The Rate of Radial Head Prosthesis Removal or Revision

Abstract

Objectives: To determine the overall rate of radial head prosthesis removal or revision and the rate of removal or revision based on the type of prosthesis fixation (cemented, uncemented loose, uncemented pressfit), material (metal, vitallium, titanium, pyrocarbon, polymethyl methacrylate), and design (short stem vs long stem, and monopolar vs bipolar), and to determine reasons for prosthetic removal/revision. Methods: Data Sources—We searched the literature, including MEDLINE, MEDLINE preprints, SCOPUS, EMBASE, and the Cochrane Central Register of Controlled Trials. Study Eligibility Criteria—We identified studies reporting the clinical outcome of radial head arthroplasties. Participants: We included 31 studies with a total of 1055 patients out of whom 85 prostheses were removed and 45 prostheses were revised. Synthesis Method—We calculated the pooled event rate and the risk ratio with 95% confidence interval (CI) using a random effects model to create a Forest plot. Results: The pooled rate of radial head prosthesis removal or revision was 10.6% (95% CI, 7.9%-14.2%). Subgroup analysis showed that the rate of removal/revision was lowest with the cemented fixation, longer stem, Vitallium material, and bipolar prosthesis. More than half of the prostheses were removed/revised for excision of the heterotopic ossification in (28%) and for the treatment of stiffness and limitation of motion (25%). Other recorded reasons were pain (16%), loosening (9.2%), overstuffing (7.7%), instability (6.9%), infection (5.4%), and prosthesis disassembly (2.3%). Limitations: Most of the studies were small case series and retrospective with short- to midterm follow-up. Conclusions: The current data show that the highest rate of removal/revision occurred within 2 years after implantation. Moreover, there seems to be differences in the reasons of removal/revision between different designs. It appears that most radial head arthroplasties have an acceptable and comparable midterm longevity; however, it is unclear whether long-term longevity will differ between devices.