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Antoni M, Bruyere A, Meyer N, Clavert P. Radial neck osteolysis after radial head replacement: Functional impact and risk factors. Orthop Traumatol Surg Res 2023; 109:103291. [PMID: 35470120 DOI: 10.1016/j.otsr.2022.103291] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/23/2021] [Accepted: 03/09/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Onset of radial neck osteolysis (RNO) has been reported after radial head replacement (RHR), but data are sparse regarding impact and risk factors. We therefore conducted a retrospective study, 1) to quantify RNO after RHR, 2) to assess clinical and radiological impact, and 3) to identify risk factors. HYPOTHESIS RNO prevalence is high, but functional impact is limited. MATERIAL AND METHOD A single-center retrospective study included all patients undergoing RHR for acute radial head fracture between 2008 and 2017: 53 patients, with a mean age of 53.8±15.7 years [range, 21-85 years]. At a minimum 2 years' follow-up, patients were assessed clinically on joint range of motion and Mayo Elbow Performance Score (MEPS) and radiologically on standard radiographs. Associations between RNO and various parameters were assessed. RESULTS At a mean 46.7±19.8 months' follow-up [range, 24-84 months], RNO was found in 54.7% of cases (29/53), with mean 4.0 ±2.8mm distal extension [range, 1.2-13.4mm], corresponding to 13.4±7.3% of stem height [range, 2.7-27.7%]. RNO at last follow-up was not significantly associated with reduced flexion-extension (121.9° versus 114.0°; p=0.11), pronation-supination (152.6° versus 138.3°; p=0.25) or MEPS (84.7 versus 84.8; p=0.97), or with higher rates of postoperative complications (11/29 (37.9%) versus 7/24 (29.2%); p=0.782) or surgical revision (11/29 (37.9%) versus 10/24 (41.7%); p=0.503). RNO was significantly associated with cementless fixation (19/29 (65.5%) versus 7/24 (29.2%); p=0.01), unipolar prosthesis (21/29 (72.4%) versus 7/24 (29.2%); p=0.002), high filling-ratio, whether proximal (88% versus 77%; p=0.002), middle (84% versus 75%; p=0.007) or distal (69% versus 59%; p=0.032), and shorter radial stem (33.2mm versus 46.3mm; p=0.011). No demographic parameters showed significant association with RNO at last follow-up. CONCLUSION RNO was frequent after RHR, but without clinical or radiological impact in the present series. The risk factors identified here argue for involvement of stress shielding. LEVEL OF EVIDENCE IV, cohort study.
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Affiliation(s)
- Maxime Antoni
- Service de Chirurgie du Membre Supérieur, Pôle de Chirurgie Orthopédique et de Traumatologie, Hôpital Hautepierre 2 - CHU Strasbourg, Avenue Molière, 67000 Strasbourg, France.
| | - Alexandra Bruyere
- Service de Chirurgie du Membre Supérieur, Pôle de Chirurgie Orthopédique et de Traumatologie, Hôpital Hautepierre 2 - CHU Strasbourg, Avenue Molière, 67000 Strasbourg, France
| | - Nicolas Meyer
- Pole de Santé Publique, Secteur Méthodologie et Biostatistiques, Hôpitaux Universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - Philippe Clavert
- Service de Chirurgie du Membre Supérieur, Pôle de Chirurgie Orthopédique et de Traumatologie, Hôpital Hautepierre 2 - CHU Strasbourg, Avenue Molière, 67000 Strasbourg, France
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Rafla S, Carroll EA, Wiesler ER, Li Z, Tuohy CJ, Nunez F, Graves BR, Papadonikolakis A. Early to midterm radiographic loosening of the press fit radial head prosthesis. Injury 2021; 52:3605-3610. [PMID: 33775415 DOI: 10.1016/j.injury.2021.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/06/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Radiographic loosening is frequently seen around the radial head (RH) implant. The hypothesis of this study was that radiographic loosening will be more frequent in patients in which the RH prosthesis was implanted due to elbow trauma leading to instability that required lateral collateral ligament repair (LCL). MATERIALS AND METHODS A retrospective review of the patients who had RH implantation between 2012 and 2019 was performed. Evaluation included evidence of radiographic loosening, stress shielding, formation of heterotopic ossification, and rate of removal of the implant. Range of motion of the elbow at the latest follow up was also recorded. RESULTS At a mean follow up of 18 months (range 1.4 - 