Mid-term outcome following radial head arthroplasty in acute trauma: risk factors for poor outcome.

Abstract

The aim of this study was to evaluate the outcomes of a large cohort of a single-type radial head implant in a mid-term follow-up and determine the associated risk factors for an inferior functional outcome. Retrospective follow-up assessment was done for 65 patients (33 women, 32 men; mean age 53.3 years [22 to 81]), who underwent radial head arthroplasty (RHA) for acute trauma between 2012 and 2018, after a minimum follow-up of 3 years. The Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), Disabilities of the Arm, Shoulder and Hand (DASH) score, as well as the Mayo Modified Wrist Score (MMWS), were evaluated, and all radiographs were analyzed. All complications and revision procedures were assessed. Bivariate and multivariate regression analyses were performed to identify potential risk factors for a poor outcome following RHA. After an average follow-up of 4.1 years (3 to 9.4y), the mean MEPS was 77.2 (SD 18.9), the mean OES was 32.0 (SD 10.6), the mean MMWS was 74.6 (SD 13.7), and the mean DASH score was 29.0 (SD 21.2). The average range of motion (ROM) was 10° (SD 15°) in extension and 125° (SD 14°) in flexion, with 81° (SD 14°) in pronation and 63° (SD 24°) in supination. The overall complication and reoperation rates were 38.5% and 30.8%, with severe elbow stiffness being the most common reason for revision. A patient age>50 years, the use of an external fixator, accompanying MCL injuries, and the development of higher-grade osteoarthritis were associated with a poor outcome. Satisfactory medium-term outcomes can be achieved using a monopolar, long-stemmed RHA in acute trauma. However, complications and revision rates are high, frequently leading to inferior outcome scores. Additionally, a higher patient age, the use of an external fixator, accompanying MCL injuries, and the occurrence of higher-grade osteoarthritis were associated with a poor outcome; these should raise awareness in treating trauma surgeons.