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Samra I, Kwaees TA, Mati W, Blundell C, Lane S, Harrison JWK, Charalambous CP. Anatomic Monopolar Press-fit Radial Head Arthroplasty; High Rate of Loosening at Mid-Term Follow Up. Shoulder Elbow 2023; 15:207-217. [PMID: 37035613 PMCID: PMC10078816 DOI: 10.1177/17585732221080768] [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: 08/10/2021] [Revised: 01/19/2022] [Accepted: 01/22/2022] [Indexed: 11/15/2022]
Abstract
Introduction Radial head arthroplasty (RHA) is used for the management of unstable or unreconstructable injuries of the radial head. Our aim was to investigate clinical and radiographic outcomes in patients treated with the Acumed anatomic radial head press-fit system for trauma. Methods Clinical and radiographic assessment of RHAs undertaken for trauma with minimum 2-year follow-up. Results 16 consecutive patients, mean age 53 (21-82) and 66 month ± 27 (26-122) clinical follow-up were included. There were marked radiographic changes with 11/16 showing periprosthetic lucent lines and 13/16 showing subcollar osteolysis. Radiographic changes occurred early post-surgery. Stem loosening was associated with larger cantilever quotients (0.47 vs 0.38, p = 0.004). Overall survivability was 81.2%, with 3 RHAs removed. Clinical outcomes for the retained RHAs were acceptable with mean flexion 134°, extension deficit of 10°, pronation of 82°, and supination of 73°. Mean VAS scores were 8.5 ± 14.4, QuickDASH 13.8 ± 18.9, Mayo Elbow Performance Scores were 91.5 ± 12.5 with no poor scores. Conclusion Mid-term clinical functional outcomes following the Acumed anatomic RHA are acceptable in most cases. However, in view of the extensive periprosthetic lucencies and surgical removal due to loosening, patients should be cautioned when consented for implantation of the prosthesis, especially if a large collar is anticipated.
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Affiliation(s)
- Inderpaul Samra
- Department of Orthopaedics, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, Lancashire, FY3 8NR, UK
| | - Tariq A Kwaees
- Department of Orthopaedics, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, Lancashire, FY3 8NR, UK
| | - Wael Mati
- Department of Radiology, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, Lancashire, FY3 8NR, UK
| | - Clare Blundell
- Department of Orthopaedics, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, Lancashire, FY3 8NR, UK
| | - Suzanne Lane
- Department of Orthopaedics, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, Lancashire, FY3 8NR, UK
| | - John WK Harrison
- Gateshead Health NHS Foundation Trust, Queen Elizabeth Avenue, Gateshead, NE9 6SX, UK
| | - Charalambos P Charalambous
- Department of Orthopaedics, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, Lancashire, FY3 8NR, UK
- School of Medicine, University of Central Lancashire, Fylde Road, Preston, Lancashire, PR1 2HE, UK
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Thyagarajan DS. Radial head replacement - A comprehensive review. J Orthop 2023; 36:51-56. [PMID: 36632343 PMCID: PMC9827028 DOI: 10.1016/j.jor.2022.12.003] [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: 10/22/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Background Radial head fractures represent 1-4% of all adult fractures and 1/3rd of elbow fractures (Kaas et al., 2010). Radial head is an important secondary stabilier of the elbow. The aim of the treatment of radial head fractures is to achieve stability and good functional outcome. Radial head replacement (RHR) is indicated when robust reconstruction and fixation of the fracture fragments is not possible. Methods This article explores history and evolution, anatomical considerations, biomechanics, implant designs, indications, surgical outcomes and controversies in radial head replacement based on current evidence. Results There is a wide range of RHR designs available without conclusive evidence to support the superiority of one design over the other. Ranges of motion, functional outcomes and complication were comparable among different designs with a high incidence of complications reported in many studies. Conclusion RHR remains a good option in unreconstructible radial head fractures, with potential to regain excellent function. It is imperative to continue with the quest to innovate and improve on current designs, to reduce complications in the long term.
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Affiliation(s)
- David S. Thyagarajan
- Consultant Trauma & Orthopaedic Surgeon, Shoulder & Elbow Unit, Northern General Hospital, Sheffield Teaching Hospitals, NHS Foundation Trust, Herries Road, Sheffield, NG5 7AU, United Kingdom
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Rotman D, Kwak JM, Rojas Lievano J, Hooke A, Camp CL, Fitzsimmons JS, O'Driscoll SW. Radial Head Lag: A Possible Biomechanical Mechanism for Osteochondritis Dissecans of the Capitellum in Baseball Pitchers. Am J Sports Med 2021; 49:3226-3233. [PMID: 34523371 DOI: 10.1177/03635465211033971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteochondritis dissecans (OCD) of the capitellum is common in throwing athletes and is believed to result from repetitive overloading on the radiocapitellar (RC) joint, although the cause and mechanism remain unclear. The torsional forces (moments) generated by the triceps during elbow extension pull only on the ulna; therefore, the radial head moves passively across the capitellum and is effectively "dragged along" by the ulna. Any laxity in the proximal radioulnar joint could lead to asynchronous motion between the radius and ulna, resulting in the radial head lagging behind the coronoid and possibly malarticulating with the capitellum during such motion. HYPOTHESIS Radial head motion on the capitellum lags behind ulnohumeral joint motion during simulated throwing. STUDY DESIGN Controlled laboratory study. METHODS A total of 8 cadaveric elbows were tested under simulated throwing, including active extension of the elbow generated by pulling of the triceps under valgus stress, as well as during passive extension under valgus stress to serve as a reference. Ulnohumeral motion was tracked using a video camera. Radial head motion was tracked using an intra-articular, thin-film pressure sensor mounted on the capitellum, and the longitudinal movement of the center of force (COF) of the radial head was measured. Radial head motion was compared between passive and active motion for each 10° of elbow extension from 90° to 20°. RESULTS Elbow motion during simulated active extension reached an angular velocity of 366 deg/s. Radial head motion during simulated active extension significantly lagged compared with its motion during passive extension at every elbow extension angle examined between 70° and 20° (P < .001). The maximal lag reached a mean of 4 mm (range, 2-7 mm). In other words, RC and ulnohumeral motion were asynchronous during simulated throwing. CONCLUSION This study describes a novel phenomenon: motion of the radial head across the capitellum during rapid extension, such as in baseball pitching, lags behind that seen during passive elbow motion. According to a new proposed theory of OCD lesion development, this lag should result in RC incongruency and elevated shear forces on the capitellum due to edge loading. CLINICAL RELEVANCE We propose a new biomechanical explanation for OCD of the capitellum in baseball pitchers: radial head lag. Understanding this process is the first step in efforts to prevent this common injury.