80) eight out of 25 patients had radiographic loosening around the implant. The radial head implant was removed in 8 patients (in 3 due to painful radiographic loosening, in 4 due pain without radiographic loosening and in 1 due to infection). Radiographic loosening around the RH implant had no association with LCL repair (p=0.18) or future removal of implant (p=0.18) or the diagnosis of Monteggia lesion (p=0.68). In addition, removal of the RH implant had no association with prior LCL repair (p=0.60) or the diagnosis of Monteggia lesion (p=0.15). Stress shielding was seen in 5 patients and was of no clinical significance. Heterotopic ossification was seen in 12 patients and was classified as Class I in 3, IIA in 3, IIC in 6, according to the Hastings Classification. The average flexion-extension arc was 23° to 130°, and average pronation-supination was 76° to 69°. CONCLUSION One third of the patients had radiographic loosening around the RH implant at a mean follow up of 18 months. Pain with or without radiographic loosening were the main reasons for removal of the implant. No associations were found between the development of radiographic loosening and LCL repair at the time of RH replacement. Limitations of this study are: (a) the retrospective design (b). the small sample size and the possibility of a type II statistical error.
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Affiliation(s)
- Samuel Rafla
- Department of Orthopaedic Surgery, Wake Forest University Medical Center, Winston Salem, NC, USA.
| | - Eben A Carroll
- Department of Orthopaedic Surgery, Wake Forest University Medical Center, Winston Salem, NC, USA.
| | - Ethan R Wiesler
- Department of Orthopaedic Surgery, Wake Forest University Medical Center, Winston Salem, NC, USA.
| | - Zhongyu Li
- Department of Orthopaedic Surgery, Wake Forest University Medical Center, Winston Salem, NC, USA.
| | - Christopher J Tuohy
- Department of Orthopaedic Surgery, Wake Forest University Medical Center, Winston Salem, NC, USA.
| | - Fiesky Nunez
- Department of Orthopaedic Surgery, Wake Forest University Medical Center, Winston Salem, NC, USA.
| | - Benjamin R Graves
- Department of Orthopaedic Surgery, Wake Forest University Medical Center, Winston Salem, NC, USA.
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Aleem AW. Buyer Beware?: Commentary on an article by Philip-C. Nolte, MD, MA, et al.: "Risk Factors for Revision Surgery Following Radial Head Arthroplasty without Cement for Unreconstructible Radial Head Fractures. Minimum 3-Year Follow-up". J Bone Joint Surg Am 2021; 103:e35. [PMID: 33849053 DOI: 10.2106/jbjs.21.00080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Alexander W Aleem
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
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Jiménez-Martín A, Contreras-Joya M, Navarro-Martínez S, Najarro-Cid F, Santos-Yubero F, Pérez-Hidalgo S. Clinical results of radial arthroplasty in Hotchkiss' terrible triad, a case series of 47. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Resultados clínicos de la artroplastia radial en la tríada terrible de Hotchkiss, a propósito de 47 casos. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:83-91. [DOI: 10.1016/j.recot.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 09/29/2019] [Accepted: 11/11/2019] [Indexed: 11/20/2022] Open
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Abstract
Radial head fractures are common injuries comprising 1/3 of the fractures about the elbow. As a secondary valgus stabilizer of the elbow, radial head fractures can compromise elbow stability leading to long-term pain, dysfunction, and degenerative change. Furthermore, radial head fractures can be accompanied by associated injuries including ligamentous lesions that can further exacerbate elbow instability, leading to long-term sequelae. As fixation principles and technology have evolved, so has the ability to render surgical treatment for these fractures. In general, minimally displaced and some displaced fractures may be treated nonoperatively with early motion. Fractures with a block to rotation and displaced fragments with 3 or fewer fragments may be treated with open reduction and internal fixation. Comminuted fractures or those with greater than 3 fragments may be successfully treated with radial head replacement. Associated elbow instability will also influence treatment decisions.
