1
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Heifner JJ, Lacau GE, Forro SD, Davis TA, Mercer DM, Rubio F. The impact of anatomic alignment on radiocapitellar pressure following radial head arthroplasty. J Shoulder Elbow Surg 2024:S1058-2746(24)00244-1. [PMID: 38609004 DOI: 10.1016/j.jse.2024.02.042] [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: 08/22/2023] [Revised: 02/19/2024] [Accepted: 02/24/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND The incidence of radial head fractures is increasing, and radial head arthroplasty (RHA) is being more frequently used as treatment for irreparable fractures. Our objective was to compare radiocapitellar pressure between the native joint and 2 radial head prosthesis conditions: (1) a prosthetic head that was aligned to the forearm axis of rotation and (2) the same prosthesis with an axisymmetric nonaligned head. METHODS Ten cadaveric specimens received a pressfit radial head prosthesis (Align; Skeletal Dynamics) for both prosthetic testing conditions. Anatomic alignment (AL) was defined as the prosthetic head aligned to the forearm axis of rotation. Axisymmetric alignment (AX) was defined as the prosthetic radial head aligned to the axis of the prosthetic stem. Axial load was applied with the elbow in extension and the forearm pronated. Data were collected using a Tekscan 4000 sensor. RESULTS The mean pressure in the AL and AX groups were significantly higher than the mean pressure in the native joint. Compared with the native joint, the mean pressure was 19% higher in the AL group and 56% higher in the AX group. Peak pressure beyond 5 MPa occurred in 0 specimens in the native joint group, in 1 specimen (10%) in the AL group, and in 5 specimens (50%) in the AX group. DISCUSSION Our results demonstrated that a pressfit radial head prosthesis aligned with the forearm axis of rotation yields capitellar pressures that were more similar to the native condition than a nonaligned pressfit prosthesis. These findings suggest that anatomic alignment may optimize capitellar wear properties, improving the long-term durability of radial head arthroplasty.
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Affiliation(s)
| | | | - Stephen D Forro
- Department of Orthopedic Surgery, Larkin Hospital, Miami, FL, USA
| | - Ty A Davis
- Department of Orthopedic Surgery, Larkin Hospital, Miami, FL, USA
| | - Deana M Mercer
- Department of Orthopaedics, University of New Mexico, Albuquerque, NM, USA
| | - Francisco Rubio
- Department of Orthopedic Surgery, Larkin Hospital, Miami, FL, USA
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2
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Luenam S, Kosiyatrakul A, Charoenlap C, Puncreobutr C, Lohwongwatana B. Radial head replacement with the 3D-printed patient-specific titanium prosthesis: Preliminary results of a multi-centric prospective study. J Orthop Surg (Hong Kong) 2024; 32:10225536241236806. [PMID: 38430070 DOI: 10.1177/10225536241236806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2024] Open
Abstract
PURPOSE To report preliminary clinical results and safety of 3D-printed patient-specific titanium radial head (RH) prosthesis in treatment of the irreparable RH fractures. MATERIAL AND METHODS This multi-centric prospective study included 10 patients (6 men and four women, mean age 41 years (range, 25-64 years)). Three cases were classified as Mason type III and 7 cases as type IV. Patients were assessed preoperatively, intraoperatively, and at 1, 6, 12, 24, 36, and 48 weeks postoperatively. Range of motion (ROM), visual analog scale (VAS) score, Disabilities of the Arm, Shoulder and Hand (DASH) score, Mayo Elbow Performance Score (MEPS), radiology imaging, and laboratory blood and urine testing were evaluated. RESULTS The prostheses were implanted utilizing cemented stems in 5 patients and cementless stems in 5 patients. Intraoperatively, well congruency of a prosthesis with capitellum and radial notch of ulna was observed in all cases. All patients had improvement of ROM, VAS score, DASH score, and MEPS during the postoperative follow-ups. At the final follow-up, mean elbow extension was 6.5° (range, 0°-30°), flexion 145° (range, 125°-150°), supination 79° (range, 70°-80°), and pronation 73.5° (range, 45°-80°). Mean VAS score was 0.3 (range, 0-3), DASH score was 12.35 (range, 1.7-23.3), and MEPS was 99.5 (range, 95-100). Postoperative radiographs demonstrated heterotopic ossification in 2 cases, periprosthetic radiolucency in 2 cases, and proximal radial neck resorption in 2 cases. No one had the evidence of capitellar erosion, implant failure, malpositioning, overstuffing, or symptomatic stem loosening. There was no significant alteration of laboratory results or adverse events related to the 3D-printed prosthesis implantation. CONCLUSION The preliminary results demonstrated that implantation of the 3D-printed patient-specific titanium RH prosthesis is safe and may be a potential treatment option for irreparable RH fracture.
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Affiliation(s)
- Suriya Luenam
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Arkaphat Kosiyatrakul
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Chris Charoenlap
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Chedtha Puncreobutr
- Department of Metallurgical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Boonrat Lohwongwatana
- Department of Metallurgical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
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3
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Elfar J, Caldwell M, Mason R, Schaffer J, Koroneos Z, Maqsoodi N, Osman WS, Olles M. Ulnohumeral joint static cartilage compression is affected by radial head implant size. Clin Biomech (Bristol, Avon) 2023; 109:105290. [PMID: 33610388 DOI: 10.1016/j.clinbiomech.2021.105290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Radiocapitellar joint arthroplasty is a commonly performed procedure, which often leads to early failure or instability. Few studies assess the effect of radiocapitellar joint arthroplasty on the ulnohumeral joint. We hypothesized that static forces of contact (compressing cartilage, or cartilage relaxation contact force) would reveal the effect of varying radial head implant size and elbow position on the ulnohumeral joint. METHODS A minimally-invasive method of measuring cartilage relaxation contact force was utilized in 10 fresh-frozen human cadaveric specimens that did not require significant dissection or intraarticular sensor placement. Specimens were rigidly fixed in various positions of elbow flexion and forearm pronosupination with increasing radial head implant lengths. Uniaxial distracting forces were applied and displacement was repeatedly measured with resultant best-fit polynomial curves to determine inflections corresponding to the force required to overcome static cartilage relaxation as in previous work. FINDINGS Baseline mean (intra-cadaver) cartilage relaxation contact force was 11.8 N (standard error of the mean = 0.3) at 90° of elbow flexion and neutral rotation. There was little variation within specimens (Intraclass correlation coefficient > 0.94). Cartilage relaxation contact force increased at the ulnohumeral joint with radial head implant overstuffing (> 4 mm, P < 0.05) and elbow flexion (120°, P < 0.001). Pronosupination altered cartilage relaxation contact force in an implant-length independent manner (P < 0.05). INTERPRETATION Radiocapitellar joint arthroplasty implant length and elbow joint position independently contribute to increased cartilage relaxation contact force at the ulnohumeral joint. This further supports attempts at anatomic reconstruction of the radiocapitellar joint to prevent pathologic ulnohumeral joint loading.
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Affiliation(s)
- John Elfar
- The Pennsylvania State University, Center for Orthopaedic Research and Translational Science, 500 University Drive, H089 Hershey, PA 17033, USA.
| | - Michael Caldwell
- Rochester Institute of Technology, Mechanical & Manufacturing Technology, 78 Lomb Memorial Drive, Rochester, NY 14623, USA
| | - Robert Mason
- Tidewater Orthopaedics, 901 Enterprise Pkwy 900, Hampton, VA 23666, USA.
| | - Joseph Schaffer
- Hughston Clinic Orthopaedics at TriStar Centennial Medical Center, 2400 Patterson Street, Suite 300, Nashville, TN 37203, USA.
| | - Zachary Koroneos
- The Pennsylvania State University, Center for Orthopaedic Research and Translational Science, 500 University Drive, H089 Hershey, PA 17033, USA.
| | - Noorullah Maqsoodi
- Rochester Institute of Technology, Mechanical & Manufacturing Technology, 78 Lomb Memorial Drive, Rochester, NY 14623, USA.
| | - Walid S Osman
- Helwan University, Orthopaedic Surgery Department, 8 st. 3 Zahraa Helwan, Cairo 11733, Egypt.
| | - Mark Olles
- Rochester Institute of Technology, Mechanical & Manufacturing Technology, 78 Lomb Memorial Drive, Rochester, NY 14623, USA.
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4
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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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5
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Corbaz J, Barimani B, Vauclair F. Early aseptic loosening of a press-fit radial head prosthesis - A case series of 6 patients. J Int Med Res 2023; 51:3000605221135881. [PMID: 37082909 PMCID: PMC10126620 DOI: 10.1177/03000605221135881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVE Radial head arthroplasty (RHA) is the principal treatment option for comminuted radial head (RH) fractures. Here, we present six cases of failed RHA using a modular monopolar press-fit RHA that was subsequently withdrawn from the market because it was associated with a high incidence of loosening. METHODS We retrospectively collected data from six patients who had received Radial Head Prothesis SystemTM at our centre between July 2015 and June 2016. The average follow-up was 40 months. RESULTS Aseptic loosening of the stem affected five (83%) of the six RHA. Four of these were symptomatic and RHA removal was performed. For these patients, the pain subsided and their elbow range of motion (ROM) improved. CONCLUSION While the ideal design for an RHA is still debatable, RHA is an efficient treatment option that restores elbow stability and function after a comminuted RH fracture. Importantly, removal of the prosthesis is an effective remedy following RHA associated elbow pain and decreased ROM.