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Affiliation(s)
- Dani Rotman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jae-Man Kwak
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Shawn W O'Driscoll
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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4
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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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5
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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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Szmit J, King GJW, Johnson JA, Langohr GDG. The effect of stem fit on the radiocapitellar contact mechanics of a metallic axisymmetric radial head hemiarthroplasty: is loose fit better than rigidly fixed? J Shoulder Elbow Surg 2019; 28:2394-2399. [PMID: 31371158 DOI: 10.1016/j.jse.2019.05.019] [Citation(s) in RCA: 5] [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: 01/23/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radial head hemiarthroplasty is commonly used to manage comminuted displaced fractures. Regarding implant fixation, current designs vary, with some prostheses aiming to achieve a tight "fixed" fit and others using a smooth stem with an over-reamed "loose" fit. The purpose of this study was to evaluate the effect of radial head hemiarthroplasty stem fit on radiocapitellar contact using a finite element model that simulated both fixed (size-for-size) and loose (1-, 2-, and 3-mm over-reamed) stem fits. It was hypothesized that a loose stem fit would improve radiocapitellar contact mechanics, with an increased contact area and decreased contact stress, by allowing the implant to find its "optimal" position with respect to the capitellum. METHODS Finite element models of the elbow were produced to compare the effects of stem fit on radiocapitellar contact of a metallic axisymmetric radial head implant. Radiocapitellar contact mechanics (contact area and maximum contact stress) were computed for 0°, 45°, 90°, and 135° of elbow flexion with the forearm in neutral rotation, pronation, and supination. RESULTS The data suggest that the loose smooth stem radial head implant may be functioning like a bipolar implant in optimizing radiocapitellar contact. Over-reaming of 3 mm produced a larger amount of stress concentration on the capitellum, suggesting there may be a limit to how loose a smooth stem implant should be implanted. CONCLUSIONS The loose 1 to 2 mm over-reamed stem provided optimal contact mechanics of the metallic axisymmetric radial head implant compared with the fixed stem.
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7
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Hackl M, Wegmann K, Hollinger B, El-Zayat BF, Seybold D, Gühring T, Schnetzke M, Schmidt-Horlohé K, Greiner S, Lill H, Ellwein A, Glanzmann MC, Siebenlist S, Jäger M, Weber J, Müller LP. Surgical revision of radial head fractures: a multicenter retrospective analysis of 466 cases. J Shoulder Elbow Surg 2019; 28:1457-1467. [PMID: 30713065 DOI: 10.1016/j.jse.2018.11.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/25/2018] [Accepted: 11/09/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radial head fractures lead to persisting disability in a considerable number of cases. This study aimed to investigate their most common revision causes and procedures. METHODS This multicenter retrospective study reviewed the cases of 466 adult patients who had undergone surgical revision after operative or nonoperative treatment of a radial head fracture. The initial diagnosis was a Mason type I fracture in 13.0%, Mason type II fracture in 14.6%, Mason type III fracture in 22.8%, Mason type IV fracture in 20.9%, terrible-triad injury in 12.8%, Monteggia-like lesion in 13.1%, and Essex-Lopresti lesion in 2.0%. Initial treatment was nonoperative in 30.2%, open reduction and internal fixation (ORIF) in 44.9%, radial head arthroplasty in 16.6%, radial head resection in 3.7%, sole treatment of concomitant injuries in 2.6%, and fragment excision in 2.0%. Up to 3 revision causes and procedures were recorded per case. RESULTS The most common complications were stiffness (67.4%), instability (36.5%), painful osteoarthritis (29.2%), ORIF related (14.8%), nonunion or necrosis (9.2%), radial head arthroplasty related (7.5%), ulnar neuropathy (6.0%), and infection (2.6%). Revision procedures frequently included arthrolysis (42.1%), arthroplasty (24.9%), implant removal (23.6%), ligament repair or reconstruction (23.0%), débridement (14.2%), repeated ORIF (8.2%), and/or radial head resection (7.7%). Mason type I or II fractures were primarily revised because of stiffness and painful osteoarthritis. Complications after Mason type III fractures were predominantly ORIF related. Fracture-dislocations showed a wide range of complications, with instability and stiffness comprising the most common causes of revision. CONCLUSIONS The complications of radial head fractures are characteristic to their classification. Knowledge of these findings might guide surgeons in treating these injuries and may help counsel patients accordingly.