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Moon JG, Shukla DR, Fitzsimmons JS, An KN, O'Driscoll SW. Stem Length and Neck Resection on Fixation Strength of Press-Fit Radial Head Prosthesis: An In Vitro Model. J Hand Surg Am 2019; 44:1098.e1-1098.e8. [PMID: 31101434 DOI: 10.1016/j.jhsa.2019.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/17/2019] [Accepted: 03/01/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Various radial head prosthesis designs are currently in use. Few studies compare different prosthetic designs. We hypothesized that increasing a cementless implant stem's length would reduce stem-bone micromotion, with both short and long neck cuts. We also hypothesized that a minimum stem length might be required for the initial fixation strength of a press-fit implant. METHODS In 16 fresh-frozen cadaveric elbows (8 pairs), the radial head and neck were cut either 10 or 21 mm below the top of the head. Modular cementless stems were inserted and sequentially lengthened in 5-mm increments. Micromotion under eccentric loading was tested after each incremental change. RESULTS Incremental lengthening of the prosthetic stem and the amount of neck resection (10-mm cut vs 21-mm cut) both had a significant effect on micromotion. After a 10-mm radial head-neck resection, we observed a significant decrease in micromotion with stem lengths of 25 mm or greater, whereas with 21 mm of neck resection there was no further reduction in micromotion with increased stem length. These differences can be explained, at least in part, by the concept of the cantilever quotient: the ratio of the head-neck length outside the bone to the total length of the implant. CONCLUSIONS The length of the stem affects the initial stability of press-fit radial head prostheses when the level of head and neck resection is at the minimum (ie, 10 mm) for currently available prosthetic designs. At this resection level, stems 25 mm or greater had significantly higher initial stability, but all stem lengths tested had mean micromotion values within the threshold for bone ingrowth. CLINICAL RELEVANCE The length of a radial head prosthetic stem affects the initial stability of press-fit radial head prostheses when the level of head and neck resection is at the minimum (ie, 10 mm) for currently available prosthetic designs.
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Affiliation(s)
- Jun-Gyu Moon
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN; Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Dave R Shukla
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - James S Fitzsimmons
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Kai-Nan An
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Shawn W O'Driscoll
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
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Shukla DR, Sahu DC, Fitzsimmons JS, An KN, O'Driscoll SW. The effect of a radial neck notch on press-fit stem stability: a biomechanical study on 7 cadavers. J Shoulder Elbow Surg 2018; 27:523-529. [PMID: 29198812 DOI: 10.1016/j.jse.2017.09.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 09/25/2017] [Accepted: 09/30/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Minimal micromotion is necessary for osteointegration of cementless radial head prostheses. When radial head fractures extend longitudinally, where the neck cut for prosthetic replacement should be made is uncertain. We hypothesized that complete resection of the notched portion of a radial neck confers no advantage in initial stability compared with not resecting the defect and inserting the implant into a notched radial neck. MATERIALS AND METHODS The radii of 7 cadavers underwent radial head resection and implantation with a 25-mm-long press-fit radial head stem. Before implantation, a 5-mm-long notch that was less than 1-mm wide was made in the radial neck. After the stem-bone micromotion was recorded, the proximal 5 mm of radial neck, incorporating the entire notch, was cut away, the stem was inserted 5 mm further, and the resulting micromotion was recorded. RESULTS The mean micromotion measured in the presence of a cortical notch was 51 ± 6 µm. After the neck was circumferentially cut and the stem was advanced, the micromotion (46 ± 9 µm) was not statistically significantly different. DISCUSSION Initial stability of an adequately sized cementless stem in the presence of a 5-mm-long cortical notch was well within the threshold needed for bone ingrowth (<100 µm). In addition, there was no reduction of micromotion after the notch-containing portion of the radial neck was resected and the stem was advanced. Making a neck cut distal to a 5-mm-long, 1-mm-wide cortical notch does not confer added stability. Thus, surgeons can preserve bone stock and avoid an aggressive neck cut.
