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DOI: 10.1055/a-2753-9915
Aptis Distal Radioulnar Joint Arthroplasty: A Systematic Literature Review
Authors
Funding Information The authors received no financial support for the authorship of this article.
Abstract
Objectives
Total distal radioulnar joint (DRUJ) arthroplasty with the Aptis implant was developed as a salvage option in complex cases of severe DRUJ involvement and after failure of conventional procedures. This systematic review aims to update the available evidence on this technique, assessing functional outcomes, complications, and implant survival.
Materials and Methods
A systematic search of PubMed was conducted in January 2025, following PRISMA 2020 guidelines. Observational studies reporting clinical outcomes after Aptis implant arthroplasty were included. Extracted data comprised functional scores (DASH, PRWE, Mayo), pain (VAS), range of motion, grip strength, complications, reoperations, and implant survival.
Results
A total of 28 studies published between 2008 and 2024 were included, comprising 664 implants. Mean postoperative pain (VAS) was 2.2 compared with 7.4 preoperatively. DASH, PRWE, and Mayo scores all showed significant improvement after surgery. Mean pronation–supination arc increased by 29 degrees, with an average postoperative arc of 148 degrees. The overall complication rate was 34%, with a reoperation rate of 23.9%. Cumulative implant survival was 94.5% at a mean follow-up of 46 months.
Conclusion
The Aptis implant provides significant functional improvement in complex DRUJ pathology, and is frequently used in revision settings. However, the high complication rate and lack of long-term follow-up, especially in younger patients, require careful patient selection. Prospective comparative studies with long-term outcomes are needed to better define the role of this implant in the therapeutic strategy.
Ethical Approval
As this study is a systematic review, no ethical approval was required.
Publication History
Received: 18 September 2025
Accepted: 18 November 2025
Article published online:
05 December 2025
© 2025. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
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References
- 1 Stuart PR, Berger RA, Linscheid RL, An K-N. The dorsopalmar stability of the distal radioulnar joint. J Hand Surg Am 2000; 25 (04) 689-699
- 2 Kessler I, Hecht O. Present application of the Darrach procedure. Clin Orthop Relat Res 1970; 72: 254-260
- 3 Kapandji IA. Opération de Kapandji-Sauvé: Techniques et indications dans les affections non rhumatismales [The Kapandji-Sauvé operation: its techniques and indications in non rheumatoid diseases]. Ann Chir Main 1986; 5 (03) 181-193
- 4 Bowers WH. Distal radioulnar joint arthroplasty: the hemiresection-interposition technique. J Hand Surg Am 1985; 10 (02) 169-178
- 5 Tulipan DJ, Eaton RG, Eberhart RE. The Darrach procedure defended: technique redefined and long-term follow-up. J Hand Surg Am 1991; 16 (03) 438-444
- 6 Nawijn F, Verhiel SHWL, Jupiter JB, Chen NC. Hemiresection interposition arthroplasty of the distal radioulnar joint: a long-term outcome study. Hand (N Y) 2021; 16 (05) 664-673
- 7 McKee MD, Richards RR. Dynamic radio-ulnar convergence after the Darrach procedure. J Bone Joint Surg Br 1996; 78 (03) 413-418
- 8 Reissner L, Schweizer A, Unterfrauner I, Estermann L, Nagy L. Long-term results of Sauvé-Kapandji procedure. J Hand Surg Eur Vol 2021; 46 (06) 626-631
- 9 Hagert CG. The distal radioulnar joint in relation to the whole forearm. Clin Orthop Relat Res 1992; (275) 56-64
- 10 Lees VC, Scheker LR. The radiological demonstration of dynamic ulnar impingement. J Hand Surg Am 1997; 22 (04) 448-450
