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Shimura H, Wakabayashi Y, Yamada T, Shirakawa K, Sato T, Fujita K, Niizeki Y, Suzuki S, Kaburagi H, Suzuki H, Nimura A. Radiographic and clinical comparisons between loose-fit and press-fit stems in monopolar radial head arthroplasty for comminuted radial head fractures. J Orthop Sci 2024:S0949-2658(24)00014-9. [PMID: 38342710 DOI: 10.1016/j.jos.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/16/2023] [Accepted: 02/02/2024] [Indexed: 02/13/2024]
Abstract
PURPOSE Few clinical studies have compared the operative outcomes between loose- and press-fit stems in radial head arthroplasty (RHA). We aimed to evaluate the radiographic and clinical results of the two radial head implant concepts. METHODS In this retrospective multicenter study, 32 patients (24 women and 8 men) with a mean age of 63.1 years who underwent RHA for comminuted radial head fractures were reviewed between 2005 and 2021. Seventeen patients underwent RHA with a loose-fit stem (L-group), whereas the remaining fifteen patients underwent RHA with a press-fit stem (P-group). The mean follow-up period was 40.1 ± 9.9 months, with the minimum follow-up duration of 12 months. The radiographic findings were evaluated for periprosthetic osteolysis; furthermore, clinical outcomes were analyzed to measure the range of motion of the elbow. The rate of reoperations and prosthesis removal were also reviewed. RESULTS The general characteristics of the patients were similar in the two groups. The rate of periprosthetic osteolysis was 17.6% in the L-group, whereas it was 53.3% in the P-group. The mean elbow flexions were 128° and 133° in the L- and P-groups, respectively. The mean elbow extensions were -12° and -9° in the L- and P-groups, respectively. The rate of reoperation was 23.5% in the L-group and 15.2% in the P-group. One patient in the L-group had the prosthesis removed because of surgical site infection, whereas one patient in the P-group had the prosthesis removed owing to painful loosening. CONCLUSIONS No significant differences in the clinical outcomes and reoperation rate were observed between the two radial head implant concepts in this study. However, osteolysis occurred more frequently in the P-group. Although patients with periprosthetic osteolysis are currently asymptomatic, they should be carefully followed up for the symptoms in the long term.
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Affiliation(s)
- Haruhiko Shimura
- Department of Orthopedic Surgery, Tokyo Bay Urayasu Ichikawa Medical Center. 3-4-32 Todaijima, Urayasu-City, Chiba, 279-0001, Japan.
| | - Yoshiaki Wakabayashi
- Department of Orthopaedic Surgery, Hand and Upper Extremity Group, Tokyo Medical and Dental University. 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Tetsuya Yamada
- Department of Orthopaedic Surgery, Hand and Upper Extremity Group, Tokyo Medical and Dental University. 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Ken Shirakawa
- Department of Orthopaedic Surgery, Hand and Upper Extremity Group, Tokyo Medical and Dental University. 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Tetsuya Sato
- Department of Orthopaedic Surgery, Hand and Upper Extremity Group, Tokyo Medical and Dental University. 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Koji Fujita
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University. 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Yumi Niizeki
- Department of Orthopaedic Surgery, Hand and Upper Extremity Group, Tokyo Medical and Dental University. 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Shiro Suzuki
- Department of Orthopaedic Surgery, Hand and Upper Extremity Group, Tokyo Medical and Dental University. 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Hidetoshi Kaburagi
- Department of Orthopaedic Surgery, Hand and Upper Extremity Group, Tokyo Medical and Dental University. 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Hidetsugu Suzuki
- Department of Orthopaedic Surgery, Hand and Upper Extremity Group, Tokyo Medical and Dental University. 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University. 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
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2
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Samra I, Kwaees TA, Mati W, Blundell C, Lane S, Harrison JWK, Charalambous CP. Anatomic Monopolar Press-fit Radial Head Arthroplasty; High Rate of Loosening at Mid-Term Follow Up. Shoulder Elbow 2023; 15:207-217. [PMID: 37035613 PMCID: PMC10078816 DOI: 10.1177/17585732221080768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 01/19/2022] [Accepted: 01/22/2022] [Indexed: 11/15/2022]
Abstract
Introduction Radial head arthroplasty (RHA) is used for the management of unstable or unreconstructable injuries of the radial head. Our aim was to investigate clinical and radiographic outcomes in patients treated with the Acumed anatomic radial head press-fit system for trauma. Methods Clinical and radiographic assessment of RHAs undertaken for trauma with minimum 2-year follow-up. Results 16 consecutive patients, mean age 53 (21-82) and 66 month ± 27 (26-122) clinical follow-up were included. There were marked radiographic changes with 11/16 showing periprosthetic lucent lines and 13/16 showing subcollar osteolysis. Radiographic changes occurred early post-surgery. Stem loosening was associated with larger cantilever quotients (0.47 vs 0.38, p = 0.004). Overall survivability was 81.2%, with 3 RHAs removed. Clinical outcomes for the retained RHAs were acceptable with mean flexion 134°, extension deficit of 10°, pronation of 82°, and supination of 73°. Mean VAS scores were 8.5 ± 14.4, QuickDASH 13.8 ± 18.9, Mayo Elbow Performance Scores were 91.5 ± 12.5 with no poor scores. Conclusion Mid-term clinical functional outcomes following the Acumed anatomic RHA are acceptable in most cases. However, in view of the extensive periprosthetic lucencies and surgical removal due to loosening, patients should be cautioned when consented for implantation of the prosthesis, especially if a large collar is anticipated.