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Affiliation(s)
- Dave R Shukla
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Dipit C Sahu
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - James S Fitzsimmons
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kai-Nan An
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Shawn W O'Driscoll
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
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Shukla DR, Shao D, Fitzsimmons JS, Thoreson AR, An KN, O'Driscoll SW. Canal preparation for prosthetic radial head replacement: rasping versus reaming. J Shoulder Elbow Surg 2013; 22:1474-9. [PMID: 24012361 DOI: 10.1016/j.jse.2013.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 06/12/2013] [Accepted: 06/16/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND While many design-specific features of radial head prostheses have been studied (ie, geometry and surface coating), the optimum technique for canal preparation has not been determined. We hypothesized that preparation of the radial canal with a reamer would allow for the accommodation of a larger stem diameter versus following canal preparation with a rasp, and would provide acceptable stem-bone micromotion. METHODS Paired proximal radii from 7 cadavers were prepared by a rasp on one side and a reamer on the contralateral side. Cementless radial head stems of increasing diameter were sequentially implanted up to the maximum size or until a fracture occurred and the micromotion between the stem and bone was recorded. RESULTS In 3 of 5 pairs, at least a 1 mm larger stem size fit into the canal after reaming versus after rasping (P = .04). 5 of 7 radii fractured secondary to intentional stem oversizing. For the optimally-sized stems, similar micromotion values were observed whether the canal was rasped (41 ± 6 μm) or reamed (44 ± 6 μm) (P = .72). DISCUSSION This study investigated an aspect of radial head arthroplasty technique about which little has currently been published. It is possible that use of a reamer rather than a rasp, while providing similar initial stability, might expand the stem size options for initial press-fit stability, and decrease the risk of fracture. CONCLUSION Radial canal preparation with a reamer allows for implantation of a 1 mm larger stem diameter versus rasping, while providing comparable initial stability to that achieved after rasping.
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Affiliation(s)
- Dave R Shukla
- Department of Orthopedic Surgery, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
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Prosthetic radial head stem pull-out as a mode of failure: a biomechanical study. INTERNATIONAL ORTHOPAEDICS 2013; 38:89-93. [PMID: 24042697 DOI: 10.1007/s00264-013-2074-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 08/06/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Press-fit cementless radial head implant longevity relies on adequate bone ingrowth. Failed implant osseointegration remains a clinical concern and has been shown to lead to prosthetic failure. The purpose of this study was to test the hypothesis that implants with sufficient initial press-fit stability would be less likely to fail due to implant pull-out, as demonstrated by an increasing amount of energy required to remove the prosthesis from the canal. METHODS Ten cadaveric radii were implanted with five sizes (6-10 mm in 1-mm increments) of grit-blasted, cementless radial head stems. A customised slap hammer was used to measure the energy required to remove each stem. Stem-bone micromotion was also measured. RESULTS The suboptimally sized stem (Max - 1) (i.e. 1 mm undersized) required less energy (0.5 ± 0 J) to pull out than the optimally sized stem (Max) (1.7 ± 0.3 J) (p = 0.008). The optimally sized stem demonstrated greater initial stability (45 ± 7 μm) than the suboptimally sized stem (79 ± 12 μm) (p = 0.004). CONCLUSIONS This investigation demonstrates the importance of obtaining adequate press-fit stability for the prevention of radial head stem pull-out failure. These data add to the relatively scant knowledge in the literature regarding radial head biomechanics. The energy required to remove a prosthetic radial head ingrowth stem decreases in conjunction with diameter. The use of an inadequately sized stem increases the stem's micromotion as well as the risk of prosthetic loosening due to pull-out.
