Abstract
The purpose of the current study was to investigate the long-term outcomes of radial head arthroplasty in complex elbow injuries through radiographic analysis and functional correlation. We evaluated 24 radial head arthroplasties in 24 consecutive patients with complex elbow fracture dislocation. All patients were treated with a single type of modular monopolar prosthesis containing smooth stem in press-fit implantation. Clinical survey using the Mayo Elbow Performance Score (MEPS), self-reported scales of shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and the visual analog scale (VAS) at more than 10-year follow-up were reported and compared to 2-year outcomes. Periprosthetic osteolysis was measured in the 10 zones of prosthesis-cortical interface with a modified radiolucency score, which was calibrated by each prosthesis size. Pearson correlation analysis was performed to detect the association between periprosthetic radiolucency and clinical assessment. At the final follow-up, MEPS, QuickDASH score and VAS score averaged 82.5 ± 15, 14.1 ± 14.3 and 1.6 ± 1.2 respectively. A decline in functional status was noted, with decreased mean MEPS and increased mean QuickDASH and VAS scores as compared to the 2-year results while the difference was insignificant. Periprosthetic osteolysis was more prevalent around stem tip of zone 3 and zone 8. The final and 2-year radiolucency scores averaged 7.4 ± 4.2 and 2.6 ± 2.3 respectively with significant difference. Pearson correlation analysis indicated that the difference between radiolucency scores and clinical outcomes in MEPS/QuickDASH/VAS was −0.836, 0.517 and 0.464. Progression of periprosthetic osteolysis after postoperative 10 years is more prevalent around the stem tip with moderate to high correlation to clinical outcomes. Sustained follow-up is warranted to justify subsequent surgery for revision or implant removal.
Highlights
Complex fracture dislocation of the elbow, most commonly termed terrible triad, involves radial head fracture, coronoid fracture and elbow dislocation with various degrees of ligamentous injuries
Pearson correlation analysis indicated that the difference between radiolucency scores and clinical outcomes in Mayo Elbow Performance Score (MEPS)/QuickDASH/visual analog scale (VAS) was
There was no significant difference in both MEPS (p = 0.442) and QuickDASH scores (p = 0.306)
Summary
Complex fracture dislocation of the elbow, most commonly termed terrible triad, involves radial head fracture, coronoid fracture and elbow dislocation with various degrees of ligamentous injuries. Late sequelae with improper management could be complicated with residual instability, development of traumatic arthrosis and joint stiffness [1]. Since the first introduction by Speed in 1941 [2], radial head prosthesis have been widely adopted to replace the irreparable radial head and to reestablish a stable elbow joint allowing ligamentous healing [3,4]. With evolution of implant design and technical refinement, short to mid-term functional results in radial head arthroplasty (RHA) are good to excellent. Late complications of RHA in terrible triad injuries including painful loosening, osteolysis, capitellar erosion and progressive ulnohumeral arthrosis are commonly described [6,7]. Long-term outcome following RHA has yet to be further investigated
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