Short- to mid-term results of metallic press-fit radial head arthroplasty in unstable injuries of the elbow

Abstract

We assessed the short- to mid-term survival of metallic press-fit radial head prostheses in patients with radial head fractures and acute traumatic instability of the elbow. The medical records of 42 patients (16 males, 26 females) with a mean age of 56 years (23 to 85) with acute unstable elbow injuries, including a fracture of the radial head requiring metallic replacement of the radial head, were reviewed retrospectively. Survival of the prosthesis was assessed from the radiographs of 37 patients after a mean follow-up of 50 months (12 to 107). The functional results of 31 patients were assessed using range-of-movement, Mayo elbow performance score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) score and the RAND 36-item health survey. At the most recent follow-up 25 prostheses were still well fixed, nine had been removed because of loosening, and three remained implanted but were loose. The mean time from implantation to loosening was 11 months (2 to 24). Radiolucent lines that developed around the prosthesis before removal were mild in three patients, moderate in one and severe in five. Range of movement parameters and mass grip strength were significantly lower in the affected elbow than in the unaffected side. The mean MEPS score was 86 (40 to 100) and the mean DASH score was 23 (0 to 81). According to RAND-36 scores, patients had more pain and lower physical function scores than normal population values. Loosening of press-fit radial head prostheses is common, occurs early, often leads to severe osteolysis of the proximal radius, and commonly requires removal of the prosthesis.

Monobloc radial head prostheses in complex elbow injuries: results after primary and secondary implantation

“…Our results are comparable to those after implantation of other modern types of prostheses [8,18,25]. In 30 patients with implantation of a newly designed bipolar RHP with a mean follow-up of 34 months the MEPS averaged 92.1 points [25].…”

“…Limitations of our study included the retrospective study design and the small cohort size, which was however comparable to other recent studies [8,18,25]. Radiological results have a short-term follow-up.…”

“…The removal rate in our study was low (n=1, 3 %); longer follow-up must be awaited to achieve better comparability to other studies. A possible reason for the high removal rate in the study of Flinkkilä et al might be that bone was rasped until cortical contact could be achieved leaving no cancellous bone for better ingrowth [8].…”

“…Recently, results of 31 patients with press-fit implantation of metallic RHP showed good clinical results with an average of 86 points in MEPS at a mean follow-up of 53 months [8]. The prosthesis had to be removed in nine cases (24 %) due to loosening and associated pain [8].…”

“…The prosthesis had to be removed in nine cases (24 %) due to loosening and associated pain [8]. Proximal forearm pain after cementless press-fit prostheses has been discussed as a strong indicator for symptomatic loosening [16].…”