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Affiliation(s)
- J Corbaz
- Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland
| | - B Barimani
- Department of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada
| | - F Vauclair
- Bone and Motion Center - Hirslanden, 1006 Lausanne, Switzerland
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6
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Sun W, Jiang X, Zha Y, Gong M, Li T, Hua K, Xiao D, Lu S. Relationship between measurements of ipsilateral capitellum and prosthetic radial head size. J Orthop Surg Res 2022; 17:496. [DOI: 10.1186/s13018-022-03393-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/06/2022] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background
Selecting the correct size of head component is challenging in radial head arthroplasty, particularly in comminuted fractures. This study aimed to investigate the relationship between measurements of the ipsilateral capitellum and the prosthetic radial head size, which may be used to predict the size of the radial head prosthesis preoperatively.
Methods
Our study enrolled all patients who underwent radial head arthroplasty at Beijing Jishuitan Hospital. Demographic, injury-related and radiographic data were collected. The prosthetic radial head size was recorded from the surgical notes. Three-dimensional models of preoperative CT scans were reconstructed, on which the lateral capitellar diameter, the capitellar width and the width between the capitellum and trochlea were measured. The correlations between measurements of the ipsilateral capitellum and the prosthetic radial head size were evaluated, and linear regression equations were established.
Results
The study enrolled 37 patients, with an average age of 42.8 ± 11.5 years and a male–female ratio of 20:17. The median diameter of the radial head prostheses was 22 (20, 22) mm. The average lateral capitellar diameter was 20.71 ± 1.93 mm, the mean capitellar width was 14.90 ± 1.40 mm, and the mean width between the capitellum and trochlea was 19.29 ± 1.78 mm. The lateral capitellar diameter (R = 0.820, P < 0.001), the capitellar width (R = 0.726, P < 0.001) and the width between the capitellum and trochlea (R = 0.626, P < 0.001) were significantly positively correlated with the size of the radial head prosthesis. The linear regression equation between the lateral capitellar diameter and the size of the radial head prosthesis was calculated and defined as follows: D = 7.44 + 0.67*d (D: diameter of radial head prosthesis; d: lateral capitellar diameter; and adjusted R2 = 0.719, P < 0.001).
Conclusions
There are positive correlations between the anatomical parameters of the ipsilateral capitellum and the prosthetic radial head size. The lateral capitellar diameter can be measured on three-dimensional CT preoperatively to predict the size of the radial head prosthesis intraoperatively.
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7
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Ramazanian T, Müller-Lebschi JA, Merlet MCH, Lee H, Vaichinger AM, Fitzsimmons JS, O'Driscoll SW. Effect of Radiocapitellar Joint Over/Under Stuffing on Elbow Joint Contact Pressure. J Hand Surg Am 2022; 48:403.e1-403.e9. [PMID: 36229309 DOI: 10.1016/j.jhsa.2021.11.006] [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: 03/01/2019] [Revised: 10/08/2021] [Accepted: 11/17/2021] [Indexed: 11/05/2022]
Abstract
PURPOSE Comminuted radial head fractures are commonly treated by surgical resection or replacement with a prosthesis. A potential problem with radial head replacement is overlengthening of the radial neck ("overstuffing" of the radial head), which has been shown to affect both ulnohumeral kinematics and radiocapitellar pressures. We hypothesized that an overstuffed radial head prosthesis increases capitellar pressure and reduces coronoid pressure. METHODS Seven human cadaveric elbows were prepared on a custom-designed apparatus simulating stabilizing muscle loads, and passively flexed from 0° to 90° under gravity valgus torque while joint contact pressures were measured. Each elbow was tested sequentially with different neck lengths, starting with the intact specimen followed by insertion of understuffed (-2 mm), standard-height (0 mm), and overstuffed (+2 mm) radial head prostheses in neutral forearm rotation, 40° pronation, and 40° supination positions, respectively. RESULTS Capitellar mean contact pressures significantly increased after insertion of an overstuffed radial head prosthesis. In valgus position with neutral forearm rotation, capitellar mean contact pressure on the joint with an intact radial head averaged 227 ± 70 kPa. Insertion of understuffed, standard-height, and overstuffed radial head prostheses changed the mean contact pressures to 152 ± 76 kPa, 212 ± 68 kPa, and 491 ± 168 kPa, respectively. The overstuffed radial head group had significantly lower whole coronoid mean contact pressures (153 ± 56 kPa) compared with the intact (390 ± 138 kPa) and standard-height (376 ± 191 kPa) radial head groups. CONCLUSIONS An increase in radial prosthesis height significantly increases capitellar contact pressures and reduces coronoid contact pressures. CLINICAL RELEVANCE Restoration of the anatomic radial head height is critical when performing radial head arthroplasty to maintain normal joint biomechanics. Elevated capitellar contact pressures can potentially lead to pain and early degenerative changes.
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Affiliation(s)
- Taghi Ramazanian
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | | | - HoMin Lee
- Department of Orthopedics, College of Medicine, Dongguk University, Gyeongju, Republic of Korea
| | - Anthony M Vaichinger
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - James S Fitzsimmons
- 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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8
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Smithson K, Smith J, Hogue W, Mannen E, Ahmadi S. Biomechanics of axial load transmission across the native human elbow. Shoulder Elbow 2021; 13:671-676. [PMID: 34804216 PMCID: PMC8600677 DOI: 10.1177/1758573220961025] [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: 03/17/2020] [Revised: 08/30/2020] [Accepted: 09/01/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Elbow and forearm motion are thought to affect elbow load transmission, yet little empirical evidence exists to quantify the biomechanics. METHODS Eight fresh-frozen human cadaver upper extremities were utilized. A 100 N axial force was applied across the elbow joint at elbow flexion angles of (0°, 30°, 60°, and 90°) and forearm rotation angles (0°, 45° supination, and 45° pronation). Pressure mapping sensors were placed in both the radiocapitellar and ulnotrochlear joints. Force distributions and contact areas were measured, and paired t-tests were used for comparison (p < 0.05). RESULTS The average maximum loading percentage of the radiocapitellar and ulnotrochlear joint pressures were 57.8 ± 4.6% and 42.2 ± 4.6%, respectively. Elbow flexion angle and forearm rotation did not significantly affect the joint loading. There was no significant difference between the contact areas of each joint, although ulnotrochlear and radiocapitellar joints demonstrated an inverse relationship. CONCLUSION Our study is the only one to date to comprehensively evaluate loading mechanics throughout both functional elbow flexion and forearm rotation across both articulations. The load sharing ratio across the radiocapitellar and ulnotrochlear joints was 58%:42%, agreeing with previously reported ratios with limited parameters. A relationship may be present between increasing radiocapitellar and decreasing ulnotrochlear contact areas as elbow flexion increases.
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Affiliation(s)
| | | | | | | | - Shahryar Ahmadi
- Shahryar Ahmadi, Department of Orthopaedic Surgery,
University of Arkansas for Medical Sciences, 4301 West Markham St., #531, Little Rock, AR
72205, USA.
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9
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Jo YH, Lee BG, Lee CH, Lee KH, Kim DH, Kim DS, Kim SJ. Radiocapitellar joint pressures following transradial amputation increase during elbow motion. Sci Rep 2021; 11:13897. [PMID: 34230504 PMCID: PMC8260786 DOI: 10.1038/s41598-021-92743-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 06/03/2021] [Indexed: 11/17/2022] Open
Abstract
This study aimed to compare the contact area, mean pressure, and peak pressure of the radiocapitellar joint (RCJ) in the upper limb after transradial amputation with those of the normal upper limb during elbow flexion and forearm rotation. Testing was performed using ten fresh-frozen upper limbs, and the transradial amputation was performed 5 cm proximal to the radial styloid process. The specimens were connected to a custom-designed apparatus for testing. A pressure sensor was inserted into the RCJ. The biomechanical indices of the RCJ were measured during elbow flexion and forearm rotation in all specimens. There was no significant difference in the contact area between the normal and transradial amputated upper limbs. However, in the upper limbs after transradial amputation, the mean pressure was higher than that in the normal upper limbs at all positions of elbow flexion and forearm rotation. The peak pressure was significantly higher in the upper limbs after transradial amputation than in the normal upper limbs, and was especially increased during pronation at 45° of elbow flexion. In conclusion, these results could cause cartilage erosion in the RCJ of transradial amputees. Thus, methods to reduce the pressure of the RCJ should be considered when a myoelectric prosthesis is developed.
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Affiliation(s)
- Young-Hoon Jo
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, South Korea
| | - Bong-Gun Lee
- Department of Orthopedic Surgery, Hanyang University Seoul Hospital, Seoul, South Korea
| | - Chang-Hun Lee
- Department of Orthopedic Surgery, Hanyang University Seoul Hospital, Seoul, South Korea
| | - Kwang-Hyun Lee
- Department of Orthopedic Surgery, Hanyang University Seoul Hospital, Seoul, South Korea
| | - Dong-Hong Kim
- Department of Orthopedic Surgery, Hanyang University Seoul Hospital, Seoul, South Korea
| | - Doo-Sup Kim
- Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Wonju, South Korea.
| | - Sung Jae Kim
- Department of Orthopaedic Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea.
