Long-term outcomes of a cemented bipolar radial head prosthesis: a large retrospective study

In acute radial head fractures (RHFs), a radial head prosthesis can be considered if open reduction and internal fixation are not technically feasible. This study provides the largest long-term clinical and radiologic follow-up study of cemented bipolar Judet prostheses implanted to manage acute RHFs, either isolated and associated with other elbow fractures. We compare their functional and radiographic outcomes to test the hypothesis that the bipolar design can achieve similar results in both groups.

We reviewed data of 63 consecutive patients implanted with a bipolar prosthesis (the articulation between the stem and the cup is semiconstrained and gives the radial cup a double range of movement) to treat unreconstructable RHFs with/without other fractures. Fifty-two patients had more than 10-year follow-up. Assessments included range of motion and stability using the Mayo Elbow Performance Score and the QuickDash questionnaire score, pain with a visual analog scale, and overall satisfaction with an interview. X-rays were examined to check the correct seating of the implant and periprosthetic loosening, prosthetic disassembly, heterotopic ossification, and capitellum and ulnohumeral degenerative changes.

At a mean follow-up of 150 months, 90% of patients were satisfied, with a mean Mayo Elbow Performance Score of 89 (range, 70-100) and a mean QuickDash score of 6.8 (range, 0-18.2). The mean arc of motion was 113° (range, 70°-140°) in flexion-extension and 149° (range, 100°-160°) in pronation-supination. Nineteen patients (30%) patients required reoperation in the first 3 years.

The bipolar Judet prosthesis is a viable implant for acute irreducible RHFs. Clinical and radiologic outcomes and complications leading to reoperation were not significantly different between isolated radial head fractures and associated radial head fractures patients.