Radial head prosthesis: results overview

Abstract

Background/purpose: Radial head replacement is frequently used in treatment of radial head fractures or sequela. Impossibility to restore a correct anatomy, acute elbow traumatic instability and failure of osteosynthesis hardware are the most common indications. The authors describe their case studies and results on the implantation of various radial head prostheses.

Materials: Between June 2005 and June 2016, 28 radial head prostheses were implanted in the same number of patients with an average follow-up of 49 months (6-104). Indications for implantation were: Mason type III and IV radial head fractures and post-traumatic arthritis due to failure of previous treatments. Monopolar prostheses were used and were press-fit implanted via Kaplan's lateral access and Kocher's anconeus approach to the humeroradial joint. At the follow-up, assessments were made of the pain, according to the visual analogic scale, range of motion (ROM), stability and functionality according to the Mayo Elbow Performance Score, presence of osteolysis and mobilization during radiography tests, personal satisfaction of the patients, Disabilities of the Arm, Shoulder and Hand and Patient-Rated Wrist Evaluation outcomes measurements.

Results: At the follow-up, we recorded an average level of pain of 1.8 in patients under acute treatments for radial head fractures and a marked reduction in the remaining cases from 6.7 to 2.1. ROM was found on average to be 107° of flexion-extension and 159° of pronosupination. Personal satisfaction was good-excellent in 23 cases. There was no case of infection; removal of the implant was necessary in three cases due to mobilization of the stem and oversized implants. In six cases, bone resorption was seen at the level of the prosthetic collar and it was in all cases asymptomatic.

Conclusions: The results of this study suggest that the use of prostheses, if well positioned, is a valid solution in the treatment of secondary arthritis and fractures of the radial head with poor prognosis, with good results in the reduction of pain, recovery of movement and improved quality of life.

Keywords: Elbow stiffness; Humeroradial post-traumatic arthritis; Radial head fractures; Radial head prosthesis; Radial head replacement.

Fig. 1

​Pre-op X-rays of 18-year-old boy with radial head malunion, calcifications and secondary humeroradial arthritis

Fig. 2

Five-year X-ray follow-up with good position of implant and stress shielding radial neck resorption

Fig. 3

Five-year clinical follow-up showing maintenance of total ROM recovery

Fig. 4

48 months X-ray follow-up of the same patient showing stress shielding radial neck resorption

Fig. 5

48 months clinical follow-up showing good ROM recovery

Fig. 6

Intraoperative statement of prosthesis dimensions after radial head removal for comminuted fracture

Fig. 7

Two months X-ray follow-up of radial head prosthesis implanted for radial head malunion