Abstract
BackgroundThe purposes of this study were to investigate the long-term outcomes of radial head replacement and to analyze the relationship between functional outcomes and periprosthetic radiolucency.MethodsWe retrospectively reviewed 32 patients who underwent unilateral radial head replacement between 2004 and 2011. Data on patient characteristics including age, gender, injury complexity, associated trauma, injury chronicity, and number of surgeries were collected and analyzed. Of these patients, 14 had terrible triad injury, 14 valgus-type injuries, 3 Monteggia fracture, and 1 concomitant distal humerus fracture. Clinical survey was performed at 7 to 15 years after replacement surgery. The Mayo Elbow Performance Score (MEPS) and shortened Disabilities of the Arm, Shoulder, and Hand (quickDASH) score were used for functional evaluation. Residual elbow or forearm pain was evaluated using visual analog scale (VAS). Radiographs were reviewed by orthopedic and radiologic specialists, and periprosthetic radiolucency was measured based on the diameter of radial head prosthesis.ResultsThe 32 patients returned for follow-up at an average of 8.94 years. None underwent prosthesis revision or removal. MEPS averaged 83.4; good or excellent results were achieved in 26 patients. QuickDASH scores averaged 11.7. Significantly better MEPS (p = 0.023) and quickDASH scores (p = 0.026) were noted when replacement surgery served as the primary surgery instead of late salvage. VAS scores averaged 1.25, with residual pain noted in 24 elbows (75%). Periprosthetic radiolucency was noted in 21 patients (66%) with a mean thickness of 3.53 mm. The difference in functional outcomes was not significant between patients with and without radiolucency, with p values of 0.127 for MEPS and 0.135 for quickDASH scores. Spearman correlation analysis showed low correlation between the measured width of radiolucency and VAS scores (r = 0.143).ConclusionSustained, encouraging clinical outcomes were reported in the present study. Although periprosthetic radiolucency did not correlate with functional or pain scores, surgical optimization and meticulous survey were warranted.
Highlights
The purposes of this study were to investigate the long-term outcomes of radial head replacement and to analyze the relationship between functional outcomes and periprosthetic radiolucency
As up to 60% of the force transmits across the radiocapitellar joint [1], the radial head plays an important role in elbow mechanics [2] and serves as a secondary constraint to valgus axial strain [3]
Because one single type of radial prosthesis was used for all replacement surgery in our institute from 2004 through 2011, this study only enrolled the surgeries performed during this period to avoid implant-selecting bias
Summary
The purposes of this study were to investigate the long-term outcomes of radial head replacement and to analyze the relationship between functional outcomes and periprosthetic radiolucency. As up to 60% of the force transmits across the radiocapitellar joint [1], the radial head plays an important role in elbow mechanics [2] and serves as a secondary constraint to valgus axial strain [3]. With the introduction of radial head prostheses in 1941 [11], various designs were available with respect to material, fixation technique, modularity, and polarity. Among those designs, modular monopolar prostheses with loose-fit implantation became commonly adopted since 2005 [12]. The purpose of our study was to report long-term results with RHR and to analyze the effect of radiolucency on clinical outcomes through a quantitative measurement
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