Mid-term outcomes of 77 modular radial head prostheses

Area of Science:

• Orthopedic surgery
• Biomaterials science
• Radiology

Background:

• Radial head fractures can be challenging to reconstruct.
• Radial head arthroplasty (RHA) is an option for non-reconstructable fractures.
• Mid-term clinical and radiographic outcomes of RHA require evaluation.

Purpose of the Study:

• To assess the mid-term clinical and radiographic results of radial head arthroplasty (RHA).
• To compare outcomes based on RHA design and timing of implantation (acute vs. sequelae).

Main Methods:

• A retrospective study of 77 RHAs implanted between 2002 and 2014.
• Four different RHA designs were used.
• Clinical outcomes assessed via Mayo Elbow Performance (MEP) and quick Disabilities of the Arm, Shoulder and Hand (quickDASH) scores.
• Radiographic assessment included osteolysis and implant positioning.
• Follow-up averaged 74 months.

Main Results:

• Mean MEP score was 90.2, mean quickDASH score was 14.0.
• No significant difference in outcomes between acute and delayed RHA.
• 30 re-operations occurred within the first three years.
• Painful loosening was the primary reason for implant removal (14 patients).
• Short-stemmed prostheses showed increased risk of loosening (OR 3.54, p=0.045).
• Overall RHA survival free from re-operation was 60.8% at 10 years.

Conclusions:

• Bipolar and press-fit RHA yield unsatisfactory mid-term outcomes for radial head fractures.
• Implant design influences clinical outcomes.
• Early re-operation rates predict long-term survival for tight-fitting RHAs.