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Affiliation(s)
- Inderpaul Samra
- Department of Orthopaedics, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, Lancashire, FY3 8NR, UK
| | - Tariq A Kwaees
- Department of Orthopaedics, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, Lancashire, FY3 8NR, UK
| | - Wael Mati
- Department of Radiology, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, Lancashire, FY3 8NR, UK
| | - Clare Blundell
- Department of Orthopaedics, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, Lancashire, FY3 8NR, UK
| | - Suzanne Lane
- Department of Orthopaedics, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, Lancashire, FY3 8NR, UK
| | - John WK Harrison
- Gateshead Health NHS Foundation Trust, Queen Elizabeth Avenue, Gateshead, NE9 6SX, UK
| | - Charalambos P Charalambous
- Department of Orthopaedics, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, Lancashire, FY3 8NR, UK
- School of Medicine, University of Central Lancashire, Fylde Road, Preston, Lancashire, PR1 2HE, UK
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Thyagarajan DS. Radial head replacement - A comprehensive review. J Orthop 2023; 36:51-56. [PMID: 36632343 PMCID: PMC9827028 DOI: 10.1016/j.jor.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Background Radial head fractures represent 1-4% of all adult fractures and 1/3rd of elbow fractures (Kaas et al., 2010). Radial head is an important secondary stabilier of the elbow. The aim of the treatment of radial head fractures is to achieve stability and good functional outcome. Radial head replacement (RHR) is indicated when robust reconstruction and fixation of the fracture fragments is not possible. Methods This article explores history and evolution, anatomical considerations, biomechanics, implant designs, indications, surgical outcomes and controversies in radial head replacement based on current evidence. Results There is a wide range of RHR designs available without conclusive evidence to support the superiority of one design over the other. Ranges of motion, functional outcomes and complication were comparable among different designs with a high incidence of complications reported in many studies. Conclusion RHR remains a good option in unreconstructible radial head fractures, with potential to regain excellent function. It is imperative to continue with the quest to innovate and improve on current designs, to reduce complications in the long term.
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Affiliation(s)
- David S. Thyagarajan
- Consultant Trauma & Orthopaedic Surgeon, Shoulder & Elbow Unit, Northern General Hospital, Sheffield Teaching Hospitals, NHS Foundation Trust, Herries Road, Sheffield, NG5 7AU, United Kingdom
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Yang G, Li S, Zhang H, Lu Y. A systematic review and meta-analysis on different stem fixation methods of radial head prostheses during long-term follow-up. Front Bioeng Biotechnol 2022; 10:1041531. [PMID: 36394008 PMCID: PMC9663814 DOI: 10.3389/fbioe.2022.1041531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/21/2022] [Indexed: 01/24/2023] Open
Abstract
Background: Radial head arthroplasty (RHA) is typically performed for non-reconstructible radial head fractures with or without valgus stability. The fixation methods can be divided into cemented rigid fixation, such as screw fixation, and uncemented micromovement fixation, including smooth stem, press-fit, expanded device, in-growth stem, and grit-blasted stem fixations. Different fixation methods may impact long-term clinical outcomes and cause complications. This study aimed to compare the long-term follow-up outcomes of cemented and uncemented radial head prostheses. Methods: A computerized literature search was performed in the PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science databases for studies on radial head prostheses, replacement, and arthroplasty published from inception to April 2022. The prostheses fixation method was divided into cemented and uncemented fixation groups. The outcomes of interest included the participant characteristics, prostheses types, clinical outcomes, reoperation rates, and complication rates during long-term follow-up. Results: A total of 57 studies involving 2050 patients who underwent RHA were included in our analysis. Cemented fixation was used in 23 of these studies, uncemented fixation in 35 studies, and both cemented and uncemented fixations in one study. Both fixation groups showed significantly improved clinical outcomes after treatment. In particular, both the reoperation and complication rates were lower in the uncemented fixation group (12% and 22%, respectively) than that in the cemented fixation group (20% and 29%, respectively). Among the studies, uncemented monopolar fixation had the lowest reoperation rate (14%), while cemented monopolar fixation had the highest reoperation rate (36%). Regarding complication rates, uncemented bipolar fixation yielded the lowest rate (12%), while cemented bipolar fixation yielded the highest rate (34%). The range of motion and clinical outcome scores were good in both groups. Conclusion: Uncemented radial head prostheses had lower reoperation and complication rates than cemented prostheses. In particular, uncemented monopolar prostheses may yield the lowest reoperation rate, while uncemented bipolar prostheses may yield the lowest overall complication rate.
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Ozdag Y, Foster B, Grandizio LC. Pathologic Periprosthetic Fracture After Radial Head Arthroplasty: A Report of 2 Cases. JBJS Case Connect 2022; 12:01709767-202209000-00043. [PMID: 36099356 DOI: 10.2106/jbjs.cc.22.00107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/17/2022] [Indexed: 06/15/2023]
Abstract
CASE We present 2 cases of pathologic periprosthetic radius fractures in the setting of osteolysis after radial head arthroplasty (RHA) with a porous-coated, press-fit implant. Both patients were managed with implant removal without subsequent instability. Although radiographic lucencies are common after RHA, progressive bone resorption can result in subsequent periprosthetic fractures. CONCLUSION Although osteolysis after RHA is not always clinically significant, these cases demonstrate that this radiographic finding may indicate adverse clinical consequences. Surgeons who perform implant excision should be ready to address further instability as needed. LEVEL OF EVIDENCE Level V, case reports.
