A stable, functioning distal radioulnar joint not only provides supination and pronation of the forearm but also is essential to gripping and lifting. Therefore, when distal radioulnar joint deterioration occurs, proper repair is crucial. Ulnar head resection typically is performed; however, a prosthesis may be needed to replace all or part of the joint. This article discusses the advantages and disadvantages of four prostheses, including a total joint replacement designed by the authors.