A 55-year-old man who had corrective osteotomy for distal radial malunion, followed by total distal radioulnar joint arthroplasty for residual instability and pain. A and B, Preoperative radiographs showing an apex-volar malunion of distal radius with marked ulnar-positive variance. C, Two months after corrective osteotomy, the apex-volar malunion was corrected but distal radioulnar joint dysfunction persisted, with wide diastasis at sigmoid notch and ulnar-positive variance. D, One month after total distal radioulnar joint arthroplasty, which resulted in resolution of pain and restoration of grip and lifting strength. There were no clinical or radiographic indications of loosening at more than 3 years of follow-up.