Long-term functional and radiographic outcomes after removal of radial head arthroplasty

If reconstruction of the radial head using osteosynthesis is not possible, radial head arthroplasty (RHA) is performed. Despite the increasing use of RHA, little reliable data is available on the functional and clinical outcomes following removal of RHA in a mid- to long-term follow-up.

This study included 27 patients who underwent removal of RHA between 2010 and 2021. The mean follow-up period was 8.8 years (2.0 to 14.2 years). The time to removal, as well as functional elbow scores (Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES) and Disabilities of arm, shoulder, and hand (DASH)) established during the follow-up period, were recorded for all patients. Furthermore, the pre- and post-operative range of motion (ROM), level of pain, and radiological images were analysed.

Across the entire cohort (46.4 ± 14.3 years; 40.7% female), moderate functional outcomes were observed during the follow-up period (MEPS: 66.7 ± 22.1; OES: 35 ± 9; DASH score: 32.6 ± 17.7). The most common reasons for revision were loosening (n = 15, 55.6%) and painful movement restrictions with anterolateral forearm pain (n = 15, 55.6%). Despite arthrolysis, there was no improvement in ROM in the long-term follow-up. The incidence of moderate to severe OA increased significantly (44.4% to 70.4%, p = 0.031).

Complications following RHA result in impaired functional outcomes that persist even after the prosthesis is removed. These findings support the importance of careful primary implantation and avoidance of overstuffing; however, removal of a failed RHA should be regarded as a salvage procedure with limited potential to restore long-term elbow function.