Radial Head Prosthesis with Interconnected Porosity Showing Low Bone Resorption Around the Stem

Abstract

Background/Objectives: Radial head arthroplasty is a commonly preferred treatment for complex, unreconstructable radial head fractures. Recent studies have raised the question of whether factors such as bone resorption may be related to failure. This observational, retrospective, multicenter, spontaneous, and non-profit study aims to assess radiological outcomes, focusing on bone resorption around the stem, for radial head replacement using a modular, cementless radial head prosthesis with interconnected porosity. Methods: A series of 42 cases was available for review. Patients underwent radial head arthroplasty using a three-dimensional-printed radial head prosthesis. Patients were eligible for inclusion if they had undergone at least one follow-up between 6 and 15 months post-operatively. A scoring system to detect bone resorption was developed and administered by two independent evaluators. Results: Forty-two patients (14 males, 28 females), with an average age of 59 ± 11 years (range: 39-80 years), were analyzed with a minimum of six months' and a maximum of 32 months' follow-up. At follow-up, 50 radiological evaluations were collected, with 29 showing ≤3 mm and 12 showing 3-6 mm resorption around the stem. The average resorption was 3.5 mm ± 2.3. No correlation was found between the extent of resorption and the time of follow-up. The developed scoring system allowed for a high level of correlation between the evaluators' measurements of bone resorption. Conclusions: Radial head prosthesis with interconnected porosity provided a low stem resorption rate for patients after a radial head fracture at short-to-mid-term follow-up after the definition of a reliable and easy-to-use radiological-based classification approach. (Level of Evidence: Level IV).

Keywords: 3D-printed radial head prosthesis; bone resorption; radial head replacement; radial head trauma; radiological outcomes.

Figure 1

Evaluation of bone resorption. An example of the scheme provided to the independent evaluators to quantify the presence or absence of bone resorption (YES or NO) on the right and left sides of the stem and, in the case of a positive answer, the length of bone reduction. The same scheme was used for the antero-posterior (AP) and lateral (LL) views.

Figure 2

Radiographs of patients without and with bone resorption. (A,B) Antero-posterior (AP) and lateral (LL) radiographs of case 27 showing no resorption at 9 months’ follow-up compared with post-op. In each radiograph, the embedded ruler was used to calculate resorption in mm. (C,D) AP and LL radiographs of case 31 showing resorption at 12 months’ follow-up compared with post-op.