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Affiliation(s)
- Michael Hackl
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany.
| | - Kilian Wegmann
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany
| | - Boris Hollinger
- Ellenbogen- und Schulterchirurgie, Arcus Sportklinik, Pforzheim, Germany
| | - Bilal F El-Zayat
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Dominik Seybold
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Thorsten Gühring
- Department of Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, Ludwigshafen, Germany
| | - Marc Schnetzke
- Department of Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, Ludwigshafen, Germany
| | | | | | - Helmut Lill
- Department of Orthopedics and Traumatology, Diakovere Friederikenstift, Hanover, Germany
| | - Alexander Ellwein
- Department of Orthopedics and Traumatology, Diakovere Friederikenstift, Hanover, Germany
| | | | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Münich, Münich, Germany
| | - Martin Jäger
- Department of Orthopaedic and Trauma Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Jörg Weber
- Department of Trauma Surgery, Orthopedics and Hand Surgery, Südstadt Hospital Rostock, Rostock, Germany
| | - Lars P Müller
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany
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Miyamura S, Sakai T, Oka K, Abe S, Shigi A, Tanaka H, Shimada S, Mae T, Sugamoto K, Yoshikawa H, Murase T. Regional Distribution of Articular Cartilage Thickness in the Elbow Joint: A 3-Dimensional Study in Elderly Humans. JB JS Open Access 2019; 4:JBJSOA-D-19-00011. [PMID: 31592501 PMCID: PMC6766381 DOI: 10.2106/jbjs.oa.19.00011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
During elbow procedures, reconstruction of the joint (including the articular cartilage) is important in order to restore elbow function; however, the regional distribution of elbow cartilage is not completely understood. The purpose of the present study was to investigate the 3-dimensional (3-D) distribution patterns of cartilage thickness of elbow bones (including the distal part of the humerus, proximal part of the ulna, and radial head) in order to elucidate the morphological relationship among them.
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Affiliation(s)
- Satoshi Miyamura
- Departments of Orthopaedic Surgery (S.M., K.O., H.T., T. Mae, H.Y., and T. Murase), Neuroscience and Cell Biology (S.S.), and Orthopaedic Biomaterial Science (K.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Takashi Sakai
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kunihiro Oka
- Departments of Orthopaedic Surgery (S.M., K.O., H.T., T. Mae, H.Y., and T. Murase), Neuroscience and Cell Biology (S.S.), and Orthopaedic Biomaterial Science (K.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Shingo Abe
- Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Atsuo Shigi
- Department of Orthopaedic Surgery, Yukioka Hospital, Osaka, Japan
| | - Hiroyuki Tanaka
- Departments of Orthopaedic Surgery (S.M., K.O., H.T., T. Mae, H.Y., and T. Murase), Neuroscience and Cell Biology (S.S.), and Orthopaedic Biomaterial Science (K.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Shoichi Shimada
- Departments of Orthopaedic Surgery (S.M., K.O., H.T., T. Mae, H.Y., and T. Murase), Neuroscience and Cell Biology (S.S.), and Orthopaedic Biomaterial Science (K.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Tatsuo Mae
- Departments of Orthopaedic Surgery (S.M., K.O., H.T., T. Mae, H.Y., and T. Murase), Neuroscience and Cell Biology (S.S.), and Orthopaedic Biomaterial Science (K.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazuomi Sugamoto
- Departments of Orthopaedic Surgery (S.M., K.O., H.T., T. Mae, H.Y., and T. Murase), Neuroscience and Cell Biology (S.S.), and Orthopaedic Biomaterial Science (K.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Hideki Yoshikawa
- Departments of Orthopaedic Surgery (S.M., K.O., H.T., T. Mae, H.Y., and T. Murase), Neuroscience and Cell Biology (S.S.), and Orthopaedic Biomaterial Science (K.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Tsuyoshi Murase
- Departments of Orthopaedic Surgery (S.M., K.O., H.T., T. Mae, H.Y., and T. Murase), Neuroscience and Cell Biology (S.S.), and Orthopaedic Biomaterial Science (K.S.), Osaka University Graduate School of Medicine, Suita, Japan
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9
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The radial head size in relation to osseous landmarks of the forearm. Surg Radiol Anat 2018; 41:415-421. [DOI: 10.1007/s00276-018-2160-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
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Vanhees M, Shukla DR, Fitzsimmons JS, An KN, O'Driscoll SW. Anthropometric Study of the Radiocapitellar Joint. J Hand Surg Am 2018; 43:867.e1-867.e6. [PMID: 29580744 DOI: 10.1016/j.jhsa.2018.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 12/12/2017] [Accepted: 02/02/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE There is scant knowledge about the relationship between the size of the radial head and the size of the capitellum. Also, no data exist comparing the size of the capitellum between the left and the right elbow. METHODS Eight pairs of elbows and 12 single elbows from fresh-frozen cadavers were obtained for this study. The vertical height and anterior width of the capitellum were measured with digital calipers. Four different measurements were performed at the radial head: longest outer diameter, shortest outer diameter, the long dish diameter, and short dish diameter. The Pearson intrarater intraclass correlation coefficients were obtained for all measurements. RESULTS For the paired elbows, the correlations ranged between 0.95 and 0.96 for the capitellar dimensions and 0.77 and 0.98 for the radial head dimensions. The correlations between the long outer diameter of the radial head with the vertical height and the anterior width of the capitellum were 0.8 and 0.9, respectively. CONCLUSIONS There is a high correlation between the long outer diameter of the radial head and the vertical height of the capitellum as well its anterior width. There is also a high correlation between the left and the right elbow. CLINICAL RELEVANCE These findings are relevant to radiocapitellar arthroplasty and may be useful for radiocapitellar prosthetic design as well as in the preoperative planning of cases in which the radial head and/or the capitellum is destroyed.
