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Loss of flexion after radial head replacement
John P Birkedal1, D Nicole Deal, David S Ruch
1Department of Orthopaedic Surgery, Wake Forest University, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
Journal of Shoulder and Elbow Surgery
|March 5, 2004
Summary
Loss of elbow flexion after prosthetic radial head replacement can occur. Biomechanical analysis revealed a smaller radiocapitellar gap during flexion, suggesting this may cause complications.
Area of Science:
- Orthopedic Surgery
- Biomechanical Engineering
- Reconstructive Surgery
Background:
- Prosthetic radial head replacement is a common orthopedic procedure.
- Recently, a decrease in elbow flexion following radial head arthroplasty has been observed.
- This complication impacts patient function and satisfaction.
Purpose of the Study:
- To investigate the cause of reduced elbow flexion after modular prosthetic radial head replacement.
- To correlate clinical findings with biomechanical data.
- To identify factors contributing to postoperative elbow motion loss.
Main Methods:
- Clinical review of 6 patients with decreased elbow flexion after radial head arthroplasty.
- Biomechanical analysis using matched-pair, fresh-frozen upper extremity specimens.
- Loading specimens to 330 N across various forearm and elbow positions to measure the radiocapitellar gap.
Main Results:
- Four of the six patients required implant removal due to pain and reduced motion.
- Biomechanical testing showed a significantly smaller radiocapitellar gap under load during elbow flexion compared to extension.
- The gap size varied with forearm rotation (neutral, pronation, supination) and elbow angle.
Conclusions:
- A reduced radiocapitellar gap during elbow flexion may lead to complications after radial head arthroplasty.
- Verification of the radiocapitellar gap throughout the range of motion is crucial during surgery.
- Proper implant sizing and positioning are essential to prevent loss of elbow flexion.