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Katthagen JC, Jensen G, Lill H, Voigt C. Monobloc radial head prostheses in complex elbow injuries: results after primary and secondary implantation. INTERNATIONAL ORTHOPAEDICS 2013; 37:631-9. [PMID: 23271690 PMCID: PMC3609984 DOI: 10.1007/s00264-012-1747-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 12/02/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Dislocations of components, loosening of the stem, overstuffing and removal in up to 24 % of common radial head prostheses (RHP) after implantation in complex elbow injuries signal the need for improvement. The latest biomechanical evidence shows advantages for monopolar designs. Clinical results after primary and secondary implantation of the newly designed press-fit monobloc monopolar RHP in cases of complex elbow injury are evaluated. METHODS Twenty-nine patients [median age 60 years (29-86)] were followed up retrospectively for a median of 25 months (7-54) post-operatively. Subjective parameters, the Mayo Elbow Performance Score (MEPS), the Broberg and Morrey score (BMS), latest radiographs and complications were evaluated. RESULTS MEPS and BMS averaged 87.2 ± 12.9 and 81.1 ± 11.9 points, respectively. No case of implant loosening was observed; the RHP had to be removed in one case (3 %). The overall complication and revision rate was higher after secondary (53 %) than after primary (19 %) implantation. CONCLUSIONS Satisfactory clinical results and low short-term removal rates emphasise the practicality of monobloc monopolar RHP. Differentiated treatment of complex elbow fracture-dislocations is compulsory to avoid the need for secondary RHP implantation which carries a higher complication rate.
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Affiliation(s)
- Jan Christoph Katthagen
- Klinik für Unfall- und Wiederherstellungschirurgie, Diakoniekrankenhaus Friederikenstift gGmbH, Hanover, Germany.
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Shukla DR, Fitzsimmons JS, An KN, O'Driscoll SW. Effect of stem length on prosthetic radial head micromotion. J Shoulder Elbow Surg 2012; 21:1559-64. [PMID: 22445160 DOI: 10.1016/j.jse.2011.11.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 09/13/2011] [Accepted: 11/14/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND Osteointegration of press-fit radial head implants is achieved by limiting micromotion between the stem and bone. Aspects of stem design that contribute to the enhancement of initial stability (ie, stem diameter and surface coating) have been investigated. The importance of total prosthesis length and level of the neck cut has not been examined. METHODS Cadaveric radii were implanted with cementless, porous-coated radial head stems. We resected 10, 12, 15, 20, and 25 mm of radial neck in each specimen. Stem-bone micromotion was measured after each cut. Values were expressed in terms of quotients (cantilever quotient). RESULTS A threshold effect was observed at 15 mm of neck resection (cantilever quotient, 0.4), with a significant increase in micromotion observed between 12 mm (40 ± 10 μm) and 15 mm (80 ± 25 μm). A cantilever quotient of 0.35 or less predicted implant stability, whereas implants with a cantilever quotient of 0.6 or more were unstable. In between, the stems were "at risk" of instability. CONCLUSION Initial stem stability of a porous-coated, cementless radial head implant is dependent on length of the implant stem within bone and the level of the cut (amount of bone resected). Stability may be compromised by an implant with a combined head and neck length that is too long compared with the stem length within the canal. We found a critical ratio of exposed prosthesis to total implant length (cantilever quotient of 0.4), which puts the prosthesis at risk of inadequate initial stability. These data carry important implications for implant design and use.
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Affiliation(s)
- Dave R Shukla
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
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Flinkkilä T, Kaisto T, Sirniö K, Hyvönen P, Leppilahti J. Short- to mid-term results of metallic press-fit radial head arthroplasty in unstable injuries of the elbow. ACTA ACUST UNITED AC 2012; 94:805-10. [DOI: 10.1302/0301-620x.94b6.28176] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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.
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Affiliation(s)
- T. Flinkkilä
- Oulu University Hospital, Department
of Surgery, Division of Orthopaedic and Trauma Surgery, PL21, FIN-90029
OYS, Oulu, Finland
| | - T. Kaisto
- Oulu University Hospital, Department
of Surgery, Division of Orthopaedic and Trauma Surgery, PL21, FIN-90029
OYS, Oulu, Finland
| | - K. Sirniö
- Oulu University Hospital, Department
of Surgery, Division of Orthopaedic and Trauma Surgery, PL21, FIN-90029
OYS, Oulu, Finland
| | - P. Hyvönen
- Oulu University Hospital, Department
of Surgery, Division of Orthopaedic and Trauma Surgery, PL21, FIN-90029
OYS, Oulu, Finland
| | - J. Leppilahti
- Oulu University Hospital, Department
of Surgery, Division of Orthopaedic and Trauma Surgery, PL21, FIN-90029
OYS, Oulu, Finland
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