- 11 Lamont S, Debkowska M, Johnsen P, Froehle A, Cotterell IH, Isaacs J. Outcomes of Darrach and Sauvé-Kapandji procedures: a systematic review. Hand (N Y) 2024; 19 (01) 68-73
- 12 Minami A, Iwasaki N, Ishikawa J, Suenaga N, Yasuda K, Kato H. Treatments of osteoarthritis of the distal radioulnar joint: long-term results of three procedures. Hand Surg 2005; 10 (2–3): 243-248
- 13 Axelsson P, Sollerman C, Kärrholm J. Ulnar head replacement: 21 cases; mean follow-up, 7.5 years. J Hand Surg Am 2015; 40 (09) 1731-1738
- 14 Adams BD, Gaffey JL. Non-constrained implant arthroplasty for the distal radioulnar joint. J Hand Surg Eur Vol 2017; 42 (04) 415-421
- 15 Multani I, Xu J, Manji J, Lawson RD, Graham DJ, Sivakumar BS. The one-bone forearm: a review. Hand (N Y) 2024; 19 (01) 12-23
- 16 Scheker LR. Implant arthroplasty for the distal radioulnar joint. J Hand Surg Am 2008; 33 (09) 1639-1644
- 17 Moulton LS, Giddins GEB. Distal radio-ulnar implant arthroplasty: a systematic review. J Hand Surg Eur Vol 2017; 42 (08) 827-838
- 18 Calcagni M, Giesen T. Distal radioulnar joint arthroplasty with implants: a systematic review. EFORT Open Rev 2017; 1 (05) 191-196
- 19 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71
- 20 Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 2003; 73 (09) 712-716
- 21 Laurentin-Pérez LA, Goodwin AN, Babb BA, Scheker LR. A study of functional outcomes following implantation of a total distal radioulnar joint prosthesis. J Hand Surg Eur Vol 2008; 33 (01) 18-28
- 22 Coffey MJ, Scheker LR, Thirkannad SM. Total distal radioulnar joint arthroplasty in adults with symptomatic Madelung's deformity. Hand (N Y) 2009; 4 (04) 427-431
- 23 Zimmerman RM, Jupiter JB. Outcomes of a self-constrained distal radioulnar joint arthroplasty: a case series of six patients. Hand (N Y) 2011; 6 (04) 460-465
- 24 Axelsson P, Sollerman C. Constrained implant arthroplasty as a secondary procedure at the distal radioulnar joint: early outcomes. J Hand Surg Am 2013; 38 (06) 1111-1118
- 25 Bizimungu RS, Dodds SD. Objective outcomes following semi-constrained total distal radioulnar joint arthroplasty. J Wrist Surg 2013; 2 (04) 319-323
- 26 Savvidou C, Murphy E, Mailhot E, Jacob S, Scheker LR. Semiconstrained distal radioulnar joint prosthesis. J Wrist Surg 2013; 2 (01) 41-48
- 27 Galvis EJ, Pessa J, Scheker LR. Total joint arthroplasty of the distal radioulnar joint for rheumatoid arthritis. J Hand Surg Am 2014; 39 (09) 1699-1704
- 28 Kachooei AR, Chase SM, Jupiter JB. Outcome assessment after Aptis distal radioulnar joint (DRUJ) implant arthroplasty. Arch Bone Jt Surg 2014; 2 (03) 180-184
- 29 Kakar S, Fox T, Wagner E, Berger R. Linked distal radioulnar joint arthroplasty: an analysis of the APTIS prosthesis. J Hand Surg Eur Vol 2014; 39 (07) 739-744
- 30 Rampazzo A, Gharb BB, Brock G, Scheker LR. Functional outcomes of the Aptis-Scheker distal radioulnar joint replacement in patients under 40 years old. J Hand Surg Am 2015; 40 (07) 1397-1403.e3
- 31 Sander AL, Ebert F, Marzi I, Frank J. Ergebnisse nach Implantation der Aptis-Prothese zum Ersatz des distalen Radioulnargelenks [Outcome after implantation of the Aptis total distal radioulnar joint replacement prosthesis]. Handchir Mikrochir Plast Chir 2015; 47 (05) 306-311
- 32 Wimalawansa SM, Lopez RR, de Lucas FG. et al. Salvage of failed Achilles tendon interposition arthroplasty for DRUJ instability after ulnar head resection with Aptis prosthesis. Hand (N Y) 2017; 12 (05) 476-483
- 33 Bellevue KD, Thayer MK, Pouliot M, Huang JI, Hanel DP. Complications of semiconstrained distal radioulnar joint arthroplasty. J Hand Surg Am 2018; 43 (06) 566.e1-566.e9
- 34 DeGeorge Jr BR, Berger RA, Shin AY. Constrained implant arthroplasty for distal radioulnar joint arthrosis: evaluation and management of soft tissue complications. J Hand Surg Am 2019; 44 (07) 614.e1-614.e9