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10
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Laumonerie P, Raad M, Tibbo ME, Kerezoudis P, Bonnevialle N, Mansat P. Midterm outcomes of 146 EVOLVE Proline modular radial head prostheses: a systematic review. Shoulder Elbow 2021; 13:205-212. [PMID: 33897852 PMCID: PMC8039765 DOI: 10.1177/1758573219850111] [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] [Received: 01/24/2019] [Revised: 03/13/2019] [Accepted: 04/22/2019] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The EVOLVE implant (Wright Medical Technology, Arlington, TN, USA) is a modular loose-fitting radial head prosthesis. The primary objective was to synthesize all available literature investigating the midterm clinical outcomes of the EVOLVE implant. MATERIALS AND METHODS An electronic literature search in Pubmed/Medline, Scopus, EMBASE, and Cochrane library was performed querying for studies published in 2000-2017. Articles describing clinical and radiographical outcomes as well as reoperation were included. Outcomes of interest included range of motion, Mayo Elbow Performance Score, Disabilities of the Arm Shoulder and Hand, radiographic outcome, and reason for reoperation. RESULTS A total of five articles consisting of 146 patients with EVOLVE implants were included. Mean patient age was 57.4 years (range 22-84), and 43.8% were males (n = 64). Mean follow-up was 4.8 years (range 1-14). Mean Mayo Elbow Performance Score and Disabilities of the Arm Shoulder and Hand score were 87.6 (range 30-100) and 18.9 (range 0-82), respectively. Midterm clinical results were good or excellent (Mayo Elbow Performance Score > 74) in 94 patients. Reoperation was observed in 12 patients, with implant revision required in 2 patients. The primary reason for reoperation was persistent stiffness (n = 9). CONCLUSION Midterm outcomes of EVOLVE radial head prosthesis are satisfactory, and associated complication rates are low. Loose-fit implant method appears to be a reliable approach to avoid failure of radial head prosthesis by painful loosening.
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Affiliation(s)
- Pierre Laumonerie
- Department of Orthopedic Surgery,
Institut Locomoteur, Hôpital Pierre-Paul Riquet, Toulouse, France,Pierre Laumonerie, Department of Orthopedic
Surgery, Institut Locomoteur, Hôpital Pierre-Paul Riquet, Place du Docteur
Baylac, Toulouse, 31059, France
| | - Maroun Raad
- Department of Orthopedic Surgery,
Institut Locomoteur, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Meagan E Tibbo
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA
| | | | - Nicolas Bonnevialle
- Department of Orthopedic Surgery,
Institut Locomoteur, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Pierre Mansat
- Department of Orthopedic Surgery,
Institut Locomoteur, Hôpital Pierre-Paul Riquet, Toulouse, France
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11
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Berkmortel C, Langohr GDG, King G, Johnson J. Hemiarthroplasty implants should have very low stiffness to optimize cartilage contact stress. J Orthop Res 2020; 38:1719-1726. [PMID: 32017162 DOI: 10.1002/jor.24610] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/15/2019] [Accepted: 01/21/2020] [Indexed: 02/04/2023]
Abstract
Hemiarthroplasty is often preferred to total arthroplasty as it preserves native tissue; however, accelerated wear of the opposing cartilage is problematic. This is thought to be caused by the stiffness mismatch between the implant and cartilage-bone construct. Reducing the stiffness of the implant by changing the material has been hypothesized as a potential solution. This study employs a finite element model to study a concave-convex hemiarthroplasty articulation for various implant materials (cobalt-chrome, pyrolytic carbon, polyether ether ketone, ultra-high-molecular-weight polyethylene, Bionate-55D, Bionate-75D, and Bionate-80A). The effect of the radius of curvature and the degree of flexion-extension was also investigated to ensure any relationships found between materials were generalizable. The implant material had a significant effect (P < .001) for both contact area and maximum contact pressure on the cartilage surface. All of the materials were different from the native state except for Bionate-80A at two of the different flexion angles. Bionate-80A and Bionate-75D, the materials with the lowest stiffnesses, were the closest to the native state for all flexion angles and radii of curvature. No evident difference between materials occurred unless the modulus was below that of Bionate-55D (288 MPa), suggesting that hemiarthroplasty materials need to be less stiff than this material if they are to protect the opposing cartilage. This is clinically significant as the findings suggest that the development of new hemiarthroplasty implants should use materials with stiffnesses much lower than currently available devices.
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Affiliation(s)
- Carolyn Berkmortel
- Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada
| | - G Daniel G Langohr
- Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada.,Bioengineering Laboratory, Roth McFarlane Hand and Upper Limb Centre, Lawson Health Research Institute, St Joseph's Health Care, Western University, Bone and Joint Institute, London, Ontario, Canada.,Department of Surgery, Western University, London, Ontario, Canada
| | - Graham King
- Bioengineering Laboratory, Roth McFarlane Hand and Upper Limb Centre, Lawson Health Research Institute, St Joseph's Health Care, Western University, Bone and Joint Institute, London, Ontario, Canada.,Department of Surgery, Western University, London, Ontario, Canada
| | - James Johnson
- Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada.,Bioengineering Laboratory, Roth McFarlane Hand and Upper Limb Centre, Lawson Health Research Institute, St Joseph's Health Care, Western University, Bone and Joint Institute, London, Ontario, Canada.,Department of Surgery, Western University, London, Ontario, Canada
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Luenam S, Vongvanichvathana A, Kosiyatrakul A, Kongphanich C, Chanpoo M, Koonchornboon T, Phakdeewisetkul K, Lohwongwatana B, Puncreobutr C. Matching precision of the reverse contralateral radial head in generating of the individualized prosthesis from the surface registration in tuberosity-neck and in tuberosity-diaphysis. J Orthop Surg (Hong Kong) 2020; 27:2309499018821774. [PMID: 30798711 DOI: 10.1177/2309499018821774] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Following the radial head replacement, the surface mismatches between the implants and the morphological characteristics of the original proximal radius decreased contact areas and increased contact forces which is potential for the long-term articulating cartilage wear. Several studies demonstrated that the individualized prosthesis, created from computed tomographic (CT) images of the contralateral side with the reverse engineering technology, may reduce the mismatch. The aim of this study is to demonstrate the matching precision of the reverse contralateral head between the surface registration in tuberosity-neck (TN) area and in tuberosity-diaphysis (TD) area. MATERIALS AND METHODS High-resolution CT scan of 11 pairs of the cadaveric arms was performed. Utilizing advanced image processing techniques, three-dimensional (3-D) models of each specimen was generated. The model of the left side was reversed and matched with the model of the right side in the same cadaver by registering in the area of radial neck along with tuberosity (TN) and in the area of radial tuberosity combined with 2 cm of proximal diaphysis (TD). The alteration of the head diameter, dish diameter, articular depth, head thickness, end-plane angle, offset, and head volume were evaluated and analyzed by paired t-test. RESULTS No statistically significant difference was found in all parameters from both TN and TD registrations ( p < 0.05). CONCLUSION The surface registration in either TN or TD area can generate the statistically symmetrical 3-D model with the original head. The registration in these areas may possibly be used in creating the individualized radial head prosthesis.
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Affiliation(s)
- Suriya Luenam
- 1 Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Adigun Vongvanichvathana
- 1 Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Arkaphat Kosiyatrakul
- 1 Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Chutcharn Kongphanich
- 2 Department of Radiology, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Malee Chanpoo
- 3 Department of Anatomy, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Tunyarut Koonchornboon
- 3 Department of Anatomy, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Kantapat Phakdeewisetkul
- 4 Department of Metallurgical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Boonrat Lohwongwatana
- 4 Department of Metallurgical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Chedtha Puncreobutr
- 4 Department of Metallurgical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
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13
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Hemmingsen CK, Thillemann TM, Elmengaard B, de Raedt S, Nielsen ET, Mosegaard SB, Stentz-Olesen K, Stilling M. Elbow Biomechanics, Radiocapitellar Joint Pressure, and Interosseous Membrane Strain Before and After Radial Head Arthroplasty. J Orthop Res 2020; 38:510-522. [PMID: 31595550 DOI: 10.1002/jor.24488] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 09/17/2019] [Indexed: 02/04/2023]
Abstract
Complex radial head fracture and elbow instability can be treated with radial head arthroplasty. Good clinical results have been described after this surgical treatment. However, the revision and complication rate reported in the literature is concerning. This might be due to altered kinematics after radial head arthroplasty. Eight human native elbows were examined with dynamic radiostereometric analysis and compared with a radial head arthroplasty. Translations of the radial head in the x-, y-, and z-directions relative to the humerus and the ulna were measured. The radiocapitellar joint pressure was measured using a pressure sensor. The tension within the interosseous membrane was measured using a custom-made strain gauge. After radial head arthroplasty, the radial head was displaced approximately 1.8 mm medially and 1.4 mm distally at the starting point. During unloaded flexion motion the difference in all translations between the native radial head and the radial head arthroplasty was less than 1 mm (95% confidence interval [CI] ± 0.5 mm) (p = 0.001). With loading the difference was less than 1.5 mm (95% CI ± 1.5 mm) (p = 0.001). The mean difference in radiocapitellar joint contact pressure was less than 0.30 MPa (95% CI ± 0.40 MPa) (p = 0.001) during unloaded flexion motion. There were only submillimetre kinematic changes and small changes in joint pressure and interosseous membrane tension after the insertion of a radial head arthroplasty in an experimental setting. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:510-522, 2020.
