Why does radial head arthroplasty fail today? A systematic review of recent literature

Viveen, Jetske; Kodde, Izaäk F.; Heijink, Andras; Koenraadt, Koen L. M.; Bekerom, Michel P.J. van den; Eygendaal, Denise

doi:10.1302/2058-5241.4.180099

Cited by 26 publications

(26 citation statements)

References 47 publications

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“…However, as clinical studies found, prosthetic replacement of the radial head comes with complications, with loosening being the most common one together with overstuffing [26]. The most commonly observed loosening is aseptic loosening [9].…”

Section: Discussionmentioning

confidence: 99%

“…In general, the implants can be differentiated into monopolar and bipolar implants. While the bipolar implants allow movement of the head component, the monopolar ones rely on a simpler construct with rigid fixation of the head to the respective neck or shaft [8,9]. Although the clinical outcomes after radial head arthroplasty are reliable, specific complications have been reported [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…While the bipolar implants allow movement of the head component, the monopolar ones rely on a simpler construct with rigid fixation of the head to the respective neck or shaft [8,9]. Although the clinical outcomes after radial head arthroplasty are reliable, specific complications have been reported [9][10][11][12]. One of these is malpositioning of the implant, where the level of the articular surface is placed too high in relation to the native height of the radial head [13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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Prosthetic replacement of the radial head

et al. 2020

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Background Radial head replacement is an established option in patients with comminuted radial head fractures and complex elbow trauma. While studies demonstrated that asymptomatic radiolucencies around the stem are common, the incidence and clinical significance of bone loss at the proximal part of the radius, just distal to the neck of the prosthesis (collar resorption), is unknown. Objectives The aim of this retrospective study was to analyse the incidence of collar resorption after radial head replacement and investigate whether this correlates with specific patient characteristics such as gender, age, indication for index surgery and the size of implant used. Materials and methods The study group consisted of 30 patients (average age 60.1 years) having undergone prosthetic replacement with a monopolar press-fit implant of the radial head at an average follow-up of 23 months. Indications for surgery included trauma sequelae or revision in 16 patients and acute, unreconstructable fractures of the radial head in 14 cases. Symptoms of loosening and revision surgery were recorded. Radiographs were analysed for signs of lucency between the bone and the implant as well as for signs of resorption of bone mass around the neck (section 1). These values were correlated with age, gender, indication for index surgery and size of implant. Results In all, 28/30 (93.3%) prostheses showed proximal osteolysis around the neck of the shaft. Of the 30, one prosthesis presented signs of shaft loosening. The average amount of osteolysis was 8.78% (range 0–26.1%; ±6.0%) of the overall length of the prosthetic shaft (OL). There was no significant difference (p = 0.49) between the amount of resorption in section 1 between the primary fracture cases (8.75 ± 4.5%; range 1.2–15.8%) and the group of secondary implantations due to degeneration or fracture sequelae (8.8 ± 7.2%; range 0–26.1%). Furthermore, the analysis did not reveal any statistically relevant correlations between the amount of neck resorption and the other cohort characteristics (age, gender, size of the components). Conclusions In the study cohort, a high amount of osteolysis/bone resorption was assessed around the neck of the press-fit radial head prosthesis used. However, no significant correlation between collar resorption, patient demographics and indication for index surgery was found at short-term follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prosthetic replacement of the radial head

et al. 2020

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“…Reported complications have consisted of nerve palsy, instability, stiffness, persistent pain, (superficial) infection, complex regional pain syndrome (CRPS) and symptomatic hardware. 10 Revision surgery was performed in a significant group of patients that experienced complications (23%) following primary RHA. A systematic review on RHA by our study group showed that, on average, 8% of radial head prosthesis had been revised early, within four years of follow-up.…”

Section: Radial Head Arthroplastymentioning

confidence: 99%

“…All recommendations are based on a critical appraisal of the literature on (revision) RHA that was recently systematically reviewed by our study group. 7 , 10 See also Table 1 . That same literature search was the basis for the current article.…”

Section: Introductionmentioning

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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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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Why does radial head arthroplasty fail today? A systematic review of recent literature

Cited by 26 publications

References 47 publications

Prosthetic replacement of the radial head

Prosthetic replacement of the radial head

Management of the failed radial head arthroplasty

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

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