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Affiliation(s)
- Matthias Vanhees
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic. Rochester, MN
| | - 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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11
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Sershon RA, Luchetti TJ, Cohen MS, Wysocki RW. Radial head replacement with a bipolar system: an average 10-year follow-up. J Shoulder Elbow Surg 2018; 27:e38-e44. [PMID: 29128376 DOI: 10.1016/j.jse.2017.09.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 09/04/2017] [Accepted: 09/09/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND We report the long-term results of a cohort of patients after radial head replacement with a bipolar design and a smooth cementless stem at a mean follow-up of 10.4 years. METHODS Of 17 possible patients from a previous minimum 2-year follow-up study, 16 were available for review. Patients were assessed using clinical and radiographic examination and with standardized outcome measures. Range of motion, stability, and radiographic evaluation of implant loosening and joint degeneration were assessed. Comparisons were performed using the Wilcoxon signed rank test for unequal groups. RESULTS The average follow-up was 10.5 years (range, 8.5-12 years). The median visual analog scale was 1 (range, 0-5), Minnesota Elbow Performance Index was 93 (range, 70-100), and the Disabilities of the Arm, Shoulder and Hand was 7.5 (range, 0-53). Range of motion was decreased on the operative side compared with the nonoperative side for flexion/extension (P = .005) and pronation/supination (P = .015). Grip strength was decreased on the affected side (P = .045). No patients had elbow instability. Significant arthritic changes developed in 2 patients at the ulnohumeral joint. The median cantilever quotient was 0.4 (range, 0.30-0.50). Osteolysis in zones 1 to 7 was found in all but 2 patients. The median stem radiolucency was 0.5 mm (range, 0.2-0.9 mm). No reoperations occurred since our previous report. Implant survival in this cohort was 97%. CONCLUSION Bipolar radial head prosthesis with a smooth cementless stem effectively restores elbow stability and function after comminuted radial head fractures with or without concomitant elbow instability. Our study demonstrates excellent long-term implant survival.
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Affiliation(s)
- Robert A Sershon
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Timothy J Luchetti
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
| | - Mark S Cohen
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Robert W Wysocki
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
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12
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Hackl M, Wegmann K, Koslowsky TC, Zeifang F, Schoierer O, Müller LP. Rare implant-specific complications of the MoPyC radial head prosthesis. J Shoulder Elbow Surg 2017; 26:830-837. [PMID: 28131684 DOI: 10.1016/j.jse.2016.11.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/06/2016] [Accepted: 11/11/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND According to currently available data, the clinical short-term results of the MoPyC radial head prosthesis (Bioprofile, Tornier, Montbonnot-Saint-Martin, France) seem favorable. However, we have encountered several implant-specific complications in recent years. Hence, this case series reports rare complications after radial head arthroplasty with the MoPyC prosthesis to make surgeons aware of their existence and to provide information about the underlying cause and possible salvage strategies. METHODS A retrospective chart review from 2011 to 2016 was conducted to identify all adult patients with a minimum 2-year follow-up who underwent or were referred after radial head arthroplasty with the MoPyC radial head prosthesis and experienced implant-related complications. RESULTS Five patients with 7 implant-related complications were found. One patient experienced breakage of the pyrocarbon head. In another patient, breakage of the stem and-after revision surgery-partial breakage were observed. Disassembly of the prosthesis was seen in 1 case. Extensive periprosthetic stress shielding was seen in 3 patients resulting in symptomatic loosening (1), periprosthetic radial neck fracture (1), and stem migration (1). CONCLUSIONS Whereas clinical short-term results of the MoPyC radial head prosthesis are satisfactory, rare implant-related complications can occur. Surgeons should be aware of these complications as they may lead to a poor outcome.
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Affiliation(s)
- Michael Hackl
- Center for Orthopedic and Trauma Surgery, Uniklinik Köln, Köln, Germany; Köln Center for Musculoskeletal Biomechanics, Medical Faculty, University of Köln, Köln, Germany.
| | - Kilian Wegmann
- Center for Orthopedic and Trauma Surgery, Uniklinik Köln, Köln, Germany; Köln Center for Musculoskeletal Biomechanics, Medical Faculty, University of Köln, Köln, Germany
| | | | - Felix Zeifang
- Center for Orthopedic and Trauma Surgery, University Medical Center, Heidelberg, Germany
| | - Oliver Schoierer
- Center for Orthopedic and Trauma Surgery, University Medical Center, Heidelberg, Germany
| | - Lars P Müller
- Center for Orthopedic and Trauma Surgery, Uniklinik Köln, Köln, Germany; Köln Center for Musculoskeletal Biomechanics, Medical Faculty, University of Köln, Köln, Germany
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13
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Tarallo L, Mugnai R, Rocchi M, Capra F, Catani F. Mason type III radial head fractures treated by anatomic radial head arthroplasty: Is this a safe treatment option? Orthop Traumatol Surg Res 2017; 103:183-189. [PMID: 27940249 DOI: 10.1016/j.otsr.2016.10.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 08/19/2016] [Accepted: 10/06/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Radial head fractures make up approximately 3% of all fractures and they are the most common elbow fracture in adults. Replacement through arthroplasty is the recommended treatment in the context of unstable elbow injury and comminuted radial head fracture. The midterm clinical, functional, and radiographic results in patients treated with anatomic radial head arthroplasty for a Mason type III radial head fracture are presented. MATERIAL AND METHODS We performed a retrospective search of our facility's prospective trauma database to identify all skeletally mature patients who were treated by primary radial head replacement or open reduction and internal fixation following an acute radial head fracture. Inclusion criteria were Mason type III fractures and anatomic radial head arthroplasty (RHA). All the patients included were evaluated using a standard postoperative protocol including clinical and radiographic evaluation at 1, 3 and 12 months of follow-up. All the patients were reviewed clinically at an average of 30 months' follow-up. RESULTS Forty-one subjects (32 Mason type III and 9 Mason IV fractures) were treated with anatomic RHA (Acumed, Hillsboro, OR, USA). Of these, two patients (1 Mason type III and 1 Mason type IV) were excluded from the analysis because severe cognitive impairment. Moreover, we decided to exclude the subjects with a Mason type IV fracture to obtain a more homogeneous sample. Therefore, 31 patients with a Mason type III fracture were included in this study. Based on the Mayo Elbow Performance Score, excellent results were obtained in 24 (77%) patients, good in 3 (10%) and fair in 4 (13%) patients. Heterotopic ossification was reported in 8 patients (26% of cases). The final elbow flexion-extension range of motion was of 112°, with a mean flexion of 125°. The final forearm rotational range of motion was 134° with a mean pronation of 68° and a mean supination of 66°. DISCUSSION Anatomic radial head replacement leads to a good functional recovery, even in the presence of severe instability, such as coronoid fractures and LUCL injury. However, patients should be informed of the high number of adverse events (mainly heterotopic ossification) following this treatment. LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- L Tarallo
- Orthopaedics and Traumatology Department, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy.
