Outcomes of implant removal after failed radial head arthroplasty: an average 7-year follow-up study

Failure of radial head implants secondary to loosening, painful capitellar wear, and other reasons is not uncommon. When radial head implants fail, the relative indications for implanting a new radial head implant vs. implant removal with or without soft-tissue interposition remain unclear. Removal theoretically reduces the risk of radiocapitellar pain; however, little is known about the outcomes following removal of failed radial head replacements. The purpose of this study was to evaluate the outcomes, complications, and rates of proximal radioulnar impingement pain following removal of failed radial head implants.

Our institution's Total Joint Registry database was queried to identify all elbows that had undergone removal of a failed radial head arthroplasty without implantation of a new prosthesis. Patients with radiocapitellar or total elbow arthroplasty at the index surgery were excluded. Thirty-seven elbows met inclusion criteria, but 12 had less than 2 years of follow-up; the remaining 25 elbows form the basis for this study. Demographics, complications, reoperations, pre-operative and post-operative range of motion, development of symptomatic proximal radioulnar impingement, and patient-reported outcome measures were collected. The mean age at the time of resection was 50 years (range, 16-75 years). The mean follow-up was 7 years (range, 2-15 years).

The mean time to removal following implantation was 31 months (range, 2-135 months). Compared to how they felt before surgery, 21/25 patients gave their elbows a Summary Outcome Determination score of "Improved" or better, while 4/25 rated their elbows as "Worse". Implants removed included 21 press-fit, 3 loose-fit, and 1 cemented radial head implant. The most common indication for removal was painful loosening (17/25, 68%), followed by head/neck uncoupling (3/25, 12%), overstuffing (2/25, 8%), maltracking (2/25, 8%), and infection (1/25, 4%). All the patients with loose implants (n = 17) reported radial-sided proximal forearm pain before resection, which had improved at the final follow-up in 76% (13/17), was unchanged in 6% (1/17), and was not recorded in 3 patients. The mean flexion-extension and pronation-supination arcs following resection did not significantly change.

Implant removal is a viable treatment strategy for failed radial head arthroplasty with good outcomes at an average 7-year follow-up. In our study, 76% of patients with loose painful implants reported improvement in proximal radial-sided forearm pain. However, patients should be counseled about the risk of developing symptomatic proximal radioulnar impingement following implant removal and the occasional progression of osteoarthritis requiring further surgery.