Radiocapitellar arthroplasty

Abstract

This article sets out the evidence demonstrating that the clinical need for a prosthetic arthroplasty designed specifically for the radiocapitellar joint has been underestimated. The prevalence of radiocapitellar degenerative change requiring treatment is discussed and the relationship between 'isolated' radiocapitellar joint arthritis and more generalised elbow arthritis is explained. Current literature now supports our view that radiocapitellar joint arthroplasty is not only an effective long-term solution for patients with localised radiocapitellar arthritis but also for those patients with more severe degenerative changes involving the elbow joint irrespective of their cause. We consider that is important to avoid resection of the radial head and therefore that resurfacing implants rather than joint replacement implants are more likely to provide a good longterm outcome for patients with elbow arthritis.

Keywords: Elbow arthroplasty; Osteoarthritis (OA); Radiocapitellar arthroplasty; Rheumatoid arthritis (RA).

Fig. 1

Upper row: Drawings illustrating the design rationale for the LRE in which the capitellum and radial head joint surfaces are prepared by surface reaming over a guide wire before insertion of surface replacement components with peg fixation. Lower row: (a) AP radiograph of a radiographically ‘well-preserved’ elbow for which the LRE was originally developed. Note the calcification involving the medial joint capsule, sometimes mistaken for an osteophyte. (b) AP radiograph of the same patient following insertion of the components of the LRE.

Fig. 2

Upper Row: (left) AP radiograph of 44-year-old male with severe pain but considered preoperatively to have only minimal evidence of degenerative change in the radiocapitellar joint, (Right) The radiocapitellar joint of the same patient seen during arthroscopy to have full thickness loss of the articular cartilage from the capitellum. Lower row: Photographs made during arthroscopy of a 42 year-old male patient with severe elbow pain but no definite abnormality seen on radiographic examination. (Left) ulnohumeral joint, (middle and right) radiocapitellar joint. (H = humerus, U = ulna, C = capitellum, RH = radial head).

Fig. 3

Radiographs demonstrating the radiological progression of degenerative change/joint space narrowing in the radiocapitellar joint whilst the ulnohumeral joint appears to remain uninvolved. Upper row: (a) No definite abnormality seen in the RC joint, arthroscopy confirmed full thickness loss of the articular cartilage in this patient, (b) Joint space narrowing in the RC joint, arthroscopy confirmed degenerative changes involving the RC joint but normal UH joint articular surfaces. Lower row: (c) Pre-operative radiograph demonstrating marked joint space narrowing in the RC joint, (d) Post-op radiograph following insertion of an LRE in this patient, normal UH joint surfaces were seen during surgery.

Fig. 4

(a) Photograph of the components of the Uni-Elbow system which are designed to replace the native radial head and capitellum. (b) Photograph of the components of the Lateral Resurfacing Elbow system which are designed to resurface the native radial head and capitellum.

Fig. 5

An example of the LRE used to treat patients with generalised elbow arthritis. Upper row: (a) (b) AP and lateral radiographs the left elbow of a 57 year-old male patient with primary osteoarthritis – despite the appearances of the radial head, there was no previous history of trauma. Lower row: (c) Intra-operative photograph during surgery on this patient. Exposure of the joint surfaces revealed complete loss of articular cartilage from RC joint surfaces. The UH joint surfaces are seen to be much better preserved. (d) Intra-operative photograph following insertion of the components of an LRE. Some loss of the articular cartilage from the radial aspect of the trochlea of the humerus can be seen demonstrating the medial progression of arthritis from the RC joint into the UH joint.

Fig. 6

A further example of the LRE used to treat patients with generalised elbow arthritis. Upper row: (a), (b) AP and lateral radiographs of the right elbow of a 74 year-old male patient demonstrating severe degenerative changes complicated by Paget's disease involving the proximal ulna. Lower row: (c), (d) AP and lateral radiographs of this patient following insertion of the components of an LRE. When reviewed 2 years following surgery his elbow was pain free – Mayo performance score 100. We consider that most would agree that because of the distortion of the proximal ulna it would have proved technically difficult to insert the components of a total elbow joint replacement arthroplasty in this patient.