| | - R Mugnai
- Orthopaedics and Traumatology Department, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy
| | - M Rocchi
- Orthopaedics and Traumatology Department, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy
| | | | - F Catani
- Orthopaedics and Traumatology Department, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy
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Ekholm C, Sampson J. Ulnohumeral dislocation despite intact radiocapitellar joint: a rare Monteggia variant. Shoulder Elbow 2017; 9:42-45. [PMID: 28572849 PMCID: PMC5441618 DOI: 10.1177/1758573216673527] [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: 07/16/2016] [Accepted: 08/31/2016] [Indexed: 11/16/2022]
Abstract
We treated one patient with a mid-diaphyseal radius fracture and concomitant anteromedial facet fracture of the coronoid. The ulnohumeral joint was severely unstable by complete ligament detachment and interosseous membrane rupture. Despite this gross instability, the radiocapitellar was congruent and stable. The possible mechanism of radiocapitellar stability is discussed and the concept of concavity-compression stability across the radiocapitellar joint is emphasized.
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Affiliation(s)
- Carl Ekholm
- Carl Ekholm, Department of Orthopaedics, Sahlgrenska University Hospital, 431 80 Göteborg, Sweden.
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Sahu D, Fitzsimmons JS, Thoreson AR, An KN, O'Driscoll SW. Radiocapitellar contact characteristics during prosthetic radial head subluxation. J Shoulder Elbow Surg 2017; 26:170-177. [PMID: 27727059 DOI: 10.1016/j.jse.2016.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 06/15/2016] [Accepted: 07/01/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Metallic radial head prostheses are often used in the management of comminuted radial head fractures and elbow instability. We hypothesized that during radiocapitellar subluxation, the contact pressure characteristics of an anatomic radial head prosthesis will more closely mimic those of the native radial head compared with a monopolar circular or a bipolar circular radial head design. MATERIALS AND METHODS With use of 6 fresh frozen cadaver elbows, mean radiocapitellar contact pressures, contact areas, and peak pressures of the native radial head were assessed at 0, 2, 4, and 6 mm of posterior subluxation. These assessments were repeated after the native radial head was replaced with anatomic, monopolar circular and bipolar circular prostheses. RESULTS The joint contact pressures increased with the native and the prosthetic radial head subluxation. The mean contact pressures for the native radial head and anatomic prosthesis increased progressively and significantly from 0 to 6 mm of subluxation (native, 0.6 ± 0.0 MPa to 1.9 ± 0.2 MPa; anatomic, 0.7 ± 0.0 MPa to 2.1 ± 0.3 MPa; P < .0001). The contact pressures with the monopolar and bipolar prostheses were significantly higher at baseline and did not change significantly further with subluxation (monopolar, 2.0 ± 0.1 MPa to 2.2 ± 0.2 MPa [P = .31]; bipolar, 1.7 ± 0.1 MPa to 1.9 ± 0.1 MPa [P = .12]). The pattern of increase in contact pressures with the anatomic prosthesis mimicked that of the native radial head. Conversely, the circular prostheses started out with higher contact pressures that stayed elevated. CONCLUSION The articular surface design of a radial head prosthesis is an important determinant of joint contact pressures.
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Affiliation(s)
- Dipit Sahu
- Department of Orthopaedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - James S Fitzsimmons
- Department of Orthopaedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Andrew R Thoreson
- Department of Orthopaedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Kai-Nan An
- Department of Orthopaedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Shawn W O'Driscoll
- Department of Orthopaedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA.
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Yeung C, Deluce S, Willing R, Johnson M, King GJW, Athwal GS. Regional Variations in Cartilage Thickness of the Radial Head: Implications for Prosthesis Design. J Hand Surg Am 2015; 40:2364-71.e1. [PMID: 26527596 DOI: 10.1016/j.jhsa.2015.09.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 08/31/2015] [Accepted: 09/08/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To characterize the regional variations in cartilage thickness around the radial head. METHODS We dissected 27 cadaveric radii and scanned them with computed tomography in neutral position. Three-dimensional cartilage and subchondral bone surface models were generated from computed tomography scans and 2 independent observers processed them through a computer program to obtain cartilage thickness measurements. These measurements were taken at 41 predetermined landmarks around the periphery of the radial head and within the articular dish. RESULTS At the periphery of the radial head, cartilage was thickest in the posteromedial region. Thickness values within the articular dish were similar but increased toward the rim. Regional variations within the rim (range, 0.76-1.73 mm) were also detected with the thickest region located anteriorly and thinnest region laterally. In addition, cartilage was significantly thicker in male relative to female specimens. CONCLUSIONS Regional variations in cartilage thickness are present around the periphery and rim and within the articular dish of the radial head. CLINICAL RELEVANCE Cartilage thickness across the articular dish may contribute to dish depth and the radius of curvature. This may be clinically important for the design of anatomic implants, because accounting for such subtle contours could help to restore radiocapitellar concavity-compression stability better.