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Affiliation(s)
- Yagiz Ozdag
- Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, Department of Orthopaedic Surgery, Danville, Pennsylvania
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6
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Foroohar A, Prentice HA, Burfeind WE, Navarro RA, Mirzayan R, Zeltser DW. Radial head arthroplasty: a descriptive study of 970 patients in an integrated health care system. J Shoulder Elbow Surg 2022; 31:1242-1253. [PMID: 35093522 DOI: 10.1016/j.jse.2021.12.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/16/2021] [Accepted: 12/19/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radial head arthroplasty (RHA) is commonly performed for isolated comminuted radial head fractures and in conjunction with traumatic elbow instability. However, there is a paucity of literature directly describing the characteristics and outcomes of patients who undergo RHA in a community-based setting. We describe a cohort of 970 RHA performed in the California regions of a US integrated health care system over a 9-year period. Patient demographics, implant selection, 90-day acute postoperative events, and cumulative reoperation/revision rates are included. METHODS Patients aged ≥18 years who underwent primary RHA were identified (2009-2017). Patient characteristics and demographics, including age, body mass index, gender, diabetes status, American Society of Anesthesiologists (ASA) classification, primary diagnosis, and concomitant procedures were described. Crude cumulative revision and reoperation probabilities were calculated as 1 minus the Kaplan-Meier estimator, with follow-up time calculated as the time from the index RHA to revision/reoperation date for those with the outcome of interest and time from index RHA to censoring date (eg, date of death, health care termination, study end date [March 31, 2018]) for those without the outcome. Ninety-day postoperative incidence of emergency department (ED) visit, readmission, and mortality was calculated as the number of patients with the event of interest over the number of patients at risk. RESULTS A total of 970 patients underwent primary unilateral RHA by 205 surgeons during the study period. Annual procedure volume increased from 53 procedures in 2009 to 157 procedures in 2017. More patients were female, without diabetes, and had an ASA classification of 1 or 2. Fracture was the predominant indication for RHA (98.4%) and more than half (54.3%) had concomitant procedures performed. Most implants were press fit (63.2%) over loose fit, and >90% were monopolar. Three-year cumulative revision and reoperation probabilities following RHA were 6.5% (95% confidence interval [CI] = 5.0%-8.5%) and 8.2% (95% CI = 6.5%-10.3%), respectively. Revisions and reoperations tended to occur within the first postoperative year. Of the 970 RHA patients, 83 (8.5%) had a 90-day ED visit, 58 (6.0%) had a 90-day readmission, and 1 (0.1%) died within a 90-day postoperative period. CONCLUSION This large cohort of RHA patients provides information about the practice of RHA at large and in the community. Surgeons are performing more RHA over time and choosing press fit stems more often. Revisions and reoperations tended to occur early. Readmission and ED visits were low but not negligible, with pain being the most common reason for ED visit.
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Affiliation(s)
- Abtin Foroohar
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, South Bay, CA, USA
| | | | | | - Ronald A Navarro
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, South Bay, CA, USA
| | - Raffy Mirzayan
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, Baldwin Park, CA, USA
| | - David W Zeltser
- Department of Orthopedic Surgery, The Permanente Medical Group, San Francisco, CA, USA
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7
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Clinical long-term results of radial head arthroplasty in comminuted radial head fractures. Musculoskelet Surg 2022; 107:197-206. [PMID: 35353327 DOI: 10.1007/s12306-022-00742-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
Modern radial head prostheses have recently become more common in the treatment of comminuted radial head fractures. The goal of this study was to evaluate how well the EVOLVE® modular metallic radial head implant prosthetic restores the functional range of motion and stability of the elbow. 30 patients with comminuted radial head fractures received an arthroplasty with an EVOLVE® prosthesis in our institution. 20 of those patients were available for long-term follow-up (mean > 10 years). The outcomes were assessed on the basis of pain, motion, and strength. The overall outcome was scored with functional rating scores. According to the Broberg-Morrey elbow evaluation score, after a mean follow-up period of 10.2 years, ten (50.0%) patients were rated as very good, four (20.0%) as good, six (30.0%) as satisfactory, and none as poor. In the long-term results the Broberg-Morrey score increased from 79 (in short-term results) to 89 points. The Disabilities of the Arm, Shoulder, and Hand (DASH) outcome measure questionnaire showed an average of 16.2 points. Initially, patients had an extension deficit of 20°, which was reduced to 5° at the latest follow-up. In our long-term results, an improvement in the function of the elbow was observed after arthroplasty using a metallic modular radial head implant. Comminuted radial head fractures with elbow instability can be treated effectively with the EVOLVE® radial head prosthesis, which restores stability in acute treatment. Our long-term results after 10.2 years demonstrate good functional outcome and low major complication rate. IV.
