Arthroscopic removal of the failed silicone radial head prosthesis

Abstract

Although silicone radial head arthroplasty has been successful in many patients, it has been associated with complications such as fractures of the prosthesis and silicone synovitis. Synovectomy and removal of the failed silicone radial head, with or without reimplantation of a metallic radial head, is indicated in such complications. In an effort to perform minimally invasive surgery, we performed arthroscopic removal of the silicone head combined with synovectomy in a series of such patients. The silicone prostheses were cut into two or three pieces and then removed. After a median follow up of 26 months, all patients reported excellent pain relief and there were no residual loose bodies. Removal of a failed silicone radial head can be successfully performed arthroscopically. This arthroscopic technique has the advantage of being minimally invasive and can be combined with other procedures including capsulectomy, if necessary.

Silicone radial head prostheses: the clinical course and treatment of failure—a case series

“…4,19 Clinical failure may occur years after implantation. 10 The broad range (3-29 years) and spontaneous start of early symptoms (11 of 15 cases) suggest that it is hard to predict the moment of failure of SRHP. In 4 of the 15 cases, complaints started after a trauma.…”

“…This supports the hypothesis that implant failure and consequential silicone debris correlate with clinical failure. 2,10,13 Earlier studies (published between 1979 and 1994) described fragmented implants even in asymptomatic patients, although in-depth analysis of these cases is unfortunately missing. 5,11,16 Nevertheless, one could argue that early treatment may prevent joint erosion caused by silicone-induced inflammation.…”

“…In this group of patients, it is important to adequately recognize and treat failed SRHP. 10 The literature lacks practical clinical guidelines on the treatment of long-term sequelae of SRHP. The host response to silicone materials is limited for solid silicone structures.…”

“…Furthermore, surgical treatment of failed SRHP has not been described extensively either. The most comprehensive study, also being the most recent one, was published in 2009 by Moon et al, 10 describing arthroscopic removal of 5 failed SRHP.…”

Management of the failed radial head arthroplasty

“…Although we are not aware of any studies describing the outcome of arthroscopic arthrolysis after metallic RHA, one small series on arthroscopic removal of silicone RHA showed satisfactory outcomes. 46 If there are issues with the RHP encountered during the procedure, it will be necessary to switch to an open approach and address them. In case of HO, administration of non-steroidal anti-inflammatory drugs following surgery might prevent recurrence of HO.…”