Revision radiocapitellar arthroplasty by mismatched implant components - A salvage option: A report of two cases with a minimum three-year follow-up

Abstract

Radiocapitellar arthroplasty has been shown to improve pain and function in patients with a degenerative joint. Due to problems with the loosening of the radial head component, one of the few available systems was removed from the global market. This offered specific challenges in terms of treatment strategies when one or both components of a system that is no longer available fail. Due to the very different geometry of the capitellar implant, revision of the capitellar component would require a complex procedure, likely requiring bone graft and a high chance of early failure, leaving resection or interposition arthroplasty as the only available option. Although implant mismatch is common practice in hip and knee arthroplasty with satisfactory results, it should remain a salvage option as the off-label use of components gives rise to several medicolegal implications. We report two cases of radiocapitellar arthroplasty partial revision, by replacing only the radial head component with an implant from another system while keeping the well-fixed original capitellar component in place. At a minimum of three-year follow-up, both cases improved from poor to good and excellent Mayo elbow performance scores. There were no signs of implant failure on standard radiographs.

Keywords: Radial head arthroplasty; elbow; osteoarthritis; radial head prosthesis; radial head replacement; revision radial head arthroplasty.