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8
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Songy CE, Kennon JC, Barlow JD, Sanchez-Sotelo J, O'Driscoll SW, Morrey ME. Radial Head Replacement for Acute Radial Head Fractures: Outcome and Survival of Three Implant Designs With and Without Cement Fixation. J Orthop Trauma 2021; 35:e202-e208. [PMID: 34006797 PMCID: PMC8115875 DOI: 10.1097/bot.0000000000001983] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine outcomes of radial head replacement (RHR) for acute fractures using 3 different implant designs with or without cement fixation. DESIGN Retrospective. SETTING Tertiary referral hospital. PATIENTS/PARTICIPANTS One hundred fourteen elbows underwent RHR for an acute radial head fracture using either (1) a nonanatomic design and smooth stem (n = 60), (2) a nonanatomic design with a grit-blasted, ingrowth, curved stem (n = 21), or (3) an anatomic design with a grit-blasted ingrowth straight stem (n = 33). Cemented (25%) or uncemented (75%) fixation was used at the discretion of the treating surgeon. INTERVENTION RHR. MAIN OUTCOME MEASUREMENTS The primary outcome was implant survivorship free of revision or removal for any reason. All elbows were evaluated clinically (the Mayo Elbow Performance Score and reoperations/complications) and radiographically. RESULTS Fourteen implants (12%) were revised. Of elbows with a minimum 2-year clinical follow-up, the average Mayo Elbow Performance Score was 88. The rate of survivorship free from revision was 92% [95% confidence interval (CI) = 87%-98%] at 2 years, 90% (CI = 84%-96%) at 5 years and 84% (CI = 75%-94%) at 10 years. The differences in survivorship between the 3 implants did not reach statistical significance, but the nonanatomic design with a grit-blasted ingrowth curved stem had a hazard ratio of 4.6 (95% CI = 0.9%-23%) for failure. There were no differences in survivorship between cemented versus uncemented stems. For those elbows with a minimum of 2 years of radiographic follow-up, implant tilt was observed in 10 (16%) elbows and loosening in 16 (26%) elbows. Stress shielding was present in 19 (42%) of well-fixed implants. CONCLUSIONS RHR for acute trauma leads to survivorship greater than 80% at 10 years. Radiographic changes (loosening, stress shielding, and implant tilting) can be expected in a substantial portion of elbows at long-term follow-up. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Chad E Songy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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9
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Abstract
Primary radial head arthroplasty (RHA) produces good or excellent results in approximately 85% of patients. However, complications are not uncommon and have been described in up to 23% of cases. The number of RHA is increasing, and consequently the absolute number of complications is expected to rise as well. The decision on whether to revise or remove the prosthesis seems more likely to depend on the preference of the surgeon or the hospital, rather than on objectifying problems with the prosthesis. The current article presents an algorithm for the work-up and treatment of most complications that can occur following RHA. Five subgroups of problems were identified: osteoarthritis, stiffness, instability, infection and implant-related issues. In short, the preferred treatment depends mainly on the chondral condition and stability of the elbow joint.
Cite this article: EFORT Open Rev 2020;5:398-407. DOI: 10.1302/2058-5241.5.190055
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Affiliation(s)
- Izaäk F Kodde
- Orthopedic Center Antwerp, AZ Monica Hospital, Antwerp, Belgium.,Department of Orthopedic Surgery, St. Antonius Hospital, Utrecht, The Netherlands
| | - Jetske Viveen
- Department of Orthopedic Surgery, Upper Limb Unit, Amphia Hospital, Breda, The Netherlands
| | - Bertram The
- Department of Orthopedic Surgery, Upper Limb Unit, Amphia Hospital, Breda, The Netherlands
| | | | - Denise Eygendaal
- Department of Orthopedic Surgery, Upper Limb Unit, Amphia Hospital, Breda, The Netherlands.,Department of Orthopedic Surgery, Amsterdam UMC, Amsterdam, The Netherlands
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10
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Carbonell-Escobar R, Vaquero-Picado A, Barco R, Antuña S. Neurologic complications after surgical management of complex elbow trauma requiring radial head replacement. J Shoulder Elbow Surg 2020; 29:1282-1288. [PMID: 32284308 DOI: 10.1016/j.jse.2020.01.086] [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] [Received: 09/06/2019] [Revised: 01/07/2020] [Accepted: 01/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radial head arthroplasty (RHA) has become a successful procedure for addressing acute unreconstructible radial head fractures that compromise elbow stability in complex elbow trauma. The purpose of this study was to investigate the incidence of and risk factors for the development of neurologic complications after surgical treatment of complex elbow fractures that require an RHA. METHODS Sixty-two patients with an unreconstructible radial head fracture and complex elbow instability treated with RHA were included. There were 33 men and 29 women, with a mean age of 54 years (range, 22-87 years). The average follow-up period was 5.2 years (range, 3-16 years). All patients were neurologically intact before surgery. The arthroplasty was implanted through a Kocher approach in 55 cases, whereas a Kaplan approach was used in 7. An uncemented smooth stem arthroplasty (Evolve) was used in 27 patients, and an anatomic ingrowth system (Anatomic Radial Head), in 35. At the time of surgery, 23 patients underwent fixation of a coronoid fracture and 15 underwent plating of the proximal ulna. All patients were clinically examined immediately after surgery and during follow-up to detect any degree of neurologic deficit. Radial and ulnar nerve injuries were classified according to the Hirachi and McGowan classifications, respectively. Functional outcomes were evaluated with the Mayo Elbow Performance Score. RESULTS A complete posterior interosseous nerve palsy occurred postoperatively in 2 patients. Hand function had completely recovered in both at 2 months after surgery without sequelae. Nine patients complained of ulnar nerve symptoms (immediately after surgery in 6 and as delayed ulnar neuropathy in 3). Most patients with ulnar nerve deficits had undergone additional surgical procedures to address ulnar fractures. Among patients with ulnar neuropathies, only 3 complained of mild sensory symptoms at the latest follow-up. No significant differences in range of motion and Mayo Elbow Performance Score were found between patients with and without neurologic complications. Associated olecranon or coronoid fixation and a prolonged tourniquet time were identified as risk factors for neurologic complications. CONCLUSION This study shows that the incidence of neurologic complications associated with the surgical treatment of complex elbow fractures requiring implantation of a radial head prosthesis may be underestimated in the literature. Inappropriate retraction in the anterior aspect of the radial neck, a prolonged ischemia time, and concomitant coronoid or olecranon fracture fixation represent the main risk factors for the development of this complication. Although the great majority of patients have full recovery of their nerve function, they should be advised on the risk of this stressful complication.
