Survivorship of anatomic press-fit short-stem radial head replacement with a pyrocarbon bearing

Abstract

Background Restoring the radial head as a stabiliser of the elbow is considered important in cases where there is an associated bony or ligamentous injury. A variety of radial head prostheses are available. There are no reports of the survivorship of a short-stem press-fit radial head prostheses with pyrocarbon bearing. Patients and methods With institutional review board approval, a retrospective case-note analysis was performed of a consecutive single-surgeon case series of the Integra LifeScience pyrocarbon radial head prostheses (Carbon Modular Radial Head) from October 2010 to October 2019 in a tertiary referral centre. The series was divided into acute trauma and salvage cohorts. Kaplan–Meier survivorship analysis was conducted. Results 36 patients were included, 23 (64%) for acute injuries and 13 (36%) for failed initial treatment. Of the acute injuries, 20 (87%) had a Wrightington type-C elbow fracture-dislocation. Reoperation was performed in 4 (11%) patients; 10 (28%) had possible loosening on radiographs. The implant survival rate was 94% at shortest follow-up of 17 months (mean 70 months). Discussion Treatment of complex radial head fractures using a pyrocarbon-bearing, anatomic press-fit design provides satisfactory short-term survivorship in this case series. The implant should be used with caution in salvage cases, due to higher rates of loosening seen in this cohort.

Retrospective review of pyrocarbon radial head replacement

“…Only 1 other article concerning this prosthesis has been recently published, by Viswanath and Watts. 28 They described similar results with 36 patients. A mean flexion arc of 105° and prono-supination of 148° was achieved; 10 stems had lucency, and 4 were revised.…”

Anatomic Monopolar Press-fit Radial Head Arthroplasty; High Rate of Loosening at Mid-Term Follow Up

“…5,[9][10][11][12][13] Previous studies have urged caution with use of monopolar press-fit designs over concerns with radiological loosening. [24][25][26] However, although radiographic changes have been previously observed with this prosthesis, their impact on longer term clinical outcomes have been less clearly defined. 9-13 Sallakh et al 12 at mean follow-up 42 months, reported all 12 patients with good-excellent clinical outcomes with no significant radiographic changes with regard to proximal migration, radiocapitellar arthritis or capitellar osteopenia, and no cases of prosthesis removal.…”