The Rate of Radial Head Prosthesis Removal or Revision: A Systematic Review and Meta-Analysis

Kachooei, Amir Reza; Baradaran, Aslan; Ebrahimzadeh, Mohammad H.; Dijk, C. Niek van; Chen, Neal C.

doi:10.1016/j.jhsa.2017.08.031

Cited by 55 publications

(37 citation statements)

References 40 publications

(37 reference statements)

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“…We were not able to assess the exact progression of radiological parameters, because plain radiographs were not carried out routinely between the postsurgical follow-up and our final follow-up. In conclusion, we believe that the use of bipolar implants in complex elbow injuries can be considered reliable if an accurate treatment of injured soft tissues is performed and if an optimal primary stability of the stem is reached, even with the use of cementation if needed; indeed, the role of soft tissues repair is strongly underscored in the most recent literature as instability represents one of the main causes of implant revision [24]. Most of the time, instability is related to LCL complex failure and lateral ligaments suture in addition to the radial head prosthesis can translate into much better outcomes (Fig.…”

Section: Discussionmentioning

confidence: 95%

“…Despite we reported satisfactory clinical outcomes, the need of second surgery in 5 out of 17 patients is not neglectable, with an overall rate of 29.4% and a removal rate of 17.6%, higher than that reported in the current literature. Indeed, in a systematic review and metaanalysis, Kachooei et al [24] found a pooled rate of radial head prostheses removal or revision of 10%; more than half of the implants were revised for excision of heterotopic ossifications (47%) and for the treatment of elbow stiffness and limitation of the range of motion (42%); other relevant causes were pain (19%), aseptic loosening (16%), overstuffing (13%) and instability (12%). In our series, the primary indication for removal was an early aseptic symptomatic loosening of the prostheses; after two months both patients presented type IV radiolucencies surrounding uncemented stems (Fig.…”

Section: Discussionmentioning

confidence: 99%

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Acute radial head replacement with bipolar prostheses: midterm results

Nosenzo

Galavotti

Menozzi

et al. 2020

Eur J Orthop Surg Traumatol

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In irreparable radial head fractures, especially if primary stabilizers of the elbow are damaged, the prosthetic replacement prevents instability and stiffness. Concerns have arisen over the use of bipolar press-fit prostheses due to the frequent finding of osteolysis and the risk of instability if compared to monopolar implants. Our aim was to assess midterm clinical and radiological outcomes of bipolar implants and the influence of osteolysis on proximal pain. Seventeen patients with irreparable fractures of the radial head, treated in acute with the same prosthetic model (rHEAD recon SBI/Stryker) between January 2015 and December 2018, were enrolled. Clinical assessment was performed using MEPS and DASH scores; a radiographic study was done to identify heterotopic ossifications and periprosthetic osteolysis. Outcomes at the last follow-up, according to MEPS, were excellent in 10 cases, good in 5 and fair in 2; none of the patients had severe pain or instability. In 3 cases, it was necessary to remove the implant, mainly because of early loosening. Radiological findings of osteolysis were detected in 9 cases, but no statistical correlation was found with MEPS and proximal pain. The use of bipolar implants is reliable if an accurate repair of ligament tears is performed and provides a good stability. Nevertheless, the risk of early aseptic loosening in uncemented implants is not negligible, and the follow-up of the patient must be strict. Late osteolysis does not seem to have clinical relevance, but further prospective studies are necessary to clarify this topic.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Acute radial head replacement with bipolar prostheses: midterm results

Nosenzo

Galavotti

Menozzi

et al. 2020

Eur J Orthop Surg Traumatol

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“…This data would suggest that monopolar prostheses provide significantly greater radiocapitellar stability when used in the treatment of terrible triad injuries, than bipolar implants. These findings have been replicated in multiple clinical studies, though without statistically significant evidence, and the monopolar implant is currently the device of choice in cases of associated soft tissue injury [12,[58][59][60][61][62][63].…”