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Affiliation(s)
- Chalotte K Hemmingsen
- Department of Clinical Medicine, Aarhus University, Groennehaven 25, 8520 Lystrup, Aarhus, Denmark.,Orthopedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Theis M Thillemann
- Department of Orthopedic Surgery, Shoulder and Elbow Section, Aarhus University Hospital, Aarhus, Denmark
| | - Brian Elmengaard
- Department of Orthopedic Surgery, Shoulder and Elbow Section, Aarhus University Hospital, Aarhus, Denmark
| | | | - Emil T Nielsen
- Department of Clinical Medicine, Aarhus University, Groennehaven 25, 8520 Lystrup, Aarhus, Denmark.,Orthopedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopedic Surgery, Hand Section, Aarhus University Hospital, Aarhus, Denmark
| | - Sebastian B Mosegaard
- Department of Clinical Medicine, Aarhus University, Groennehaven 25, 8520 Lystrup, Aarhus, Denmark.,Department of Orthopedic Surgery, Hand Section, Aarhus University Hospital, Aarhus, Denmark
| | | | - Maiken Stilling
- Department of Clinical Medicine, Aarhus University, Groennehaven 25, 8520 Lystrup, Aarhus, Denmark.,Orthopedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopedic Surgery, Hand Section, Aarhus University Hospital, Aarhus, Denmark
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14
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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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15
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Moungondo FGP, Andrzejewski A, van Riet RRP, Feipel V, Rooze M, Schuind FA. Joint contact areas after radial head arthroplasty: a comparative study of 3 prostheses. J Shoulder Elbow Surg 2019; 28:1546-1553. [PMID: 31029518 DOI: 10.1016/j.jse.2019.01.023] [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: 08/17/2018] [Revised: 01/17/2019] [Accepted: 01/21/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Contact stresses of radial head prostheses remain a concern, potentially leading to early capitellar cartilage wear and erosion. In particular, point contact or edge loading could have a detrimental effect. The purpose of this study was to compare 3 different types of radial head prostheses in terms of joint contact areas with each other and with the native situation. The hypothesis was that the joint contact areas would be lower after monopolar arthroplasty. METHODS Seven fresh-frozen cadaveric upper limbs were used. Radiocapitellar contact areas of a monopolar design, a straight-neck bipolar design, and an angled-neck bipolar design were compared with each other and with the native joint. After standardized preparation, polysiloxane was injected into the loaded radiocapitellar joint to create a cast from which the joint contact area was measured. Measurements were performed at 3 angles of elbow flexion and in 3 different forearm positions. RESULTS In the native elbow, contact areas were highest in supination. Elbow flexion had no significant effect on native and prosthetic joint contact areas. Contact areas were decreased for all types of arthroplasties compared with the native joint (from 11% to 53%). No significant contact area difference was found between the 3 designs. However, bipolar prostheses showed lateral subluxation in neutral forearm rotation, resulting in a significant decrease in the contact areas from pronation to the neutral position. CONCLUSIONS All types of radial head prostheses tested showed a significant decrease in radiocapitellar contact area compared with the native joint. Bipolar designs led to subluxation of the radial head, further decreasing radiocapitellar contact.
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Affiliation(s)
- Fabian G P Moungondo
- Department of Orthopaedics and Traumatology, Université Libre de Bruxelles, Erasme University Hospital, Brussels, Belgium; Université Libre de Bruxelles, Brussels, Belgium.
| | - Aurélie Andrzejewski
- Department of Orthopaedics and Traumatology, Université Libre de Bruxelles, Erasme University Hospital, Brussels, Belgium; Université Libre de Bruxelles, Brussels, Belgium
| | | | - Véronique Feipel
- Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Anatomy, Biomechanics and Organogenesis, Université Libre de Bruxelles, Brussels, Belgium
| | - Marcel Rooze
- Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Anatomy, Biomechanics and Organogenesis, Université Libre de Bruxelles, Brussels, Belgium
| | - Frédéric A Schuind
- Department of Orthopaedics and Traumatology, Université Libre de Bruxelles, Erasme University Hospital, Brussels, Belgium; Université Libre de Bruxelles, Brussels, Belgium
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16
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Sun Y, Hong H, Adikrishna A, Kim YJ, Jeon IH. Contact Mechanics of Anatomic Radial Head Prosthesis: Comparison Between Native Radial Head and Anatomic Radial Head Prostheses in the Dynamic Mode. J Hand Surg Am 2019; 44:517.e1-517.e7. [PMID: 30292716 DOI: 10.1016/j.jhsa.2018.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 06/26/2018] [Accepted: 08/08/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The biomechanical characteristics of anatomic radial head prostheses have not been completely investigated. We compared and analyzed the contact kinematic characteristics of the native radial head and radial head prostheses replicating the native head contour, using a real-time flexion simulation model. METHODS Ten fresh-frozen cadavers were used in this pilot study. A simulating dynamic motion mode from 0° to 130° of elbow flexion was applied. Radiocapitellar contact pressure and area were measured using a real-time digitized pressure sensor. Further, contact area and pressure curves were obtained during flexion, using a motion-tracking device. RESULTS The mean contact area, mean contact pressure, and peak contact pressure of the native radial head and radial head prosthesis were 39 mm2, 0.0078 kgf/mm2, 0.0123 kgf/mm2, and 33 mm2, 0.0093 kgf/dm2, 0.0148 kgf/mm2, respectively. The contact area and pressure curves were parabolic nonlinear for the radial head prosthesis and more linear for the native radial head. CONCLUSIONS The radial head prosthesis mimics the mechanics of the native radial head in terms of mean contact area, mean contact pressure, and peak contact pressure; however, different patterns of contact pressure and area curves during elbow flexion-extension were observed. CLINICAL RELEVANCE We found that the biomechanics of the anatomic radial head prostheses used in the study were similar to those of the native radial head.
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Affiliation(s)
- Yucheng Sun
- Department of Orthopedic Surgery, ASAN Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Hanpyo Hong
- Department of Orthopedic Surgery, ASAN Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Arnold Adikrishna
- Department of Orthopedic Surgery, ASAN Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Yoon-Jeong Kim
- Department of Orthopedic Surgery, ASAN Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, ASAN Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
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17
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Sun Y, Adikrishna A, Hong H, Tan J, Jeon IH. Comparison of the biomechanics of radial head prostheses with dynamic loading in the radiocapitellar joint. J Hand Surg Eur Vol 2019; 44:408-413. [PMID: 30744462 DOI: 10.1177/1753193419825526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We used eight fresh cadaveric elbows to evaluate the biomechanical characteristics of the native radial head, an anatomic radial head prosthesis, and a non-anatomic radial head prosthesis using a dynamic model. The biceps, brachialis, and triceps were attached to pneumatic actuators loaded to mimic muscle force. The radiocapitellar contact pressure and area were measured in real time, and the associated curves were depicted simultaneously. No significant differences in the contact area or associated curves were found between native radial head and the anatomic radial head prosthesis. The contact pressure and associated curve for the anatomic radial head prosthesis were better than those for the non-anatomic radial head prosthesis. We conclude from this study that the contact pressure and area of the elbow with anatomic radial head prosthesis are similar to those of the native radial head. The anatomic radial head prosthesis appears to be more suitable in clinical use.
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Affiliation(s)
- Yucheng Sun
- 1 Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.,2 Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Arnold Adikrishna
- 1 Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Hanpyo Hong
- 1 Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Jun Tan
- 2 Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - In-Ho Jeon
- 1 Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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18
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Hwang JT, Kim Y, Shields MN, Bachman DR, Berglund LJ, Fitzsimmons AT, Fitzsimmons JS, O'Driscoll SW. Effects of axial forearm instability on force transmission across the elbow. J Shoulder Elbow Surg 2019; 28:170-177. [PMID: 30337267 DOI: 10.1016/j.jse.2018.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 06/29/2018] [Accepted: 07/13/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The interosseous membrane (IOM) and distal radioulnar joint (DRUJ) provide axial stability to the forearm. Our hypothesis was that injury to these structures alters force transmission through the elbow. METHODS A custom-designed apparatus that applies axial loads from the wrist to the elbow was used to test 10 cadaveric upper limbs under the following simulated conditions (1) intact, (2) DRUJ injury, (3) IOM injury, or (4) IOM + DRUJ injury. IOM injury was simulated by osteotomies of the IOM attachment to the radius, and DRUJ injury was simulated by distal ulnar oblique osteotomy. We applied 160 N of axial force during cyclic and functional range of forearm rotation (40o pronation/40o supination), and force, contact pressure, and contact area through the elbow joint were measured simultaneously. RESULTS The force across the radiocapitellar joint was significantly higher in the IOM + DRUJ injury and the IOM injury groups than in the intact and DRUJ injury groups. The mean force across the radiocapitellar joint was not significantly different between the intact and DRUJ injury groups or between the IOM + DRUJ injury and the IOM injury groups. Forces across the ulnohumeral joint showed an inverse pattern to those in the radiocapitellar joint. CONCLUSIONS These findings suggest that injury to the IOM contributes more to the disruption of the normal distribution of axial loads across the elbow than injury to the DRUJ.