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Affiliation(s)
| | | | - Raúl Barco
- Instituto de Investigación Hospital Universitario La Paz (IDIPAZ), Hospital Universitario La Paz, Madrid, Spain
| | - Samuel Antuña
- Instituto de Investigación Hospital Universitario La Paz (IDIPAZ), Hospital Universitario La Paz, Madrid, Spain
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11
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Raven TF, Banken L, Schmidmaier G, Studier-Fischer S, Biglari B, Moghaddam A. Evaluation of two different types of radial head prosthesis in practical use. Using either Evolve® or MoPyC ® radial head prosthesis in the treatment of comminuted radial head fractures. Orthop Rev (Pavia) 2020; 12:8386. [PMID: 32391133 PMCID: PMC7206368 DOI: 10.4081/or.2020.8386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/14/2020] [Indexed: 11/26/2022] Open
Abstract
The aim of this retrospective study was to undertake a comparative evaluation of the Evolve® modular metallic radial head implant prosthesis and the MoPyC® pyrocarbon prosthesis in acute care. Seventyfive patients having a comminuted radial head fracture with an Evolve® prosthesis (=G1) and 11 with a MoPyC® prosthesis (=G2) were available for a follow-up. Postoperative patient outcomes were evaluated according to a standardized follow-up protocol which included the Morrey rating system. Assessment criteria were range of motion (ROM), functional scores, and rate of complications. G1 showed a mean Morrey score of 86 points. Four direct prosthesis complications were observed in this group (n=75). The average achieved Morrey score in G2 was 84 points. In this group (n=11), 2 direct prosthesis complications were diagnosed. The average range of motion did not differ greatly between both groups. Radial head replacement with either prosthesis yielded sufficient to satisfactory results in a mid-term perspective regarding the range of motion and function of the elbow joint when performed in carefully selected patients. The Evolve® Prothesis appears to show a slightly lower rate of complication by way of a similar functional outcome.
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Affiliation(s)
- Tim Friedrich Raven
- ATORG - Aschaffenburg Trauma and Orthopaedic Research Group, Center of Orthopaedic and Trauma surgery and Sports medicine, Aschaffenburg.,HTRG - Heidelberg Trauma Research Group, Division of Trauma and Reconstructive Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University Hospital Heidelberg
| | - Lukas Banken
- HTRG - Heidelberg Trauma Research Group, Division of Trauma and Reconstructive Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University Hospital Heidelberg.,Schön Klinik Hamburg- Eilbek, Hamburg
| | - Gerhard Schmidmaier
- HTRG - Heidelberg Trauma Research Group, Division of Trauma and Reconstructive Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University Hospital Heidelberg
| | | | | | - Arash Moghaddam
- ATORG - Aschaffenburg Trauma and Orthopaedic Research Group, Center of Orthopaedic and Trauma surgery and Sports medicine, Aschaffenburg.,HTRG - Heidelberg Trauma Research Group, Division of Trauma and Reconstructive Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University Hospital Heidelberg
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12
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Mikel AB, Javier AB, Fausto LM, Ángel PM, Irene LT, Carlos ÁG. A retrospective comparative cohort study of radial head arthroplasty versus resection in complex elbow dislocations. Injury 2020; 51 Suppl 1:S89-S93. [PMID: 32089283 DOI: 10.1016/j.injury.2020.02.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/08/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The management of radial head fractures for the treatment of complex elbow dislocations remains controversial. Until the publication of recent therapeutic algorithms, different actions have been carried out, including resection or arthroplasty of the radial head. This study aims to compare the clinical and radiological results of these two techniques. MATERIALS AND METHODS A retrospective study was conducted between the years 2001 and 2016 in complex elbow dislocations associating comminuted fractures of the radial head (Mason type IV) for two cohorts: 20 patients who received a radial head prosthesis against 12 patients treated with resection. At the end of the follow-up, two functional valuation scales were applied: Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand score (DASH). Radiological study included the presence of post-traumatic osteoarthritis and heterotopic ossifications in both groups; and specific complications in the group of patients treated with an arthroplasty. RESULTS The average age of the sample was 52.2 years in the prosthesis group, and 58.5 for the resection group, with a mean follow-up of 83.8 and 163 months respectively. No statistically significant differences were found in the mean values of the MEPS scale between the two groups (p = 0.5). The mean DASH score was significantly higher in the resection group (29.8 versus 10.3 with p = 0.006). A significantly higher rate of reinterventions and heterotopic ossifications was documented in the group of patients treated with radial head excision. The rate of specific radiological complications in the prosthesis group was 45%. CONCLUSIONS Although radial head resection could be a valid treatment in this group of patients, radial head arthroplasty would remain as the main option for the treatment of these lesions. LEVEL OF EVIDENCE Level IV; Case Series; Treatment Study.
