Impact of Radiocapitellar Interposition Arthroplasty on Ulnohumeral Joint Biomechanics.

Abstract

Radial head excision has been shown to increase contact pressures within the ulnohumeral joint. Radiocapitellar interposition arthroplasty with the use of a soft tissue graft is an alternative for the treatment of isolated radiocapitellar arthritis or with failure of radial head replacement. We investigated contact pressures and contact area within the ulnohumeral joint after radial head excision (RHE) compared to radiocapitellar interposition arthroplasty with dermal autograft (RCIA). Six fresh-frozen cadaver elbows were tested on a custom dynamic elbow frame. A pressure sensor was inserted into the intact elbow joint, and mean contact pressure, peak contact pressure, contact area, and force within the ulnohumeral joint were recorded at 0°, 30°, 60°, 90°, and 120° of flexion as a valgus load was applied to the elbow. The radial head was then excised and specimens were retested. Finally, a dermal graft matched to the size of the resected radial head was inserted in the radiocapitellar space and the specimens were tested a third time. At 90° of flexion, contact pressure within the ulnohumeral joint was significantly lower with RCIA compared with RHE (110.8 kPa vs. 216.8 kPa.; P = 0.013). Mean peak contact pressure was also significantly lower with RCIA compared with RHE at 90° (279.4 vs. 626.7 kPa; P =0.025). No statistically significant differences were seen in mean contact area or force between the three testing conditions at any flexion position. RCIA with a dermal graft reduced contact pressures within the ulnohumeral joint compared to radial head excision at 90° of flexion without a significant change in contact area or contact force.