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Affiliation(s)
- Celine Yeung
- Department of Anatomy and Cell Biology, Western University, London, Ontario, Canada
| | - Simon Deluce
- Hand and Upper Limb Centre, St Joseph's Health Care, Western University, London, Ontario, Canada
| | - Ryan Willing
- Hand and Upper Limb Centre, St Joseph's Health Care, Western University, London, Ontario, Canada
| | - Marjorie Johnson
- Department of Anatomy and Cell Biology, Western University, London, Ontario, Canada
| | - Graham J W King
- Hand and Upper Limb Centre, St Joseph's Health Care, Western University, London, Ontario, Canada
| | - George S Athwal
- Hand and Upper Limb Centre, St Joseph's Health Care, Western University, London, Ontario, Canada.
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17
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Die Passgenauigkeit monopolarer Radiuskopfprothesen im proximalen Radioulnargelenk. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s11678-015-0337-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Contreras-Joya M, Jiménez-Martín A, Santos-Yubero F, Navarro-Martínez S, Najarro-Cid F, Sánchez-Sotelo J, Pérez-Hidalgo S. Radial head arthroplasty, 11 years’ experience: A series of 82 patients. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015. [DOI: 10.1016/j.recote.2015.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Artroplastia de cúpula radial, experiencia de 11 años. Estudio sobre 82 pacientes. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015; 59:307-17. [DOI: 10.1016/j.recot.2015.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 08/12/2014] [Accepted: 02/06/2015] [Indexed: 11/23/2022] Open
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Irish SE, Langohr GDG, Willing R, King GJ, Johnson JA. Implications of radial head hemiarthroplasty dish depth on radiocapitellar contact mechanics. J Hand Surg Am 2015; 40:723-9. [PMID: 25813921 DOI: 10.1016/j.jhsa.2015.01.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 01/21/2015] [Accepted: 01/21/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the effect of radial head implant dish depth on radiocapitellar joint contact mechanics. METHODS Computed tomography images of 13 fresh-frozen cadaveric humeri were reconstructed into 3-dimensional finite element models with accurate cartilage geometry. Native humeri were paired with the corresponding native radial heads and axisymmetric radial head prosthesis models of the following dish depths: 1.0 mm, 1.5 mm, 2.0 mm, 2.5 mm, and 3.0 mm. Radiocapitellar contact mechanics were quantified at 4 different flexion angles (0°, 45°, 90°, and 135°) with a 100-N axial load applied to the radial head using a modeling protocol previously validated by cadaveric studies. The radial head was permitted to translate freely to its optimal position while the humerus was fully constrained. Output variables were contact area and peak contact stress. RESULTS All prostheses had significantly decreased contact area and increased peak contact stress at all flexion angles relative to the native radiocapitellar joint. Contact area increased with prosthesis dish depth until reaching a plateau with a predicted local maximum at a mean depth of 3.2 ± 0.7 mm. Peak contact stress was elevated for both the shallowest and deepest models and reached a predicted local minimum at a mean depth of 1.8 ± 0.3 mm. CONCLUSIONS Contact area and peak contact stress were dependent on radial head prosthesis dish depth. There was an optimal implant dish depth for radiocapitellar contact mechanics at approximately 2 mm. CLINICAL RELEVANCE Optimizing radiocapitellar contact mechanics using rigorous and systematic prosthesis design techniques may lead to better clinical outcomes due to reduced capitellar cartilage degradation.
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Affiliation(s)
- S Elizabeth Irish
- Roth McFarlane Hand and Upper Limb Centre Bioengineering, St. Joseph's Health Centre, London, Ontario, Canada.
| | - G Daniel G Langohr
- Roth McFarlane Hand and Upper Limb Centre Bioengineering, St. Joseph's Health Centre, London, Ontario, Canada
| | - Ryan Willing
- Roth McFarlane Hand and Upper Limb Centre Bioengineering, St. Joseph's Health Centre, London, Ontario, Canada
| | - Graham J King
- Roth McFarlane Hand and Upper Limb Centre Bioengineering, St. Joseph's Health Centre, London, Ontario, Canada
| | - James A Johnson
- Roth McFarlane Hand and Upper Limb Centre Bioengineering, St. Joseph's Health Centre, London, Ontario, Canada
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Effect of radial head implant shape on joint contact area and location during static loading. J Hand Surg Am 2015; 40:716-22. [PMID: 25813920 DOI: 10.1016/j.jhsa.2014.12.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 12/09/2014] [Accepted: 12/09/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the effect of implant shape on radiocapitellar joint contact area and location in vitro. METHODS We used 8 fresh-frozen cadaveric upper extremities. An elbow loading simulator examined joint contact in pronation, neutral rotation, and supination with the elbow at 90° flexion. Muscle tendons were attached to pneumatic actuators to allow for computer-controlled loading to achieve the desired forearm rotation. We performed testing with the native radial head, an axisymmetric implant, a reverse-engineered patient-specific implant, and a population-based quasi-anatomic implant. Implants were inserted using computer navigation. Contact area and location were quantified using a casting technique. RESULTS We found no significant difference between contact locations for the native radial head and the 3 implants. All of the implants had a contact area lower than the native radial head; however, only the axisymmetric implant was significantly different. There was no significant difference in contact area between implant shapes. CONCLUSIONS The similar contact areas and locations of the 3 implant designs suggest that the shape of the implant may not be important with respect to radiocapitellar joint contact mechanics when placed optimally using computer navigation. Further work is needed to explore the sensitivity of radial head implant malpositioning on articular contact. The lower contact area of the radial head implants relative to the native radial head is similar to previous benchtop studies and is likely the result of the greater stiffness of the implant. CLINICAL RELEVANCE Radial head implant shape does not appear to have a pronounced influence on articular contact, and both axisymmetric and anatomic metal designs result in elevated cartilage stress relative to the intact state.
