Radial head arthropolasty in unreconstructable comminuted fracturesof the radial head: Long-term results and factors influencing the outcome

Abstract

Radial head arthroplasty is recognized as the gold standard in the treatment of patients with unreconstructable radial head fractures. The aim of this retrospective study was to investigate the long-term results after prosthetic replacement of the radial head and in asubgroup analysis to identify factors which influence the outcome. A total of 48patients with unreconstructable fractures of the radial head and neck were treated by cementless radial head arthroplasty between 05/2008 and 10/2018 (30 bipolar prosthesis type rHead Recon, 18 monopolar prosthesis type MoPyc). After amean follow-up of 4.6years 39patients were assessed clinically and radiologically. The median MEP score was 95points. Compared to the uninjured side the median range of motion was reduced by 10° for extension/flexion as well as for pronation/supination. In 36of 39cases an osseous integration of the prosthesis could be documented. One prosthesis had to be removed after 23months because of painful loosening. Overlengthening was present in 11cases (28%), 25patients (64%) had subcollar bone resorption with astable osteointegrated stem. Nonbridging heterotopic ossification was observed in 15patients (38%), 16patients (41%) showed posttraumatic arthrosis. Patients with sustained elbow dislocation had asignificantly worse function in the MEP score and tended to develop an arthrosis more frequently. Ulnohumeral joint degeneration was significantly increased when overlengthening was present. Radial head arthroplasty is an effective treatment option for unreconstructable fractures of the radial head and can provide good to excellent mid-term to long-term results. Sustained elbow dislocation as well as overlengthening of the prosthesis had anegative impact on the clinical outcome.