Management of the radial head and linked total elbow arthroplasty

In properly selected patients, the radial head need not be resected in linked elbow replacement.

For linked prostheses, whether the radial head is addressed is a function of the specific pathology present. We reviewed our management of the radial head in linked elbow arthroplasty (TEA) to determine the frequency and indication for subsequent surgery if not resected at the time of the primary procedure.

We reviewed indications in 709 patients who underwent TEA to determine how the radial head was managed. Indications for secondary resection as a result of radial head impingement were identified. Significant differences between the rheumatoid and post-traumatic groups were tested with χ(2) analysis.

Of 381 rheumatoid patients who underwent TEA, the radial head was addressed surgically in 169 (44%); of which 68 patients (17.8%) in the rheumatoid arthritis group required complete radial head resection and 101 (27%) had a "radiusing" debridement procedure. Post-traumatic disease was present in 328 patients, and 38 (13%) underwent radial head resection, 5 underwent a debridement radiusing. The radial head was addressed surgically more often in the rheumatoid arthritis group (P = .001). Only 4 of the 709 patients (0.6%) required a secondary resection for radial head impingement, all with good results.

Most often the radial head can be preserved with this linked prosthesis. Rheumatoid arthritis carries a higher prevalence of radial head disease, and hence requires attention more commonly, usually with simple debridement. If impingement symptoms of radial head develop, secondary resection yields good results.