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22
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The effect of capitellar impaction fractures on radiocapitellar stability. J Hand Surg Am 2015; 40:520-5. [PMID: 25510156 DOI: 10.1016/j.jhsa.2014.10.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 10/20/2014] [Accepted: 10/21/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the effect of capitellar impaction fractures on radiocapitellar stability in a model that simulated a terrible triad injury. METHODS Six cadaveric elbows were dissected free of skin and muscles. Tendons were preserved. The lateral collateral ligament was released and repaired (surgical control). Two sizes of capitellar impaction defects were created. After lateral collateral ligament release and repair, we then sequentially created osseous components of a terrible triad injury (partial radial head resection and coronoid fracture) through an olecranon osteotomy that was fixed with a plate. Radiocapitellar stability was recorded after the creation of each new condition. RESULTS Significantly less force was required for radiocapitellar subluxation after the creation of 20° and 40° capitellar defects compared with the surgical control (intact capitellum). After the addition of a Mason type II radial head defect and then a coronoid defect, stability decreased significantly further. CONCLUSIONS Impaction fractures of the distal portion of the capitellum may contribute to a loss of radiocapitellar stability, particularly in an elbow fracture-dislocation. CLINICAL RELEVANCE Because these injuries may be unrecognized, consideration should be given to diagnosing and addressing them.
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Bachman DR, Thaveepunsan S, Park S, Fitzsimmons JS, An KN, O'Driscoll SW. The effect of prosthetic radial head geometry on the distribution and magnitude of radiocapitellar joint contact pressures. J Hand Surg Am 2015; 40:281-8. [PMID: 25542439 DOI: 10.1016/j.jhsa.2014.11.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 11/04/2014] [Accepted: 11/04/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine if radiocapitellar contact pressures would be elevated with nonanatomical (circular) prostheses over those mimicking native anatomy and if such pressures would be related to the depth and contour of the articular dish and to the pattern of prosthetic articulation against the lateral trochlear ridge. METHODS Three commercially available circular radial head designs were compared with an anatomical radial head and 2 modified anatomical prototype radial head designs in 10 cadaveric specimens. Each prosthesis and specimen combination was loaded in neutral rotation and maximal extension with a custom testing apparatus while measuring contact areas and pressures using thin-film pressure sensors. RESULTS Anatomical radial head prototype 2 had similar radiocapitellar contact areas and mean pressures as the native radial head; all other designs showed significant decreases in contact area and increased mean pressures. Peak contact pressures were also measured and were significantly elevated with all prostheses tested. Anatomical designs are statistically more likely to mimic normal contact with the lateral trochlear ridge and its adjacent sulcus than circular prostheses. They are also significantly less likely to have contact pressures above the 5 MPa threshold that is thought to be harmful to cartilage. The depth of the articular dish had a significant effect on contact area and pressure. CONCLUSIONS Commercially available radial head prostheses demonstrated reduced radiocapitellar contact areas and elevated contact pressures during compressive loading. These were significantly greater with symmetrical circular prostheses than with asymmetrical elliptical designs. The prosthesis that best mimicked native contact behavior was the anatomical radial head prototype 2 owing to its design for articulating with the capitellum, the lateral trochlear ridge, and the sulcus between. CLINICAL RELEVANCE Because radial head prostheses have the potential to cause capitellar erosion or arthritic change, those with lower contact pressures may lead to fewer such complications.
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Affiliation(s)
| | | | - Sangeun Park
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | - Kai-Nan An
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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The effect of radial head implant shape on radiocapitellar kinematics during in vitro forearm rotation. J Shoulder Elbow Surg 2015; 24:258-64. [PMID: 25457776 DOI: 10.1016/j.jse.2014.09.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 09/09/2014] [Accepted: 09/12/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND A number of radial head implants are in clinical use for the management of radial head fractures and their sequelae. However, the optimal shape of a radial head implant to ensure proper tracking relative to the capitellum has not been established. This in vitro biomechanical study compared radiocapitellar joint kinematics for 3 radial head implant designs as well as the native head. METHODS Eight cadaveric upper extremities were tested using a forearm rotation simulator with the elbow at 90° of flexion. Motion of the radius relative to the capitellum was optically tracked. A stem was navigated into a predetermined location and cemented in place. Three unipolar implant shapes were tested: axisymmetric, reverse-engineered patient-specific, and population-based quasi-anatomic. The patient-specific and quasi-anatomic implants were derived from measurements performed on computed tomography models. RESULTS Medial-lateral and anterior-posterior translation of the radial head with respect to the capitellum varied with forearm rotation and radial head condition. A significant difference in medial-lateral (P = .03) and anterior-posterior (P = .03) translation was found between the native radial head and the 3 implants. No differences were observed among the radial head conditions except for a difference in medial-lateral translation between the axisymmetric and patient-specific implants (P = .04). CONCLUSIONS Radiocapitellar kinematics of the tested radial head implants were similar in all but one comparison, and all had different kinematics from the native radial head. Patient-specific radial head implants did not prove advantageous relative to conventional implant designs. The shape of the fixed stem unipolar radial head implants had little influence on radiocapitellar kinematics when optimally positioned in this testing model.