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Affiliation(s)
- Jung-Taek Hwang
- Department of Orthopedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon, Republic of Korea
| | - Youngbok Kim
- Department of Orthopedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Maegan N Shields
- Department of Orthopedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Daniel R Bachman
- Department of Orthopedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Lawrence J Berglund
- Department of Orthopedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | | | - James S Fitzsimmons
- Department of Orthopedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Shawn W O'Driscoll
- Department of Orthopedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA.
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Abstract
OBJECTIVE To evaluate the effect of intentional undersizing of prosthetic radial head implant diameters on joint contact pressures. METHODS Eight fresh-frozen cadaveric elbows were aligned in neutral extension and loaded with 100 N using a custom testing apparatus. Radiocapitellar contact pressures were recorded using a Tekscan thin-film pressure sensor. Prosthetic radial head replacement was performed with 2 prostheses: the Anatomic Radial Head and the Evolve Proline Radial Head prostheses. Each design was sized according to the manufacturer's recommendations and then again using 2-mm smaller radial heads. RESULTS Average and peak pressures were significantly higher with the Evolve than the Anatomic prostheses (P < 0.03 and 0.02, respectively). Peak pressures decreased from 4.2 ± 0.5 MPa to 2.9 ± 0.3 MPa for the Anatomic Radial Heads and from 5.6 ± 0.5 MPa to 3.9 ± 0.6 MPa when the Evolve Radial Heads were undersized by 2 mm. The mean pressures of the Anatomic Radial Heads (1.4 ± 0.1 MPa) did not change significantly with undersizing (1.3 ± 0.1 MPa, P = 0.12), whereas the mean pressures of the Evolve Radial Heads (1.6 ± 0.1 MPa) were significantly reduced with undersizing (1.4 ± 0.1 MPa, P < 0.02). CONCLUSION Both mean and peak pressures were initially high for the Evolve Radial Head sized based on the short axis diameter and were improved with further undersizing by 2 mm. Peak, but not mean, contact pressures were improved by undersizing the Anatomic prosthesis based on the long axis diameter. CLINICAL RELEVANCE These findings support the clinical recommendation of some surgeons to undersize the Evolve prosthesis by 2-mm smaller diameter than the current manufacturer's suggestion and give reason to consider doing the same for the Anatomic prosthesis.
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20
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Mukka S, Sjöholm P, Perisynakis N, Wahlström P, Rahme H, Kadum B. Radial head arthroplasty for radial head fractures: a clinical and radiological comparison of monopolar and bipolar radial head arthroplasty at a mean follow-up of 6 years. Eur J Trauma Emerg Surg 2018; 46:565-572. [PMID: 30382314 DOI: 10.1007/s00068-018-1042-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/28/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to compare clinical and radiographic outcomes of bipolar and monopolar radial head arthroplasty in treatment of radial head fracture at a mean follow-up of 6 years. METHODS A retrospective multicentre cohort study of 30 patients treated for unreconstructable radial head fractures. Patients were treated either with a cemented bipolar or an uncemented monopolar radial head arthroplasty. All patients included were evaluated with patient-rated outcome questionnaire, physical examination, and radiographic evaluation at a mean of 6 years (range, 2-12 years) postoperatively. RESULTS There was no statistical difference in QuickDASH between the bipolar or monopolar groups. The majority of patients had no to little pain during rest. Neither flexion nor extension of the injured arm was significantly affected by the type of prosthesis. None of the patients in the bipolar group had any secondary surgery at the time of follow-up. In the monopolar group, four patients required removal of the arthroplasty. Signs of ulnohumeral degenerative changes were seen in the majority of patients in both groups (55% in the monopolar group, 92% in the bipolar group). CONCLUSION In this retrospective cohort study comparing a bipolar and a monopolar radial head arthroplasty for treatment of radial head fractures, we found comparable functional outcome but more revision procedures in the monopolar group at a mean follow-up of 6 years.
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Affiliation(s)
- Sebastian Mukka
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Pontus Sjöholm
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Nikolaos Perisynakis
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Per Wahlström
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Hans Rahme
- Department of Orthopaedics, Elisabeth hospital, Uppsala, Sweden
| | - Bakir Kadum
- Department of Clinical and Experimental Medicine, Linköping university, Linköping, Sweden.
- Department of Orthopaedics, Ryhov hospital, Jönköping, Sweden.
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21
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Chytas ID, Antonopoulos C, Cheva A, Givissis P. Capitellar erosion after radial head arthroplasty: A comparative biomechanical study of operated radial head fractures on cadaveric specimens. Orthop Traumatol Surg Res 2018; 104:853-857. [PMID: 29581069 DOI: 10.1016/j.otsr.2018.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 01/10/2018] [Accepted: 02/06/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND We asked whether open reduction and internal fixation (ORIF) or radial head arthroplasty (RHA), common techniques used for the confrontation of displaced or comminuted radial head fractures, are correlated with cartilage wear of the capitulum. HYPOTHESIS We hypothesized that neither ORIF nor RHA are correlated with capitellar cartilage wear. MATERIAL AND METHODS On 5 cadaveric elbow specimens, osteotomies were employed to simulate radial head comminuted fractures followed with ORIF by Herbert screws. Radial heads were also excised from other 5 cadaveric elbow specimens and were replaced by metallic monopolar implants. Finally, 2 elbows were not operated and used as a control group. Custom-made rotary machines, working unstoppably, generated 700,000 pronation and supination forearm movements at a 110° arc of motion. The elbow joints were examined with pre- and postoperative magnetic resonance imaging (MRI) scans and the articular surfaces of the capitula were resected and sent for histopathology study. RESULTS In the 2 cadaveric elbows of the control group and the 4 elbows treated with ORIF, no cartilage damage was found. The fifth one displayed cartilage fissures, which were, classified according to International Cartilage Repair Society (ICRS) grading system as grade I cartilage damage. On the contrary, all 5 elbows treated with RHA sustained complete cartilage loss, exposure of the subchondral bone and were classified as ICRS grade IV cartilage damage. DISCUSSION Our study suggests that metallic monopolar RHA after a displaced or comminuted radial head fracture carries a high risk of rapidly evolving cartilage loss of the capitulum.
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Affiliation(s)
- I D Chytas
- 1st Orthopaedic Department of Aristotle University, "G. Papanikolaou" General Hospital, Papanikolaou avenue, 019, Exohi, 57010 Thessaloniki, Greece.
| | - C Antonopoulos
- School of Electrical and Computer Engineering of Aristotle University, 54124 Thessaloniki, Greece
| | - A Cheva
- Pathology Laboratory of "G. Papanikolaou" General Hospital, Exohi, 57010 Thessaloniki, Greece
| | - P Givissis
- 1st Orthopaedic Department of Aristotle University, "G. Papanikolaou" General Hospital, Papanikolaou avenue, 019, Exohi, 57010 Thessaloniki, Greece
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22
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Ramazanian T, Müller-Lebschi JA, Chuang MY, Vaichinger AM, Fitzsimmons JS, O'Driscoll SW. Effect of radiocapitellar Achilles disc arthroplasty on coronoid and capitellar contact pressures after radial head excision. J Shoulder Elbow Surg 2018; 27:1785-1791. [PMID: 30007821 DOI: 10.1016/j.jse.2018.05.022] [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: 12/15/2017] [Revised: 05/09/2018] [Accepted: 05/13/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Long-term radiographic arthritis has been commonly reported after radial head excision. Concern over radial head arthroplasty may arise in certain situations including capitellar arthritis, radiocapitellar malalignment, and in young and active patients. We hypothesized that radial head excision increases coronoid contact pressures, which may at least be partially reduced by radiocapitellar Achilles tendon disc arthroplasty. METHODS Coronoid and capitellar contact pressure was measured on 6 human cadaveric elbows on a custom-designed gravity-valgus simulator under passive flexion from 0° to 90°. Sequential testing, starting with the intact specimen, resection of the radial head, and finally, radiocapitellar Achilles tendon disc arthroplasty were performed on each specimen. RESULTS Mean contact pressure of the coronoid significantly increased after radial head excision (P < .0001) and significantly improved after Achilles disc arthroplasty (P < .0001). The pressure difference was most pronounced on the lateral coronoid. From 15° to 85° of elbow flexion, mean contact pressures on the lateral coronoid were 291 kPa and 476 kPa before and after radial head excision, respectively (P < .0001). Achilles disc arthroplasty significantly lowered coronoid contact pressures to 385 kPa (P = .002); however, they remained significantly higher than those in the intact radial head group (P = .0009). CONCLUSIONS Radial head resection increases contact pressure in the coronoid, especially the lateral coronoid. This study showed that radiocapitellar Achilles disc arthroplasty significantly improves contact pressures on the coronoid after radial head resection. Achilles disc arthroplasty could be considered in patients who are not candidates for radial head arthroplasty.
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Affiliation(s)
- Taghi Ramazanian
- Biomechanics Laboratory, Department of Orthopedics, Mayo Clinic, Rochester, MN, USA
| | | | - Min Yao Chuang
- Department of Orthopedics, MacKay Memorial Hospital, Taipei, Taiwan
| | - Anthony M Vaichinger
- Biomechanics Laboratory, Department of Orthopedics, Mayo Clinic, Rochester, MN, USA
| | - James S Fitzsimmons
- Biomechanics Laboratory, Department of Orthopedics, Mayo Clinic, Rochester, MN, USA
| | - Shawn W O'Driscoll
- Biomechanics Laboratory, Department of Orthopedics, Mayo Clinic, Rochester, MN, USA.
