Salvage of Failed Achilles Tendon Interposition Arthroplasty for DRUJ Instability After Ulnar Head Resection With Aptis Prosthesis

Hand (N Y). 2017 Sep;12(5):476-483. doi: 10.1177/1558944716676251. Epub 2016 Oct 28.


Background: Historically, failed conservative treatment for irreparably damaged distal radioulnar joints (DRUJs) is treated via distal ulnar resection or DRUJ fusion; complications include disabling painful convergence of the radius and ulnar stump during lifting Various treatments for radioulnar impingement include distal radioulnar Achilles tendon allograft interpositional arthroplasty. This technique does not adequately prevent radioulnar impingement and we explore an alternative treatment.

Methods: We report 7 adult patients who failed Achilles tendon interposition, subsequently treated with Aptis total DRUJ prostheses (mean follow-up, 26 months; range, 7-40).

Results: Revision to Aptis prosthesis produced clinically stable DRUJ, improved grip strength and painless lifting capabilities, high patient satisfaction, and no major complications. All returned to daily activities and even recreational sports.

Conclusions: Tendon lacks biomechanical features key to the shock-absorbing function of cartilage-features it cannot deliver when used to prevent radioulnar convergence. We report Aptis DRUJ prosthesis as an alternative to the tendon allograft technique.

Keywords: Aptis total DRUJ prosthesis; allograft interposition arthroplasty; radioulnar impingement.

MeSH terms

  • Achilles Tendon / transplantation
  • Adult
  • Allografts
  • Arthroplasty, Replacement*
  • Female
  • Follow-Up Studies
  • Hand Strength
  • Humans
  • Joint Instability / surgery*
  • Joint Prosthesis*
  • Male
  • Middle Aged
  • Patient Satisfaction
  • Prosthesis Design
  • Recovery of Function
  • Reoperation
  • Salvage Therapy*
  • Treatment Failure
  • Ulna / surgery*
  • Wrist Joint / diagnostic imaging
  • Wrist Joint / surgery*
  • Young Adult