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Affiliation(s)
- Aburto Bernardo Mikel
- Unidad de Cirugía de Hombro y Codo, Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Arnal Burró Javier
- Unidad de Cirugía de Hombro y Codo, Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - López Mombiela Fausto
- Unidad de Cirugía de Hombro y Codo, Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pérez Martín Ángel
- Unidad de Cirugía de Hombro y Codo, Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - López Torres Irene
- Unidad de Cirugía de Hombro y Codo, Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Álvarez González Carlos
- Unidad de Cirugía de Hombro y Codo, Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Jiménez-Martín A, Contreras-Joya M, Navarro-Martínez S, Najarro-Cid F, Santos-Yubero F, Pérez-Hidalgo S. Clinical results of radial arthroplasty in Hotchkiss' terrible triad, a case series of 47. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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14
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Resultados clínicos de la artroplastia radial en la tríada terrible de Hotchkiss, a propósito de 47 casos. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:83-91. [DOI: 10.1016/j.recot.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 09/29/2019] [Accepted: 11/11/2019] [Indexed: 11/20/2022] Open
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Vannabouathong C, Venugopal N, Athwal GS, Moro J, Bhandari M. Radial head arthroplasty: fixed-stem implants are not all equal-a systematic review and meta-analysis. JSES Int 2020; 4:30-38. [PMID: 32195463 PMCID: PMC7075758 DOI: 10.1016/j.jseint.2019.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Background Numerous fixed-stem implants exist for radial head arthroplasty; therefore, we conducted a systematic review to compare the safety and efficacy of different types of fixed-stem implants. Methods We conducted a literature search, updated from a previous systematic review, to identify studies evaluating a fixed-stem radial head arthroplasty implant for any indication. We extracted data on revision rates, specific complications, and functional scores. We pooled results across studies using a random-effects method, using proportions for dichotomous data and mean values for functional scores. We analyzed outcomes by indication and specific implant. Results We included 31 studies. Studies included patients with radial head fractures only, terrible-triad injuries, or Essex-Lopresti injuries or included a heterogeneous population. We identified 15 different fixed-stem implants. The results of our analysis revealed that patients with terrible-triad injuries may be at an increased risk of revision and instability and patients with Essex-Lopresti injuries may be at an increased risk of arthritis, capitellar erosion, and osteolysis. After removing these outliers and pooling the results by specific device, we observed variability across devices in the rates of revision, arthritis, capitellar erosion, instability, and osteolysis, as well as in functional scores. Conclusion Differences were seen across different implants in revision rates, certain complications, and functional scores. This study highlighted that these devices should be evaluated within the context of the patient population under examination, as patients with Essex-Lopresti or terrible-triad injuries may demonstrate worse outcomes relative to those with a fracture only.
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Affiliation(s)
| | | | - George S Athwal
- Department of Surgery, Western University, London, ON, Canada
| | - Jaydeep Moro
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
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Viveen J, Kodde IF, Heijink A, Koenraadt KLM, van den Bekerom MPJ, Eygendaal D. Why does radial head arthroplasty fail today? A systematic review of recent literature. EFORT Open Rev 2020; 4:659-667. [PMID: 32010454 PMCID: PMC6986390 DOI: 10.1302/2058-5241.4.180099] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Since the introduction of the radial head prosthesis (RHP) in 1941, many designs have been introduced. It is not clear whether prosthesis design parameters are related to early failure. The aim of this systematic review is to report on failure modes and to explore the association between implant design and early failure.A search was conducted to identify studies reporting on failed primary RHP. The results are clustered per type of RHP based on: material, fixation technique, modularity, and polarity. Chi-square tests are used to compare reasons for failure between the groups.Thirty-four articles are included involving 152 failed radial head arthroplasties (RHAs) in 152 patients. Eighteen different types of RHPs have been used.The most frequent reasons for revision surgery after RHA are (aseptic) loosening (30%), elbow stiffness (20%) and/or persisting pain (17%). Failure occurs after an average of 34 months (range, 0-348 months; median, 14 months).Press-fit prostheses fail at a higher ratio because of symptomatic loosening than intentionally loose-fit prostheses and prostheses that are fixed with an expandable stem (p < 0.01).Because of the many different types of RHP used to date and the limited numbers and evidence on early failure of RHA, the current data provide no evidence for a specific RHP design. Cite this article: EFORT Open Rev 2019;4:659-667. DOI: 10.1302/2058-5241.4.180099.
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Affiliation(s)
- Jetske Viveen
- Department of Trauma and Orthopedic Surgery, Flinders Medical Centre and University, Adelaide, Australia.,Upper Limb Unit, Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Izaak F Kodde
- Department of Orthopedic Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Andras Heijink
- Department of Orthopedic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Koen L M Koenraadt
- Foundation for Orthopedic Research, Care & Education, Amphia Hospital, Breda, The Netherlands
| | | | - Denise Eygendaal
- Upper Limb Unit, Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands.,Department of Orthopedic Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Abstract
Radial head fractures are common injuries comprising 1/3 of the fractures about the elbow. As a secondary valgus stabilizer of the elbow, radial head fractures can compromise elbow stability leading to long-term pain, dysfunction, and degenerative change. Furthermore, radial head fractures can be accompanied by associated injuries including ligamentous lesions that can further exacerbate elbow instability, leading to long-term sequelae. As fixation principles and technology have evolved, so has the ability to render surgical treatment for these fractures. In general, minimally displaced and some displaced fractures may be treated nonoperatively with early motion. Fractures with a block to rotation and displaced fragments with 3 or fewer fragments may be treated with open reduction and internal fixation. Comminuted fractures or those with greater than 3 fragments may be successfully treated with radial head replacement. Associated elbow instability will also influence treatment decisions.