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Sahu D, Holmes DM, Fitzsimmons JS, Thoreson AR, Berglund LJ, An KN, O'Driscoll SW. Influence of radial head prosthetic design on radiocapitellar joint contact mechanics. J Shoulder Elbow Surg 2014; 23:456-62. [PMID: 24630544 DOI: 10.1016/j.jse.2013.11.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 11/14/2013] [Accepted: 11/22/2013] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Our aim was to test whether anatomically designed metallic radial head implants could better reproduce native radiocapitellar contact pressure and areas than nonanatomic implants. METHODS The distal humerus and proximal radius from 6 cadaveric upper extremities were serially tested in supination with 100 N of compression force at 4 angles of flexion (0°, 30°, 60°, and 90°). By use of a thin flexible pressure transducer, contact pressures and areas were measured for the native radial head, an anatomic implant, a nonanatomic circular monopolar implant, and a bipolar nonanatomic implant. The data (mean contact pressure and mean contact area) were modeled using a 2-factor repeated-measures analysis of variance with P ≤ .05 considered to be significant. RESULTS The mean contact areas for the prosthetic radial heads were significantly less than those seen with the intact radial heads at every angle tested (P < .01). The mean contact pressures increased significantly with all prosthetic radial head types as compared with the native head. The mean contact pressures increased by 29% with the anatomic prosthesis, 230% with the monopolar prosthesis, and 220% with the bipolar prosthesis. Peak pressures of more than 5 MPa were more commonly observed with both the monopolar and bipolar prostheses than with the anatomic or native radial heads. CONCLUSIONS The geometry of radial head implants strongly influences their contact characteristics. In a direct radius-to-capitellum axial loading experiment, an anatomically designed radial head prosthesis had lower and more evenly distributed contact pressures than the nonanatomic implants that were tested.
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Affiliation(s)
- Dipit Sahu
- Department of Orthopaedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - David M Holmes
- Department of Orthopaedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - James S Fitzsimmons
- Department of Orthopaedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Andrew R Thoreson
- Department of Orthopaedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Lawrence J Berglund
- Department of Orthopaedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Kai-Nan An
- Department of Orthopaedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Shawn W O'Driscoll
- Department of Orthopaedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA.
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Abstract
Radial head arthroplasty is the treatment of choice for non-reconstructble radial head fractures. Solid prostheses made of metal or pyocarbon can restore valgus stability of the elbow independent of design or stem fixation. Short-term and mid-term results show mostly good to excellent results without any evident differences between the different prosthesis philosophies. In order to obtain good results it is important to implant the prosthesis correctly without overfilling and to judge concomitant ligament injuries correctly. This article discusses the anatomical and biomechanical basis of radial head arthroplasty as well as the surgical technique and radiological diagnosis of overfilling.
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Abstract
OBJECTIVES The integrity of elbow soft tissues affects radiocapitellar joint stability in the presence of bipolar radial head (RH) prostheses. This study examined the effect on radiocapitellar stability of monopolar designs versus bipolar RH prostheses in an elbow model with a surgically controlled terrible triad injury. METHODS In each of 8 fresh-frozen elbow specimens (4 male and 4 female), a terrible triad fracture dislocation was created through soft tissue releases, coronoid fracture, and RH resection. Radiocapitellar stability was recorded under the following 3 sets of conditions: (1) surgical control (native RH), (2) RH replacement (circular monopolar or bipolar), (3) replacement with alternate circular RH not used in condition 2, and (4) replacement with the anatomic RH. RESULTS The type of RH used significantly impacted the mean peak force required to resist posterior subluxation (p = 0.0001). The mean peak subluxation force of the bipolar prosthesis (1 ± 1 N) was significantly less than both the anatomic (16 ± 1 N) and nonanatomic circular (12 ± 1 N) implants (p = 0.0002). The peak subluxation force of the native RH (18 ± 2 N) was not different than the anatomic implant (p = 0.09) but was greater than the nonanatomic circular design (p = 0.0006). CONCLUSIONS Monopolar RHs confer greater radiocapitellar stability than bipolar implants in the setting of terrible triad injuries. Of the 2 monopolar designs tested, the anatomic design provided more stability than the non-anatomic RH prosthesis.
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Shukla DR, Fitzsimmons JS, An KN, O'Driscoll SW. Effect of radial head malunion on radiocapitellar stability. J Shoulder Elbow Surg 2012; 21:789-94. [PMID: 22521392 DOI: 10.1016/j.jse.2011.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 12/09/2011] [Accepted: 12/19/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND Management for Mason type II radial head fractures is controversial. We hypothesized that angulation or depression of a marginal radial head fragment would affect radiocapitellar stability similarly to fragment excision. MATERIALS AND METHODS A Mason type II radial head fracture was created in 6 cadaveric elbows by excising a segment from the anterolateral quadrant that was 30% of the diameter of the articular surface. Radiocapitellar stability was recorded under 5 sets of conditions: (1) intact radial head (intact), (2) 30% surface area fragment resected (partially excised), (3) anatomic fragment fixation with screws (fixed), (4) fragment fixation with 2 mm of depression relative to the articular surface (depressed), and (5) fragment fixation after a 30° wedge resection (angulated). RESULTS The forces required to subluxate the joint were greatly reduced after fragment excision (5 ± 1 N; P = .0001) and restored to normal (21 ± 1 N; P = .9) after anatomic fixation of the excised fragment. The peak forces were significantly reduced with fragment depression (4 ± 1 N) and angulation (4 ± 2 N; P = .0001). CONCLUSION A radial head fracture that is depressed 2 mm or angulated 30° may cause up to an 80% loss of concavity-compression stability of the radiocapitellar joint.
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Affiliation(s)
- Dave R Shukla
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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