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Laumonerie P, Tibbo ME, Reina N, Pham TT, Bonnevialle N, Mansat P. Radial head arthroplasty: a historical perspective. INTERNATIONAL ORTHOPAEDICS 2018; 43:1643-1651. [DOI: 10.1007/s00264-018-4082-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/31/2018] [Indexed: 12/20/2022]
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Laumonerie P, Tibbo ME, Kerezoudis P, Gauci MO, Reina N, Bonnevialle N, Mansat P. Short to midterm outcomes of one hundred and seventy one MoPyC radial head prostheses: meta-analysis. INTERNATIONAL ORTHOPAEDICS 2018; 42:2403-2411. [PMID: 30062566 DOI: 10.1007/s00264-018-4070-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 07/23/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND The MoPyC implant is an uncemented long-stemmed radial head prosthesis that obtains primary press-fit fixation via controlled expansion of the stem. Current literature regarding MoPyC implants appears promising; however, sample sizes in these studies are small. Our primary objective was to evaluate the short- to midterm clinical outcomes of a large sample of the MoPyC prostheses. The secondary objective was to determine the reasons for failure of the MoPyC devices. METHODS Four electronic databases were queried for literature published between January 2000 and March 2017. Articles describing clinical and radiographic outcomes as well as reasons for reoperation were included. A meta-analysis was performed to obtain range of motion, mean Mayo Elbow Performance score (MEPS), radiographic outcome, and reason for failure. RESULTS A total of five articles describing 171 patients (82 males) with MoPyC implants were included. Mean patient age and follow-up were 52 years (18-79) and 3.1 years (1-9), respectively. Midterm clinical results were good or excellent (MEPS > 74) in 157 patients. Overall complication rate was low (n = 22), while periprosthetic osteolysis was reported in 78 patients. Nineteen patients returned to the operating room, with implant revision being required in ten patients. The two primary reasons for failure were (intra-)prosthetic dislocation (n = 8) followed by stiffness (n = 7); no painful loosening was described. CONCLUSION Short- to midterm outcomes of MoPyC prostheses are satisfactory and complications associated are low. The use of stem auto-expansion as a mode of obtaining primary fixation in radial head arthroplasty appears to be an effective solution for reducing the risk of painful loosening.
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Affiliation(s)
- Pierre Laumonerie
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France.
| | - Meagan E Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - Marc Olivier Gauci
- Department of Orthopaedic Surgery, iULS (Institut Universitaire Locomoteur & Sport) Hôpital Pasteur 2, 06001, Nice, France
| | - Nicolas Reina
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France
| | - Nicolas Bonnevialle
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France
| | - Pierre Mansat
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France
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Laumonerie P, Reina N, Kerezoudis P, Declaux S, Tibbo ME, Bonnevialle N, Mansat P. The minimum follow-up required for radial head arthroplasty: a meta-analysis. Bone Joint J 2017; 99-B:1561-1570. [PMID: 29212677 DOI: 10.1302/0301-620x.99b12.bjj-2017-0543.r2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 08/11/2017] [Indexed: 11/05/2022]
Abstract
AIMS The primary aim of this study was to define the standard minimum follow-up required to produce a reliable estimate of the rate of re-operation after radial head arthroplasty (RHA). The secondary objective was to define the leading reasons for re-operation. MATERIALS AND METHODS Four electronic databases, between January 2000 and March 2017 were searched. Articles reporting reasons for re-operation (Group I) and results (Group II) after RHA were included. In Group I, a meta-analysis was performed to obtain the standard minimum follow-up, the mean time to re-operation and the reason for failure. In Group II, the minimum follow-up for each study was compared with the standard minimum follow-up. RESULTS A total of 40 studies were analysed: three were Group I and included 80 implants and 37 were Group II and included 1192 implants. In Group I, the mean time to re-operation was 1.37 years (0 to 11.25), the standard minimum follow-up was 3.25 years; painful loosening was the main indication for re-operation. In Group II, 33 Group II articles (89.2%) reported a minimum follow-up of < 3.25 years. CONCLUSION The literature does not provide a reliable estimate of the rate of re-operation after RHA. The reproducibility of results would be improved by using a minimum follow-up of three years combined with a consensus of the definition of the reasons for failure after RHA. Cite this article: Bone Joint J 2017;99-B:1561-70.
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Affiliation(s)
- P Laumonerie
- Institut Locomoteur, Hôpital Pierre-Paul Riquet, Place du Dr Baylac, TSA 40 031, Toulouse 31059, France
| | - N Reina
- Institut Locomoteur, Hôpital Pierre-Paul Riquet, Place du Dr Baylac, TSA 40 031, Toulouse 31059, France
| | - P Kerezoudis
- Mayo Clinic, 1216 2nd Street SW, Rochester, Minnesota 55905, USA
| | - S Declaux
- Institut Locomoteur, Hôpital Pierre-Paul Riquet, Place du Dr Baylac, TSA 40 031, Toulouse 31059, France
| | - M E Tibbo
- Mayo Clinic, 1216 2nd Street SW, Rochester, Minnesota 55905, USA
| | - N Bonnevialle
- Institut Locomoteur, Hôpital Pierre-Paul Riquet, Place du Dr Baylac, TSA 40 031, Toulouse 31059, France
| | - P Mansat
- Institut Locomoteur, Hôpital Pierre-Paul Riquet, Place du Dr Baylac, TSA 40 031, Toulouse 31059, France
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Laumonerie P, Reina N, Gutierrez C, Delclaux S, Tibbo ME, Bonnevialle N, Mansat P. Tight-fitting radial head prosthesis: does stem size help prevent painful loosening? INTERNATIONAL ORTHOPAEDICS 2017; 42:161-167. [PMID: 28936610 DOI: 10.1007/s00264-017-3644-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 09/10/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The most common reason for removal of well-fixed radial head prostheses is painful loosening. We hypothesised that short-stemmed prostheses, used for radial head arthroplasty, are not associated with an increased risk of implant loosening. METHODS From 2002 to 2014, 65 patients were enrolled in a retrospective single-centre study. The radial head prostheses were classified as having either a long (30-mm) or short (16- to 22-mm) stem. The long-stemmed implants comprised 30 GUEPAR® DePuy Synthes (West Chester, PA, USA) and 20 Evolutive® Aston Medical (Saint-Etienne, France) devices; the short-stemmed implants comprised nine RECON and six STANDARD rHead® SBI-Stryker (Morrisville, PA, USA) devices. At last follow-up, clinical (range of motion, Disabilities of the Arm, Shoulder, and Hand score, Mayo Elbow Performance score) and radiographic (osteolysis) outcomes were assessed. RESULTS At a mean follow-up of 76.78 months (24-141), the rate of painful loosening [6 (40%) vs 8 (16%), p = 0.047] and osteolysis [12 (80%) vs 23 (46%), p = 0.02] were significantly higher in patients with short-stemmed versus long-stemmed implants. Despite the significant difference in loosening between stems as groups, individual stem length was not determined. CONCLUSIONS Tight-fitting implants with short stems are more prone to painful loosening.
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Affiliation(s)
- Pierre Laumonerie
- Department of Orthopaedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France.
| | - Nicolas Reina
- Department of Orthopaedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France
| | - Claudia Gutierrez
- Mayo Clinic School of Medicine, 200 1st St SW, Rochester, MN, 55905, USA
| | - Stephanie Delclaux
- Department of Orthopaedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France
| | - Meagan E Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Nicolas Bonnevialle
- Department of Orthopaedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France
| | - Pierre Mansat
- Department of Orthopaedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France
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Laumonerie P, Reina N, Ancelin D, Delclaux S, Tibbo ME, Bonnevialle N, Mansat P. Mid-term outcomes of 77 modular radial head prostheses. Bone Joint J 2017; 99-B:1197-1203. [PMID: 28860400 DOI: 10.1302/0301-620x.99b9.bjj-2016-1043.r2] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 04/03/2017] [Indexed: 11/05/2022]
Abstract
AIMS Radial head arthroplasty (RHA) may be used in the treatment of non-reconstructable radial head fractures. The aim of this study was to evaluate the mid-term clinical and radiographic results of RHA. PATIENTS AND METHODS Between 2002 and 2014, 77 RHAs were implanted in 54 men and 23 women with either acute injuries (54) or with traumatic sequelae (23) of a fracture of the radial head. Four designs of RHA were used, including the Guepar (Small Bone Innovations (SBi)/Stryker; 36), Evolutive (Aston Medical; 24), rHead RECON (SBi/Stryker; ten) or rHead STANDARD (SBi/Stryker; 7) prostheses. The mean follow-up was 74.0 months (standard deviation (sd) 38.6; 24 to 141). The indication for further surgery, range of movement, mean Mayo Elbow Performance (MEP) score, quick Disabilities of the Arm, Shoulder and Hand (quickDASH) score, osteolysis and positioning of the implant were also assessed according to the design, and acute or delayed use. RESULTS The mean MEP and quickDASH scores were 90.2 (sd 14; 45 to 100), and 14.0 points (sd 12; 1.2 to 52.5), respectively. There were no significant differences between RHA performed in acute or delayed fashion. There were 30 re-operations (19 with, and 11 without removal of the implant) during the first three post-operative years. Painful loosening was the primary indication for removal in 14 patients. Short-stemmed prostheses (16 mm to 22 mm in length) were also associated with an increased risk of painful loosening (odds ratio 3.54 (1.02 to 12.2), p = 0.045). Radiocapitellar instability was the primary indication for re-operation with retention of the implant (5). The overall survival of the RHA, free from re-operation, was 60.8% (sd 5.7%) at ten years. CONCLUSION Bipolar and press-fit RHA gives unsatisfactory mid-term outcomes in the treatment of acute fractures of the radial head or their sequelae. The outcome may vary according to the design of the implant. The rate of re-operation during the first three years is predictive of the long-term survival in tight-fitting RHAs. Cite this article: Bone Joint J 2017;99-B1197-1203.