Section: Revolutionmentioning

confidence: 95%

“…Sahu et al [62] showed that anatomic RHP with articular surfaces that match the radius of curvature of the capitellum have increased radiocapitellar contact areas and lower peak pressures compared to mono-and bipolar implants. Although comparative clinical studies could not reproduce these results, the use of the anatomic RH is recommended to avoid long-term cartilage damage; the polarity of the design does not appear to affect this endpoint [12,51,[59][60][61][62][63].…”

Section: Revolutionmentioning

confidence: 99%

Radial head arthroplasty: a historical perspective

Laumonerie

Tibbo

Reina

et al. 2018

International Orthopaedics (SICOT)

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There has been lively debate regarding the rationale behind the use of radial head arthroplasty (RHA) for more than 80 years. Currently, its primary indication is for treatment of non-reconstructible RH fractures. The first RH implant, released in 1941, was a ferrul cap used to prevent heterotopic ossification. Biomechanical studies in the 1980s stimulated a revolution in RHA design by promoting modular implants that replicated the native bony anatomy of the elbow. Subsequent data-driven evolution in design led to the creation of a variety of devices that also accommodated for common ligamentous injuries occurring at the time of RH fracture. Despite significant advances in our understanding of complex elbow instability, improvements in implant design have to make RHA the gold standard for treatment of non-reconstructible RH fractures. The challenge in the coming years will be to perform high-level clinical studies in order to obtain consensus regarding the most appropriate treatment for comminuted RH fractures.

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“…Despite a plethora of clinical outcome studies, no design has shown clinical superiority. 2,6,13 In general, short and mid-term clinical outcomes are mostly good but long-term results are still poorly documented. 3,8 Some biomechanical studies have suggested less joint stability after bipolar prostheses 5,18 with increased elbow valgus laxity.…”

Section: Introductionmentioning

confidence: 99%

Joint contact areas after radial head arthroplasty: a comparative study of 3 prostheses

Moungondo

Andrzejewski

Riet³

et al. 2019

Journal of Shoulder and Elbow Surgery

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Background: Contact stresses of radial head prostheses remain a concern, potentially leading to early capitellar cartilage wear and erosion. Especially point contact or edge loading could have a detrimental effect. The purpose of this study was to compare three different types of radial head prostheses in terms of joint contact areas, in comparison to the native situation. The hypothesis was that the joint contacts are lower after monopolar arthroplasty. Methods: Seven fresh frozen cadaver upper limbs were used. Radiocapitellar contact areas of a monopolar, straight neck bipolar and a bipolar design with an angled neck were compared with each other and with the native joint. After standardized preparation, polysiloxane was injected into the loaded radiocapitellar joint to create a cast from which the joint contact area was measured. Measurements were performed at three angles of elbow flexion, and in three different forearm positions. Results: In the native elbow, contact areas were highest in supination. Elbow flexion had no significant effect on native and prosthetic joint contact areas. Contact areas were decreased for all types of arthroplasties when compared to the native joint (from 11% to 53%). There was no significant contact area difference between the three designs. However, bipolar prostheses showed a lateral subluxation in neutral forearm rotation, resulting in a significant decrease of the contact areas from pronation to neutral position. Conclusions: All types of radial head prostheses tested showed a significant decrease in radiocapitellar contact area, when compared to the native joint. Bipolar designs lead to a subluxation of the radial head, further decreasing the radiocapitellar contact.

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The Rate of Radial Head Prosthesis Removal or Revision: A Systematic Review and Meta-Analysis

Abstract: Prognostic II.

Cited by 55 publications

References 40 publications

Acute radial head replacement with bipolar prostheses: midterm results

Acute radial head replacement with bipolar prostheses: midterm results

Radial head arthroplasty: a historical perspective

Joint contact areas after radial head arthroplasty: a comparative study of 3 prostheses

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