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18
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Jung M, Groetzner-Schmidt C, Porschke F, Grützner PA, Guehring T, Schnetzke M. Low return-to-sports rate after elbow injury and treatment with radial head arthroplasty. J Shoulder Elbow Surg 2019; 28:1441-1448. [PMID: 31227468 DOI: 10.1016/j.jse.2019.03.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/05/2019] [Accepted: 03/07/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to analyze sports participation after radial head arthroplasty among recreational athletes. METHODS A total of 57 recreational athletes (mean age, 49 years; age range, 18-79 years) treated with radial head arthroplasty for non-reconstructible radial head fractures were included in this retrospective study. The return-to-sports rate and the time to return to sports were analyzed. The clinical and radiologic outcomes were compared between patients who returned to sports (group 1) and those who did not (group 2). RESULTS After a mean follow-up period of 8.4 years (range, 2.5-16.4 years), 30 of 57 patients (53%) had returned to sports. The mean sports frequency significantly decreased from 5.2 ± 5.0 h/week to 2.2 ± 2.9 h/week after surgery (P < .001). In group 1, 83% of patients returned to the same sports activity whereas 17% changed to a less demanding sports activity. The mean time to return to sports was 158 days (range, 21-588 days). Patients who returned to sports had a significantly better Mayo Elbow Performance Score (MEPS) (84 ± 19 points vs. 63 ± 20 points, P < .001); Disabilities of the Arm, Shoulder and Hand score (16 ± 17 vs. 46 ± 22, P < .001); and arc of flexion (114° ± 32° vs. 89° ± 36°, P = .007). A secondary radial head prosthesis (P = .046) and MEPS lower than 85 points (P = .001) were associated with a significantly lower return-to-sports rate. No differences regarding radiographic changes were found between the 2 groups (P ≥ .256). CONCLUSION The return-to-sports rate after radial head replacement is low. A secondary radial head prosthesis and a worse clinical outcome (MEPS < 85 points) significantly increase the risk of not returning to sports after radial head arthroplasty.
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Affiliation(s)
- Matthias Jung
- BG Trauma Center Ludwigshafen University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Ludwigshafen am Rhein, Germany
| | - Corinna Groetzner-Schmidt
- BG Trauma Center Ludwigshafen University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Ludwigshafen am Rhein, Germany
| | - Felix Porschke
- BG Trauma Center Ludwigshafen University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Ludwigshafen am Rhein, Germany
| | - Paul A Grützner
- BG Trauma Center Ludwigshafen University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Ludwigshafen am Rhein, Germany
| | - Thorsten Guehring
- BG Trauma Center Ludwigshafen University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Ludwigshafen am Rhein, Germany
| | - Marc Schnetzke
- BG Trauma Center Ludwigshafen University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Ludwigshafen am Rhein, Germany.
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Vannabouathong C, Akhter S, Athwal GS, Moro J, Bhandari M. Interventions for displaced radial head fractures: network meta-analysis of randomized trials. J Shoulder Elbow Surg 2019; 28:578-586. [PMID: 30626538 DOI: 10.1016/j.jse.2018.10.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/04/2018] [Accepted: 10/19/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to conduct a systematic review of studies comparing treatments for displaced radial head fractures (RHFs) and perform a network meta-analysis of randomized controlled trials (RCTs). METHODS We searched electronic databases and reviewed the reference lists of included studies and prior systematic reviews. We included RCTs and cohort studies that (1) compared treatments for displaced RHFs in adults and (2) reported a functional outcome or postoperative complications. Data from RCTs were synthesized using a Bayesian network meta-analysis. We compared the proportion of patients categorized as "excellent" or "good" according to the Broberg and Morrey scale and the rate of postoperative complications using odds ratios (OR) with 95% credible intervals (CrI). RESULTS We included 20 studies (4 RCTs). The evidence from RCTs examined radial head arthroplasty (RHA), open reduction and internal fixation (ORIF) with metal implants (ORIF-M), and ORIF with biodegradable implants (ORIF-B). The network meta-analysis demonstrated that patients treated with an RHA had greater odds of achieving an "excellent" or "good" score compared with ORIF-M (OR, 22.5; 95% CrI, 2.73-299.58) and ORIF-B (OR, 11.83; 95% CrI, 0.58-324.57). For postoperative complications, RHA patients had a lower odds of experiencing a complication than ORIF-M (OR, 0.15; 95% CrI, 0.01-1.81) and ORIF-B (OR, 0.16; 95% CrI, 0.01-3.06) patients. CONCLUSION The network meta-analysis of RCTs indicated that RHA results in better function and reduced postoperative complications than ORIF-M and ORIF-B over 2 years in the treatment of displaced RHFs.
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Affiliation(s)
| | - Shakib Akhter
- Department of Health, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - George S Athwal
- Department of Surgery, Western University, London, ON, Canada
| | - Jaydeep Moro
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
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Erickson J, Liu JX, Glickel SZ. Failure of Adjustably Aligned Modular Radial Head Arthroplasty With Head-Neck Dissociation and Metallosis. J Hand Surg Am 2019; 44:253.e1-253.e5. [PMID: 30292711 DOI: 10.1016/j.jhsa.2018.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 06/08/2018] [Accepted: 07/25/2018] [Indexed: 02/02/2023]
Abstract
Radial head arthroplasty was introduced in 1941 and the literature supports satisfactory overall midterm patient outcomes and acceptable complication profiles with several models. There are several previously described mechanisms by which radial head complications typically occur. We present the case of a rarely described mechanism of radial head implant failure: elbow synovitis and pain from partial dissociation and metallosis in an adjustably aligned, modular, monopolar, mixed metal, press-fit radial head arthroplasty.