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Affiliation(s)
- P Laumonerie
- Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, Toulouse 31059, France
| | - N Reina
- Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, Toulouse 31059, France
| | - D Ancelin
- Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, Toulouse 31059, France
| | - S Delclaux
- Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, Toulouse 31059, France
| | - M E Tibbo
- Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, Toulouse 31059, France
| | - N Bonnevialle
- Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, Toulouse 31059, France
| | - P Mansat
- Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, Toulouse 31059, France
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Adikrishna A, Shin YH, Zulkarnain RF, Hong H, Sun Y, Jeon IH. Beveled posteromedial corner of the radial head: a three-dimensional micro-computed tomography modeling study. J Anat 2017; 231:690-697. [PMID: 28815587 DOI: 10.1111/joa.12672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2017] [Indexed: 01/04/2023] Open
Abstract
The posteromedial quadrant of the radial head is known to be different from the other quadrants. However, the explanation of this unique anatomical feature remains elusive. Hence, this study was designed to address this unique anatomical variance using three-dimensional μCT (micro-computed tomography) analysis. Nine fresh cadaveric radial heads were scanned using μCT. Three-dimensional subchondral bone and cartilage models were rendered. Both models were separated into the four quadrants at both the periphery (rim) and the articulating dish (fovea): anteromedial (AM), posteromedial (PM), posterolateral (PL), and anterolateral (AL). Each quadrant was analyzed in terms of (1) subchondral bone porosity (SBP), (2) mean subchondral bone thickness (MSBT), and (3) mean cartilage thickness (MCT). There was a significant difference between the fovea and the rim in terms of its microarchitectural features. Although within the fovea, the PM quadrant did not differ significantly from the other quadrants, a significant difference was found within the rim. In terms of SBP, PM, AM, PL and AL were calculated as 33, 37, 36 and 35%, respectively. In terms of MSBT, PM, AM, PL and AL were calculated as 0.11, 0.10, 0.09, and 0.09 mm, respectively. In terms of MCT, PM, AM, PL and AL were calculated 1.09, 0.81, 0.84 and 0.83 mm, respectively. The PM corner of the radial head between the 8 and 9 o'clock positions, was beveled. This might explain why the PM quadrant of the rim differed significantly from the other quadrants in terms of its microarchitectural features.
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Affiliation(s)
- Arnold Adikrishna
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Young-Ho Shin
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Rizki F Zulkarnain
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Hanpyo Hong
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Yucheng Sun
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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Radial shortening osteotomy reduces radiocapitellar contact pressures while preserving valgus stability of the elbow. Knee Surg Sports Traumatol Arthrosc 2017; 25:2280-2288. [PMID: 28238092 DOI: 10.1007/s00167-017-4468-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 02/06/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Shortening osteotomy of the proximal radius might represent a potential salvage procedure in symptomatic radiocapitellar osteoarthritis, which could decrease radiocapitellar load while preserving the native radial head. In an in-vitro biomechanical investigation, we sought to determine whether shortening osteotomy of the proximal radius (1) decreases the radiocapitellar joint pressure upon axial loading and (2) retains valgus stability of the elbow. In addition, the anatomic configuration of the lesser sigmoid notch was evaluated to assess possible contraindications. METHODS Axial loading (0-400 N) and valgus torque (7.5 N m) over the full range of motion were applied to 14 fresh-frozen specimens before and after shortening osteotomy of the proximal radius by 2.5 mm. Radiocapitellar and ulnohumeral load distribution during axial compression was evaluated using a digital pressure mapping sensor. Valgus displacement was analyzed with a 3D camera system. The inclination angle (α) of the lesser sigmoid notch was assessed via 50 CT scans. RESULTS Up to axial loading of 250 N, shortening osteotomy caused a significant decrease in radiocapitellar contact pressures (p < 0.041). Valgus stability of specimens did not differ before and after shortening osteotomy (n.s.). The mean inclination angle (α) of the lesser sigmoid notch was 11.3° ± 6.3°. 46% had an inclination angle of ≤ 10° (type I). 46% had an inclination angle of 11°-20° (type II). In 8%, the inclination angle was >20° (type III). CONCLUSION Shortening osteotomy of the proximal radius can decrease radiocapitellar contact pressures during axial loading of up to 250 N. Primary valgus stability is not relevantly influenced by this procedure. In few patients, shortening osteotomy may cause radioulnar impingement of the radial head at the distal edge of the lesser sigmoid notch due to an inclination angle of >20°. Shortening osteotomy might be a promising treatment option to decrease pain levels in case of isolated radiocapitellar osteoarthritis.
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Lalone EA, Shannon HL, Deluce SR, Giles JW, King GJW, Johnson JA. Effect of Radial Head Implant Shape on Radiocapitellar Joint Congruency. J Hand Surg Am 2017; 42:476.e1-476.e11. [PMID: 28450100 DOI: 10.1016/j.jhsa.2017.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 02/14/2017] [Accepted: 03/09/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Radial head arthroplasty is indicated in displaced fractures in which comminution precludes successful internal fixation. Many types of radial head implants have been developed varying in material, methods of fixation, and degrees of modularity and geometry. The purpose of this study was to investigate the effect of radial head implant shape on radiocapitellar joint congruency. METHODS Joint congruency was quantified in 7 cadaveric specimens employing a registration and inter-surface distance algorithm and 3-dimensional models obtained using computed tomography. Forearm rotation was simulated after computer-guided implantation of an axisymmetric radial head, a population-based quasi-anatomic radial head implant, and a reverse-engineered anatomic radial head implant. Inter-surface distances were measured to investigate the relative position of the radial head implant and displayed on 3-dimensional color-contour maps. Surface area was measured for inter-surface distances (1.5 mm) and compared for each radial head geometry. RESULTS There were no statistical differences in the contact surface area between radial head implants during active or passive forearm rotation. The joint was more congruent (larger contact surface area) during active forearm rotation compared with passive forearm rotation. CONCLUSIONS This study investigated the effect of implant geometry on the radiocapitellar joint contact mechanics by examining a commercially available radial head system (axisymmetric), a quasi-anatomic design, and an anatomic reverse-engineered radial head implant. We found no statistical differences in radiocapitellar joint contact mechanics as measured by 3-dimensional joint congruency in cadaveric specimens undergoing continuous simulated forearm rotation. CLINICAL RELEVANCE The importance of choosing an implant that matches the general size of the native radial head is recognized, but the degree to which it is necessary to create an implant that replicates the native anatomy to restore elbow stability and prevent cartilage degenerative changes remains unclear. This study concluded that the geometry of the implant did not have a statistically significant effect on joint contact mechanics; therefore, future work is needed to examine additional factors related to implant design, such as material choice and implant positioning to investigate their influence on joint contact mechanics.
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Affiliation(s)
- Emily A Lalone
- Bioengineering Laboratory, Roth McFarlane Hand and Upper Limb Centre, St Joseph's Hospital, London, Canada
| | - Hannah L Shannon
- Bioengineering Laboratory, Roth McFarlane Hand and Upper Limb Centre, St Joseph's Hospital, London, Canada
| | - Simon R Deluce
- Bioengineering Laboratory, Roth McFarlane Hand and Upper Limb Centre, St Joseph's Hospital, London, Canada
| | - Joshua W Giles
- Bioengineering Laboratory, Roth McFarlane Hand and Upper Limb Centre, St Joseph's Hospital, London, Canada
| | - Graham J W King
- Bioengineering Laboratory, Roth McFarlane Hand and Upper Limb Centre, St Joseph's Hospital, London, Canada; Department of Surgery, University of Western Ontario, London, Canada
| | - James A Johnson
- Bioengineering Laboratory, Roth McFarlane Hand and Upper Limb Centre, St Joseph's Hospital, London, Canada; Department of Mechanical and Materials Engineering, University of Western Ontario, London, Canada.
