Radial Head Prosthesis Removal:a Retrospective Case Series of 14 Patients

Document Type: RESEARCH PAPER

Authors

1 Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Suite 2100, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA

2 Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Orthopedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114 USA.

Abstract

Background: 
 The purpose of this study was to report the preoperative complaints and postoperative outcome of patients after removal of the radial head prosthesis.   
Methods: 
 This is a retrospective review of 14 adult patients (6 females and 8 males) from 2007 to 2011, who underwent radial head prosthesis removal by three surgeons. The average time between implantation and removal was 23 months (range from 2 weeks to 12 years, median 12 months). 
 Results: 
 The leading reported complaints before removal were restricted mobility of the elbow (active range of motion of less than 100 degrees) in 6, pain in 3, and pain together with restricted mobility in 4 patients. The objective  findings before removal were restricted mobility of the elbow in 10 (71%), capitellar cartilage wear, loose implants, and heterotopic ossification each in 8 (57%), subluxation of the radio-capitellar joint or malpositioning of the stem in 5 (36%), and chronic infection in 2 (14%) patients. All patients with pain had wear of the capitellar cartilage on radiographs. The ulnar nerve was decompressed in four patients at the time of removal. Four patients underwent a subsequent operation for postoperative ulnar nerve symptoms 5 to 21 months after removal. Four patients were still complaining about persistent pain at the last follow-up visit. Except two patients, the total range of motion improved with a mean of 34 degrees (range 5 to 70) after a mean follow-up of 11 months. 
Conclusions: 
 Removal of radial head prosthesis improved function and lessened pain in our case series. The reoperation rate was yet nearly 30% due to ulnar neuritis. Selective ulnar nerve decompression at the time of removal must be evaluated, especially in patients with expected large gain in range of motion after removal.

Keywords


  1. Ruan HJ, Fan CY, Liu JJ, Zeng BF. A comparative study of internal fixation and prosthesis replacement for radial head fractures of Mason type III. Int Orthop. 2009;33(1):249-53.
  2. Grewal R, MacDermid JC, Faber KJ, Drosdowech DS, King GJ. Comminuted radial head fractures treated with a modular metallic radial head arthroplasty. Study of outcomes. J Bone Joint Surg Am. 2006;88(10):2192-200.
  3. Dotzis A, Cochu G, Mabit C, Charissoux JL, Arnaud JP. Comminuted fractures of the radial head treated by the Judet floating radial head prosthesis. J Bone Joint Surg Br. 2006;88(6):760-4.
  4. Harrington IJ, Sekyi-Otu A, Barrington TW, Evans DC, Tuli V. The functional outcome with metallic radial head implants in the treatment of unstable elbow fractures: a long-term review. J Trauma. 2001;50(1):46-52.
  5. Burkhart KJ, Mattyasovszky SG, Runkel M, Schwarz C, Kuchle R, Hessmann MH, et al. Mid- to long-term results after bipolar radial head arthroplasty. J Shoulder Elbow Surg. 2010;19(7):965-72.
  6. Ricon FJ, Sanchez P, Lajara F, Galan A, Lozano JA, Guerado E. Result of a pyrocarbon prosthesis after comminuted and unreconstructable radial head fractures. J Shoulder Elbow Surg. 2011.
  7. O’Driscoll SW, Herald J. Symptomatic failure of snap-on bipolar radial head prosthesis. J Shoulder Elbow Surg. 2009;18(5):e7-11.
  8. O’Driscoll SW, Herald JA. Forearm pain associated with loose radial head prostheses. J Shoulder Elbow Surg. 2011.
  9. Doornberg JN, Parisien R, van Duijn PJ, Ring D. Radial head arthroplasty with a modular metal spacer to treat acute traumatic elbow instability. J Bone Joint Surg Am. 2007;89(5):1075-80.
  10. van Riet RP, Morrey BF. Delayed valgus instability and proximal migration of the radius after radial head prosthesis failure. J Shoulder Elbow Surg. 2010;19(7):e7-10.
  11. Morrey BF, Askew LJ, Chao EY. A biomechanical study of normal functional elbow motion. J Bone Joint Surg Am. 1981;63(6):872-7.
  12. Broberg MA, Morrey BF. Results of delayed excision of the radial head after fracture. J Bone Joint Surg Am. 1986;68(5):669-74.
  13. van Riet RP, van Glabbeek F, de Weerdt W, Oemar J, Bortier H. Validation of the lesser sigmoid notch of the ulna as a reference point for accurate placement of a prosthesis for the head of the radius: a cadaver study. J Bone Joint Surg Br. 2007;89(3):413-6.
  14. Frank SG, Grewal R, Johnson J, Faber KJ, King GJ, Athwal GS. Determination of correct implant size in radial head arthroplasty to avoid overlengthening. J Bone Joint Surg Am. 2009;91(7):1738-46.
  15. van Riet RP, Sanchez-Sotelo J, Morrey BF. Failure of metal radial head replacement. J Bone Joint Surg Br. 2010;92(5):661-7.
  16. Allavena C, Delclaux S, Bonnevialle N, Rongières M, Bonnevialle P, Mansat P. Outcomes of bipolar radial head prosthesis to treat complex radial head fractures in 22 patients with a mean follow-up of 50 months. Orthop Traumatol Surg Res. 2014;100(7):703-9.
  17. Duckworth AD, Wickramasinghe NR, Clement ND, Court-Brown CM, McQueen MM. Radial head replacement for acute complex fractures: what are the rate and risks factors for revision or removal? Clin Orthop Relat Res. 2014;472(7):2136-43.
  18. Athwal GS, Rouleau DM, MacDermid JC, King GJ. Contralateral elbow radiographs can reliably diagnose radial head implant overlengthening. J Bone Joint Surg Am. 2011;93(14):1339-46.
  19. Van Riet RP, Van Glabbeek F, Verborgt O, Gielen J. Capitellar erosion caused by a metal radial head prosthesis. A case report. J Bone Joint Surg Am. 2004;86-A(5):1061-4.
  20. Monica JT, Mudgal CS. Radial head arthroplasty. Hand Clin. 2010;26(3):403-10, vii.
  21. Park MJ, Chang MJ, Lee YB, Kang HJ. Surgical release for posttraumatic loss of elbow flexion. J Bone Joint Surg Am. 2010;92(16):2692-9.
  22. Wretenberg P, Ericson A, Stark A. Radial head prosthesis after fracture of radial head with associated elbow instability. Arch Orthop Trauma Surg. 2006;126(3):145-9.