Can Ulnar Variance Be Used to Detect Overstuffing After Radial Head Arthroplasty?

Moon, Jun Gyu; Hong, Jin; Bither, Nitin; Shon, Won Yong

doi:10.1007/s11999-013-3277-z

Cited by 8 publications

(6 citation statements)

References 14 publications

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“…Moon et al presented an experimental study in which they found significant differences in the radioulnar variance of the wrist after sequential overlengthening of the radial column with a monopolar prosthesis [ 17 ]. They tested the specimens in full extension and neutral position.…”

Section: Discussionmentioning

confidence: 99%

“…Monopolar systems in contrast do not allow compensatory movements as the shaft is amotile to the head component. This could be the reason why in the study of Moon and colleagues more distinct differences were found by overstuffing of the radial column on the radioulnar variance [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, the need for reliable tools to visualize overlengthening intraoperatively remains. Recently, Moon et al have published an experimental study in which artificial radial overlengthening led to significant changes at the distal radioulnar joint with distalization of the radius [ 17 ]. To our knowledge, no study has yet evaluated an intraoperative test based on radiographic images of the wrist to diagnose radial overlengthening by a multipolar prosthesis.…”

Section: Introductionmentioning

confidence: 99%

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Is the distal radioulnar variance useful for identification of radial head prosthesis overlengthening? A cadaver study

et al. 2016

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BackgroundOverlengthening by radial head prosthetic replacement leads to insufficient functionality and increased capitellar wear. It has been shown that in monopolar prostheses, the radial overlengthening by an overstuffed prosthesis leads to significant differences in the distal radioulnar variance at the wrist. This study evaluated ipsilateral ulnar variance as a predictor for overlengthening after implantation of a multipolar prosthesis.MethodsThe radial heads of seven fresh frozen upper extremities were resected and a multipolar radial head prosthesis was implanted. Thereafter, the native radioulnar variance at the wrist was documented via fluoroscopy. The alignment of the distal radioulnar joint in neutral, pronated and supinated rotational positions of the forearm was recorded fluoroscopically, and digital image analysis was performed regarding radioulnar shifting.ResultsStatistical analysis of the difference between native height and the manipulated states did not show consistent significant differences with stepwise overlengthening of +1.5, +3, +4.5 and +6 mm and with respect to rotational position of the forearm (p > 0.05). Interclass correlation coefficients showed excellent interobserver reliability (ICC 96 %), as did tests for intraobserver reliability (ICC 98–99 %).ConclusionsNo consistent influence of overlengthening on the alignment of the radius and ulna at the distal radioulnar joint was found after sequential overlengthening with a multipolar prosthesis. Maybe the ligamentous structures of the forearm prevent significant longitudinal dislocation of the radius, as the multipolar prosthesis gives way by at the radiocapitellar joint. According to the data of the present study, the ipsilateral wrist is not useful in diagnosing overlengthening of the radial column in multipolar prosthetic replacement of the radial head—in contrast to the reported results with monopolar prostheses.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is the distal radioulnar variance useful for identification of radial head prosthesis overlengthening? A cadaver study

et al. 2016

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“…As described before, overstuffing can be assessed based on the position relative to the lesser sigmoid notch of the ulna. 44 , 51 Plain radiographs will only show overlengthening in severe cases. 19 In case of overstuffing, it is sometimes necessary to revise the implant, whereas some implants can be shortened in situ (for instance changing the head component of a bipolar implant).…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

Management of the failed radial head arthroplasty

et al. 2020

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Primary radial head arthroplasty (RHA) produces good or excellent results in approximately 85% of patients. However, complications are not uncommon and have been described in up to 23% of cases. The number of RHA is increasing, and consequently the absolute number of complications is expected to rise as well. The decision on whether to revise or remove the prosthesis seems more likely to depend on the preference of the surgeon or the hospital, rather than on objectifying problems with the prosthesis. The current article presents an algorithm for the work-up and treatment of most complications that can occur following RHA. Five subgroups of problems were identified: osteoarthritis, stiffness, instability, infection and implant-related issues. In short, the preferred treatment depends mainly on the chondral condition and stability of the elbow joint. Cite this article: EFORT Open Rev 2020;5:398-407. DOI: 10.1302/2058-5241.5.190055

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“…With their method, according to the authors, it is possible to quantify the magnitude of overlengthening; in this paper the authors used the Evolve prosthesis (Wright Medical). Another group reported on the usefulness of the ulnar variance, to detect overlengthening [ 24 ]. Moon et al could show that increasing radial length by overlengthening of a radial head implant leads to a decrease of ulnar variance.…”

Section: Introductionmentioning

confidence: 99%

Overlengthening of the radial column in radial head replacement: a review of the literature and presentation of a classification system

Wegmann

Hackl

Leschinger

et al. 2020

Arch Orthop Trauma Surg

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Background Radial head arthroplasty is a common procedure in elbow surgery. It has been shown to be of benefit for the patients, but there also are relevant complications that should be prevented if possible. One significant complication is overlengthening of the radial head prosthesis. In overlengthening, the head of the prosthesis overextends the physiological level of the native radial head and leads to overcompression in the radiohumeral joint. Rapid erosion and arthritic changes may then impede the clinical outcome. The incidence of overlengthening is not precisely known, but estimations range to up to 20% of all implanted prostheses. Methods The present review discusses the available body of literature on overlengthening and lines out a classification system that may be used to guide treatment algorithms. The classification is based on the personal experiences of the author during their clinical practice. Results In low-grade overlengthening (type I) conservative treatment can be an option. In Types II–IV usually revision surgery is needed. Depending on the state of the capitulum and joint stability, it is possible re-implant a prosthesis, or rely on implant removal alone. Discussion The present review aimed at shedding light into overlengthening as a complication radial head replacement and to help identify and treat it.

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Can Ulnar Variance Be Used to Detect Overstuffing After Radial Head Arthroplasty?

Cited by 8 publications

References 14 publications

Is the distal radioulnar variance useful for identification of radial head prosthesis overlengthening? A cadaver study

Is the distal radioulnar variance useful for identification of radial head prosthesis overlengthening? A cadaver study

Management of the failed radial head arthroplasty

Overlengthening of the radial column in radial head replacement: a review of the literature and presentation of a classification system

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