Radiographic Predictors for Short-term Functional Outcome after Radial Head Arthroplasty in Patients with Persistent Symptoms after Treatment for Radial Head

Document Type : RESEARCH PAPER


1 Orthotrauma Research Center Amsterdam, University of Amsterdam, Amsterdam, the Netherlands; Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA

2 Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, the Netherlands; Department of Orthopaedic Surgery, Upper Limb Unit, Amphia Hospital, Breda, the Netherlands

3 Academic Medical Center, Amsterdam, the Netherlands, Department of Orthopaedic Surgery, Upper Limb Unit, Amphia Hospital, Breda, the Netherlands

4 Department of Orthopaedic Surgery, Shoulder and Elbow Unit, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands

5 Orthopaedic Surgeon, Department of Orthopaedic Surgery, Upper Limb Unit, Amphia Hospital, Breda, the Netherlands


Background: Evaluation of the accurate position after radial head arthroplasty remains a challenge for surgeons.
Standard radiographs are used to evaluate the position of the implant, however, results regarding radiographic
deficiencies on clinical outcome are not consistent. In this retrospective study our main aim was to determine if subtle
radiographic deficiencies after radial head arthroplasty can predict functional outcomes measured with the Mayo Elbow
Performance Score (MEPS).
Methods: A total of 24 patients, that had a press-fit bipolar radial head arthroplasty because of persistent symptoms
after treatment of a radial head fracture, were included. The mean follow-up time was 27 months and the MEPS was
assessed at the final follow-up. Three upper extremity orthopaedic surgeons evaluated 12 potential deficiencies on
anteroposterior and lateral radiographs in consensus agreement.
Results: The median MEPS was 97.5 (Interquartile Range 82.5-100). No association was found between the presence
of subtle radiographic deficiencies and MEPS.
Conclusion: Functional outcome of the elbow after uncemented press-fit bipolar radial head arthroplasty is not
associated with subtle radiographic deficiencies. Therefore, surgeons might accept small imperfections on postoperative
Level of evidence: IV


Main Subjects

1. Moro JK, Werier J, MacDermid JC, Patterson SD,
King GJ. Arthroplasty with a metal radial head for
unreconstructible fractures of the radial head. J Bone
Joint Surg Am. 2001; 83(8):1201-11.
2. Zunkiewicz MR, Clemente JS, Miller MC, Baratz ME,
Wysocki RW, Cohen MS. Radial head replacement
with a bipolar system: a minimum 2-year follow-up.J
Shoulder Elbow Surg. 2012; 21(1):98-104.
3. Popovic N, Lemaire R, Georis P, Gillet P. Midterm results
with a bipolar radial head prosthesis: radiographic
evidence of loosening at the bone-cement interface. J
Bone Joint Surg Am. 2007; 89(11):2469-76.
4. 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.
5. Flinkkila T, Kaisto T, Sirnio K, Hyvonen P, Leppilahti J.
Short- to mid-term results of metallic press-fit radial
head arthroplasty in unstable injuries of the elbow. J
Bone Joint Surg Br. 2012; 94(6):805-10.
6. Van Hoecke E, Van De Vijver A, Van Glabbeek F,
Gielen J. Long term results after bipolar radial head
arthroplasty. Acta Orthop Belg. 2016; 82(2):382-8.
7. Allavena C, Delclaux S, Bonnevialle N, Rongieres 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.
8. Birkedal JP, Deal DN, Ruch DS. Loss of flexion after
radial head replacement. J Shoulder Elbow Surg.
2004; 13(2):208-13.
9. 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(5):1061-4.
10. 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.
11. 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;
12. Berschback JC, Lynch TS, Kalainov DM, Wysocki
RW, Merk BR, Cohen MS. Clinical and radiographic
comparisons of two different radial head implant
designs. J Shoulder Elbow Surg. 2013; 22(8):1108-20.
13. Rotini R, Marinelli A, Guerra E, Bettelli G, Cavaciocchi
M. Radial head replacement with unipolar and bipolar
SBi system: a clinical and radiographic analysis after
a 2-year mean follow-up. Musculoskelet Surg. 2012;
14. Fehringer EV, Burns EM, Knierim A, Sun J, Apker
KA, Berg RE. Radiolucencies surrounding a smoothstemmed
radial head component may not correlate
with forearm pain or poor elbow function. J Shoulder
Elbow Surg. 2009; 18(2):275-8.
15. Levy JC, Formaini NT, Kurowicki J. Outcomes and
radiographic findings of anatomic press-fit radial
head arthroplasty. J Shoulder Elbow Surg. 2016;
16. Ha AS, Petscavage JM, Chew FS. Radial head
arthroplasty: a radiologic outcome study. AJR Am J
Roentgenol. 2012; 199(5):1078-82.
17. Morrey B. Tendon injuries about the elbow. The elbow
and its disorders. Philadelphia: Saunders; 1993. P.
18. Cusick MC, Bonnaig NS, Azar FM, Mauck BM, Smith
RA, Throckmorton TW. Accuracy and reliability of
the Mayo Elbow Performance Score. J Hand Surg Am.
2014; 39(6):1146-50.
19. Broberg MA, Morrey BF. Results of treatment of
fracture-dislocations of the elbow. Clin Orthop Relat
Res. 1987; 216:109-19.
20. Hastings H, 2nd, Graham TJ. The classification and
treatment of heterotopic ossification about the elbow
and forearm. Hand clin. 1994; 10(3):417-37.
21. Hong CC, Nashi N, Hey HW, Chee YH, Murphy D.
Clinically relevant heterotopic ossification after
elbow fracture surgery: a risk factors study. Orthop
Traumatol Surg Res. 2015; 101(2):209-13.
22. Hartzler RU, Morrey BF, Steinmann SP, Llusa-Perez
M, Sanchez-Sotelo J. Radial head reconstruction
in elbow fracture-dislocation: monopolar or
bipolar prosthesis? Clin Orthop Relat Res. 2014;
23. Moghaddam A, Raven TF, Dremel E, Studier-Fischer
S, Grutzner PA, Biglari B. Outcome of Radial Head
Arthroplasty in Comminuted Radial Head Fractures:
Short and Midterm Results. Trauma mon. 2016;
24. Heijink A, Kodde IF, Mulder PGH, Van Dijk CN,
Eygendaal D. Cemented bipolar radial head
arthroplasty: midterm follow-up results. J Shoulder
Elbow Surg. 2016; 25(11):1829-38.