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Causes for early and late surgical re-intervention after radial head arthroplasty. INTERNATIONAL ORTHOPAEDICS 2017; 41:1435-1443. [DOI: 10.1007/s00264-017-3496-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 04/21/2017] [Indexed: 11/25/2022]
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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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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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Bigazzi P, Biondi M, Ceruso M. Radiocapitellar prosthetic arthroplasty in traumatic and post-traumatic complex lesions of the elbow. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:851-858. [PMID: 27544680 DOI: 10.1007/s00590-016-1837-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 08/11/2016] [Indexed: 10/21/2022]
Abstract
Radiocapitellar prosthetic arthroplasty is a fascinating new option in the treatment of complex lesions of the elbow. The device has been developed in order to treat primitive and post-traumatic radiocapitellar degenerative arthritis, while preserving the ulnohumeral joint of the elbow. Compared to a radial head resection, it avoids valgus and axial instability of the elbow and forearm preventing ulnohumeral degeneration. Seven patients have been reviewed with a mean of follow-up of 40 months. Two of them presented with an acute trauma and five of them with a post-traumatic degenerative arthritis involving the radial compartment of the elbow. The patients' evaluation was performed using DASH and Mayo elbow performance score (MEPS). Implant overstuffing, loosening and degenerative changes of the ulnohumeral joint have been monitored with X-ray controls. All patients presented with a marked improvement in elbow function, no signs of overstuffing or ulnohumeral degeneration were observed. Two patients developed a clinically asymptomatic aseptic loosening of the radial press-fit stem. The radiocapitellar prosthetic arthroplasty shows convincing results in the treatment of symptomatic radiocapitellar degenerative arthritis. It has also been effective in acute trauma scenarios in the presence of major osteoarticular wearing or loss of the entire radiocapitellar joint.
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Affiliation(s)
- Prospero Bigazzi
- Hand Surgery and Reconstructive Microsurgery Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Marco Biondi
- Orthopaedic Clinic, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Massimo Ceruso
- Hand Surgery and Reconstructive Microsurgery Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Langohr GDG, Willing R, Medley JB, King GJW, Johnson JA. The Effect of Radial Head Hemiarthroplasty Geometry on Proximal Radioulnar Joint Contact Mechanics. J Hand Surg Am 2016; 41:745-52. [PMID: 27241850 DOI: 10.1016/j.jhsa.2016.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 01/19/2016] [Accepted: 05/01/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the joint contact area and peak contact stress of different radial head (RH) hemiarthroplasty articular profiles for the proximal radioulnar joint (PRUJ) to the native radial head with the hypothesis that the side radius and side angle closest to the native mating ulnar articular profile would provide the best contact mechanics. METHODS Finite element models generated from the computed tomography geometry of 14 native elbows (73 ± 17.5 years) were subjected to 12 different RH profiles having varying side radii (flat [r = ∞ mm], 16.25, 8.12, and 4.50 mm) and side angles (0°, 5°, and 10°) under a constant compressive 20-N medial load. Contact areas and peak contact stresses were computed and compared with the native joint. RESULTS On average, RH implants significantly reduced PRUJ contact area by 55% ± 16% and increased peak contact stress by 337% ± 241% compared with the native RH. The prosthesis side radius had significant effects on both contact area and stress, but side angle did not. The 16.25-mm radii produced the largest contact areas, and the 4.50-mm radius model generated the smallest contact areas. As the side radius was decreased, peak contact stress was reduced as the contact migrated toward the center of the native ulnar articulation, although the 8.12-mm radius achieved the lowest peak contact stress. CONCLUSIONS Whereas RH hemiarthroplasty side radius can affect both contact area and peak contact stress, the magnitude of the effect on contact area is relatively small compared with that of the peak contact stress. Furthermore, although a flat RH side profile with a side angle of 5° more closely matched the side profile of the native ulnas used in the present study, the optimal profile was found to be a smaller radius of 8.12 mm. CLINICAL RELEVANCE Optimizing PRUJ contact mechanics after metallic RH hemiarthroplasty may contribute to better clinical outcomes by reducing the potential for native cartilage degeneration.
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Affiliation(s)
- G Daniel G Langohr
- Roth
- McFarlane Hand and Upper Limb Center, St Joseph's Health Care, University of Western Ontario, London, Ontario, Canada
| | - Ryan Willing
- Binghamton University, State University of New York, Binghamton, NY
| | | | - Graham J W King
- Roth
- McFarlane Hand and Upper Limb Center, St Joseph's Health Care, University of Western Ontario, London, Ontario, Canada
| | - James A Johnson
- Roth
- McFarlane Hand and Upper Limb Center, St Joseph's Health Care, University of Western Ontario, London, Ontario, Canada.
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Giannicola G, Sedati P, Polimanti D, Cinotti G, Bullitta G. Contribution of cartilage to size and shape of radial head circumference: magnetic resonance imaging analysis of 78 elbows. J Shoulder Elbow Surg 2016; 25:120-6. [PMID: 26410345 DOI: 10.1016/j.jse.2015.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 06/30/2015] [Accepted: 07/08/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aims of our study were to quantify cartilage thickness at the minimum and maximum diameters of the radial head circumference and to investigate its influence on the size and shape of the proximal radius. METHODS We analyzed high-definition magnetic resonance imaging scans of 78 healthy elbows in 19 men and 20 women, with a mean age of 28 (21-32) years. All measurements were estimated in the axial plane just distal to the fovea radialis. Maximum and minimum bone diameters, maximum and minimum total diameters (including cartilage thickness), and cartilage thickness were calculated. Cartilage thickness was measured at 4 different points: (1) at the articular side of the maximum diameter (point A), (2) at the nonarticular side of the maximum diameter (point B), (3) at the medial side of the minimum diameter (point C), and (4) at the lateral side of the minimum diameter (point D). Pearson correlation and t test were used for the statistical analysis. RESULTS Mean maximum and minimum bone diameters and maximum and minimum total diameters were 22.2, 21.5, 24.0, and 23.2 mm, respectively. All differences between diameters were statistically significant. Mean cartilage thickness at points A, C, and D was 1.7, 0.8, and 0.8 mm, respectively. No measurable cartilage thickness was found at point B. No significant correlation was found between bone diameters and cartilage thickness. CONCLUSIONS Cartilage surface significantly increases and modifies the size and shape of the radial head. The observation that cartilage thickness varies between subjects and does not correlate with bone parameters suggests that the diameters of the radial head cannot be inferred from indirect measurements of dry bones or radiographs.
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Affiliation(s)
- Giuseppe Giannicola
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, "Sapienza" University of Rome, Rome, Italy.
| | - Pietro Sedati
- Department of Radiology, Campus Bio-medico University of Rome, Rome, Italy
| | - David Polimanti
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Gianluca Cinotti
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Gianluca Bullitta
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, "Sapienza" University of Rome, Rome, Italy
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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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Langohr GDG, Willing R, Medley JB, King GJW, Johnson JA. Contact analysis of the native radiocapitellar joint compared with axisymmetric and nonaxisymmetric radial head hemiarthroplasty. J Shoulder Elbow Surg 2015; 24:787-95. [PMID: 25725964 DOI: 10.1016/j.jse.2014.12.011] [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: 08/26/2014] [Revised: 12/04/2014] [Accepted: 12/06/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radial head (RH) implants are manufactured from stiff materials, resulting in reduced radiocapitellar contact area that may lead to cartilage degeneration. Although the native RH is nonaxisymmetric, most implants are axisymmetric, potentially contributing to altered contact mechanics. This study compared the joint contact area (Ac) and maximum contact stress (σmax) of axisymmetric and nonaxisymmetric RH implants to the native radiocapitellar joint. METHODS The contact mechanics of intact elbows derived from cadaveric computed tomography data (n = 15) were compared with axisymmetric (size: 18, 20, 22 mm) and nonaxisymmetric (size: 16 × 18, 18 × 20, 20 × 22 mm) RH hemiarthroplasty reconstructed elbows using Abaqus finite element software. Under a 100 N load, Ac and σmax were computed for ±90° pronation-supination and 0°, 45°, 90°, and 135° flexion. RESULTS Compared with native, both hemiarthroplasty models produced significantly lower Ac and higher σmax (P < .001). In the best orientation, the nonaxisymmetric RH provided significantly larger Ac at 0° and 135° flexion (P = .03, P = .007) and reduced levels of σmax at 45° and 90° flexion (P = .003, P < .001). However, there was also a worst orientation that reduced Ac and increased σmax for all flexion angles (P < .003 for all). The native RH was less sensitive to rotation than the nonaxisymmetric RH in terms of σmax (P < .001). The axisymmetric RH was not sensitive to rotation. CONCLUSIONS Whereas a nonaxisymmetric RH can provide improved contact mechanics at certain forearm rotations and flexions, there are also orientations where Ac is reduced and σmax is increased. Axisymmetric designs are more consistent throughout forearm rotation and therefore may be more forgiving than the nonaxisymmetric RH implant design used in this study.
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Affiliation(s)
- G Daniel G Langohr
- Bioengineering Research Laboratory, Roth
- McFarlane Hand and Upper Limb Center, St. Joseph's Health Care, University of Western Ontario, London, ON, Canada
| | - Ryan Willing
- Department of Mechanical Engineering, Binghamton University, Binghamton, NY, USA
| | | | - Graham J W King
- Bioengineering Research Laboratory, Roth
- McFarlane Hand and Upper Limb Center, St. Joseph's Health Care, University of Western Ontario, London, ON, Canada
| | - James A Johnson
- Bioengineering Research Laboratory, Roth
- McFarlane Hand and Upper Limb Center, St. Joseph's Health Care, University of Western Ontario, London, ON, Canada.
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O'Driscoll SW, Bachman DR. Letter regarding "Radiocapitellar joint contact pressures following radial head arthroplasty". J Hand Surg Am 2015; 40:863-4. [PMID: 25813933 DOI: 10.1016/j.jhsa.2014.12.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 12/10/2014] [Indexed: 02/02/2023]
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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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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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