- 35 Lans J, Chen S-H, Jupiter JB, Scheker LR. Distal radioulnar joint replacement in the scarred wrist. J Wrist Surg 2019; 8 (01) 55-60
- 36 Fuchs N, Meier LA, Giesen T, Calcagni M, Reissner L. Long-term results after semiconstrained distal radioulnar joint arthroplasty: a focus on complications. Hand Surg Rehabil 2020; 39 (03) 186-192
- 37 Amundsen A, Rizzo M, Berger R, Moran SL. Salvage of painful porous coated stem ulnar head prosthesis with semiconstrained distal radioulnar joint arthroplasty. J Hand Surg Am 2022; 47 (07) 689.e1-689.e8
- 38 Brannan PS, Ward WA, Gaston RG, Chadderdon RC, Woodside JC, Connell B. Two-Year Clinical and Radiographic Evaluation of Scheker Prosthesis. Two-year clinical and radiographic evaluation of Scheker prosthesis (Aptis) distal radioulnar joint arthroplasty. J Hand Surg Am 2022; 47 (03) 290.e1-290.e11
- 39 Lambrecht D, Vanhove W, Hollevoet N. Clinical and radiological results of distal radioulnar joint arthroplasty with the Aptis prosthesis. J Hand Surg Eur Vol 2022; 47 (04) 379-386
- 40 Pääkkönen M. Complications of Scheker semiconstrained distal radioulnar joint arthroplasty in a low-volume unit. Hand Surg Rehabil 2022; 41 (04) 441-444
- 41 Warlop J, Nuffel MV, Smet L, Degreef I. Midterm functional outcome of the linked semiconstrained distal radioulnar joint prosthesis. J Wrist Surg 2021; 11 (04) 335-343
- 42 Amundsen A, Rizzo M, Berger RA, Houdek MT, Frihagen F, Moran SL. Twenty-year experience with primary distal radioulnar joint arthroplasty from a single institution. J Hand Surg Am 2023; 48 (01) 53-67
- 43 Jawahier PA, Derksen BM, Jaquet JB, Schep NWL. Replacement of the distal radio-ulnar joint with a semi-constrained Scheker DRUJ prosthesis. Oper Orthop Traumatol 2023; 35 (06) 341-351
- 44 Levina Y, Mesa L, Hannon PJ, Coutelle NA, Hess AV, Garcia MJ. Retrospective and prospective outcomes of distal radioulnar joint prosthesis arthroplasty at a single center. J Hand Surg Glob Online 2023; 5 (05) 620-623
- 45 Sommer K, Sturm R, Sterz J, Marzi I, Frank J. The semiconstrained DRUJ prosthesis: blessing or curse?. Eur J Trauma Emerg Surg 2023; 49 (05) 2097-2103
- 46 Martínez Villén G, Espada Blasco C, Rodríguez Nogué L, García González E. Long-term results of the AptisTM total distal radioulnar joint prosthesis after previous failed surgical procedures. J Hand Surg Eur Vol 2024; 49 (01) 82-90
- 47 Smith MP, Kleinman WB, Crosby NE. Early results in total replacement of the distal radioulnar joint. Hand (N Y) 2025; 20 (05) 733-739
- 48 Stougie SD, Boekel LCV, Beumer A, Hoogvliet P, Strackee SD, Coert JH. Aptis distal radioulnar joint arthroplasty: a multicenter evaluation of functional outcomes, complications, and patient satisfaction. J Wrist Surg 2023; 13 (04) 318-327
- 49 Deneuville M, Germon C, Sturbois-Nachef N, Chazard E, Chantelot C, Saab M. Intervention de Sauvé-Kapandji pour la prise en charge de l'arthrose radio-ulnaire distale post-traumatique: résultats à long terme et analyse des facteurs de risque de reprise chirurgicale [The Sauvé-Kapandji procedure for post-traumatic distal radioulnar arthrosis: Long-term results and analysis of risks factors for revision surgery]. Rev Chir Orthoped Traumatol 2024; 110 (01) 33-40
- 50 Giberson-Chen CC, Leland HA, Benavent KA, Harper CM, Earp BE, Rozental TD. Functional outcomes after Sauve-Kapandji arthrodesis. J Hand Surg Am 2020; 45 (05) 408-416
- 51 Hernández-Cortés P, Catena A, Hernández-Peregrina P, Elizondo-Espósito D, Pajares-López M, Rosales RS. Association between radioulnar impingement and salvage surgical procedures of the distal radioulnar joint: influence of confounding variables. J Hand Surg Eur Vol 2024; 49 (01) 73-81