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Affiliation(s)
- John Erickson
- Department of Orthopaedic Surgery, Division of Hand Surgery, NYU Langone Medical Center Hospital for Joint Diseases, New York, NY
| | - James X Liu
- Department of Orthopaedic Surgery, Division of Hand Surgery, NYU Langone Medical Center Hospital for Joint Diseases, New York, NY.
| | - Steven Z Glickel
- Department of Orthopaedic Surgery, Division of Hand Surgery, NYU Langone Medical Center Hospital for Joint Diseases, New York, NY
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21
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Agyeman KD, Damodar D, Watkins I, Dodds SD. Does radial head implant fixation affect functional outcomes? A systematic review and meta-analysis. J Shoulder Elbow Surg 2019; 28:126-130. [PMID: 30342823 DOI: 10.1016/j.jse.2018.07.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 07/16/2018] [Accepted: 07/29/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radial head arthroplasty is used in the treatment of nonreconstructible radial head fractures. Although traditional implants have been loosely fixed, smooth stemmed implants functioning more as spacers, modern designs have introduced press-fit, tapered implants that articulate at the capitellum with more rigidly maintained congruity. Cemented implants also use rigid initial fixation. This study was conducted to help determine which fixation method results in better functional outcomes: "fixed" or "unfixed." METHODS A systematic review and meta-analysis was used. We identified 63 articles via 3 databases. Ten non-English or articles with insufficient text were excluded, and 17 others did not contain sufficient data or follow-up. The remaining 36 articles were qualitatively and quantitatively reviewed. RESULTS We identified 36 populations, with 878 unduplicated patients: 522 fixed and 356 unfixed. Respectively, mean follow-up in months was 46.2 and 37.4. Average Mayo Elbow Performance Scores were 85.9 and 88.2 (P = .08). Average Disabilities of the Arm, Shoulder and Hand scores were 17.1 and 18.7 (P = .47). Average final flexion/extension arcs were 119.1° and 115.8° (P = .08). Revision rates were 7.9% and 3.1%, and complication rates were 25.5% and 13.2%. Relative risks of revision and complications for the fixed cohort were 2.48 (P = .006) and 1.88 (P < 0.0001), respectively. CONCLUSIONS Implant fixation type does not appear to affect functional outcomes of radial head arthroplasty. However, rigidly fixing the implant may increase the risks of revision and complications.
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Affiliation(s)
- Kofi D Agyeman
- Department of Orthopaedic Surgery and Rehabilitation, University of Miami Hospital, Miami, FL, USA; Department of Orthopaedic Surgery and Rehabilitation, Jackson Memorial Hospital, Miami, FL, USA.
| | - Dhanur Damodar
- Department of Orthopaedic Surgery and Rehabilitation, University of Miami Hospital, Miami, FL, USA; Department of Orthopaedic Surgery and Rehabilitation, Jackson Memorial Hospital, Miami, FL, USA
| | - Ian Watkins
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Seth D Dodds
- Department of Orthopaedic Surgery and Rehabilitation, University of Miami Hospital, Miami, FL, USA; Department of Orthopaedic Surgery and Rehabilitation, Jackson Memorial Hospital, Miami, FL, USA
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Complications after radial head arthroplasty: a comparison between short-stemmed bipolar and monopolar long-stemmed osteointegrative rigidly fixed prostheses. INTERNATIONAL ORTHOPAEDICS 2018; 43:1917-1925. [PMID: 30267243 DOI: 10.1007/s00264-018-4173-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION To date, only a few studies have compared radial head prostheses (RHP) and their different anchoring principles. The aim of this study was to characterize concomitant injuries, necessary adjuvant procedures, complications, and radiological findings after implantation of two different types of RHP. METHODS Sixty-six patients with radial head fractures were treated with MoPyC (Tornier/France, 50 mm stem, monopolar) or SBI rHead prostheses (Small Bone Innovations/USA, 22-mm stem, bipolar) and followed up over 42 months (16-64 months). Primary objective was the detection of different loosening and explantation rates. In addition to the revision rate and the reasons for revision, we also used radiological findings to assess the dynamics of lysis phenomena. RESULTS Thirty-five patients (mean age 48 years; 22-73 years) were treated with the MoPyC, and 31 patients (mean age 47 years, 19-69 years) with the rHead prosthesis. Of these, 98% had a Mason 3 or 4 type of radial head fracture, and 94% showed concomitant injuries, which were addressed in 89% of cases by adjuvant procedures. The surgical revision rate was 20% (rHead 23%; MoPyC 18%). Significantly more of the rHead prostheses had to be explanted compared to MoPyC prostheses because of painful loosening (16% vs. 3%; p = 0.029). Predictors of subsequent loosening were significant radiolucent lines in the RHP over the first six months and an increase in width by two and a half times within the first 50 days after implantation. CONCLUSION Complex radial head fractures are frequent and difficult to treat. The monopolar long-stemmed prosthesis showed significantly lower rates of painful loosening and explanation rates than the bipolar short-stemmed prosthesis.
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Radial Head Resection versus Arthroplasty in Unrepairable Comminuted Fractures Mason Type III and Type IV: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4020625. [PMID: 30112387 PMCID: PMC6077546 DOI: 10.1155/2018/4020625] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 07/03/2018] [Indexed: 12/03/2022]
Abstract
Unrepairable comminuted fractures of the radial head Mason type III or type IV have poor outcomes when treated by open reduction and internal fixation. Radial head resection has been proposed as good option for surgical treatment, while in the last decades, the development of technology and design in radial head prosthesis has increased efficacy in prosthetic replacement. The present review was conducted to determine the best surgical treatment for comminuted radial head when ORIF is not possible. Better outcomes are reported for radial head arthroplasty in terms of elbow stability, range of motion, pain, and fewer complications compared to radial head excision. Nevertheless, radial head resection still can be considered an option of treatment in isolated radial head fractures with no associated ligament injuries lesion of ligaments or in case of older patients with low demanding function.
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