The review was conducted according to PRISMA guidelines.
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Of the 27 publications reporting on nine different implants, we excluded reports with less than five cases and silastic replacements of the ulna head. Eighteen publications describing a total of five implants were selected for analysis. Nine of the publications were useful for the evaluation of implant longevity. Despite methodological shortcomings in many of the source documents, a summary estimate was possible.
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It seems that DRUJ implants have good potential to improve function through pain reduction; an improvement was observed in 17 series, although it was significant in only seven series.
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Instability is not uncommon with ulna head-only implants, but they cause fewer clinical problems and re-interventions than might be expected.
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The risk of deep infection is small with the available implants.
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Overall implant survival in papers with at least five years’ follow-up is 95%, with a slightly better longevity of 98% for the constrained implants.
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Periprosthetic osteolysis/radiolucency is frequently reported. Its causes and consequences are not clarified.
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