Optimal Prosthesis Sizing for Radial Head Arthroplasty

Bagley, Joshua J.; Rocca, Gregory J. Della; Smith, Matthew J.; Kim, H. Mike

doi:10.2106/jbjs.rvw.20.00178

Cited by 7 publications

(1 citation statement)

References 28 publications

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“… 1 , 19 Improved outcomes in contemporary primary RHA have been attributed to standardization of surgical techniques such as more appropriate prosthesis positioning and sizing. 20 - 23 Further, improvements in prosthetic design have been indicated as important components in achieving favorable outcomes in primary RHA. 14 , 15 , 20 , 24 - 26 These variables also have the potential to contribute to improved outcomes after revision RHA.…”

Section: Discussionmentioning

confidence: 99%

Revision of Failed Radial Head Arthroplasty

Heifner

Kolovich²,

Bolano³

et al. 2023

Hand (New York, N,Y.)

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Background: Revision of radial head arthroplasty (RHA) may be indicated in cases of prosthesis loosening and malposition. Inherent difficulties in revision surgery include poor bone stock and disrupted soft tissue envelope. Although cases of RHA used for revision of failed RHA are rare, there is reasonable expectation for increasing frequency of these cases due to the increasing incidence of primary RHA. Furthermore, there is an increasing demand for postoperative recovery of function; thus, surgeons may consider revising a failed RHA to a new RHA. We report on series of failed RHA which were revised to a new radial head prosthesis. Methods: A retrospective review was performed at multiple institutions for a single radial head prosthesis used for revision of a failed radial head prosthesis. Clinical and radiographic outcomes were collected with a minimum of 1 year of follow-up. Results: Across 11 patients at a mean follow-up of 45.1 months, the mean Mayo Elbow Performance Score was 81.7; mean Disabilities of the Arm, Shoulder, and Hand scores were 24.4; and mean Visual Analog Scale for pain was 0.6. Radiographic analysis yielded no evidence of capitellar wear or stem loosening. Conclusion: A radial head prosthesis can produce satisfactory results when used for revision of a failed prosthesis. Inherent difficulties in revision surgery include the potential for reduced bone stock and a disrupted soft tissue envelope. Elements of prosthesis design which may contribute to effectively managing revision surgery include a long stem with in-growth surface and prosthetic head alignment to the axis of forearm rotation.

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Section: Discussionmentioning

confidence: 99%

Revision of Failed Radial Head Arthroplasty

Heifner

Kolovich²,

Bolano³

et al. 2023

Hand (New York, N,Y.)

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Radial head arthroplasty diameter impact on elbow kinematics evaluated by dynamic radiostereometric analysis

Teilmann,

Petersen,

Thillemann

et al. 2024

J. exp. orthop.

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PurposeRadial head arthroplasty (RHA) reestablishes elbow stability after complex radial head fracture, but complication rates are high, possibly due to inappropriate implant sizing. Knowledge of impact of radial head implant diameter on elbow kinematics is limited and warranted. This study evaluated elbow kinematics of different radial head implant diameters after RHA using dynamic radiostereometric analysis (dRSA).MethodsEight human donor arms were examined with dRSA during elbow flexion with the forearm in unloaded neutral position, and in supinated‐ and pronated position without and with 10N either varus or valgus load, respectively. Elbow kinematics were examined before and after RHA with head diameters of anatomical size, −2 mm (undersized), and +2 mm (oversized). The ligaments were kept intact by use of step‐cut humerus osteotomy for repeated RHA exchange. Bone models were obtained from CT, and by AutoRSA software bone models were matched with dRSA recordings. The elbow kinematics were described using anatomical coordinate systems.ResultsCompared to the native radial head during elbow flexion, the anatomical sized RHA shifted 2.0 mm in ulnar direction during unloaded pronated forearm position. The undersized RHA shifted 1.5 mm in posterior direction and 2.1 mm in ulnar direction during unloaded pronated forearm position and increased the varus angle by 2.4° during supinated loaded forearm position. The oversized RHA shifted 1.6 mm in radial direction during loaded supinated forearm position.ConclusionsThe anatomically sized RHA should be preferred as it maintained native elbow kinematics the best. The kinematic changes with oversized and undersized RHA diameters were small, suggesting forgiveness for the RHA diameter size.Level of EvidenceLevel III.

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