1
|
Ayuob A, Ur-Rahman Z, Jordan RW, D'Alessandro P, MacLean S, Malik SS. Pyrocarbon radial head arthroplasty offers satisfactory clinical and radiological outcomes with low revision rate: A systematic review. Orthop Traumatol Surg Res 2024; 110:103750. [PMID: 37949394 DOI: 10.1016/j.otsr.2023.103750] [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] [Received: 03/08/2023] [Revised: 09/16/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Pyrocarbon promises to be an optimal material choice for radial head arthroplasty (RHA) due to an elastic modulus comparable to the radial diaphysis and thus providing higher biocompatibility. Primary objective was to determine the complications and revision rates related to the usage of these prostheses. The secondary objective was to assess the clinical and radiological outcomes of Pyrocarbon RHAs. HYPOTHESIS Pyrocarbon RHAs have good clinical and radiological outcomes with low complications and revisions. METHODS Ovid MEDLINE and Embase databases were used to search for studies on outcomes and complications of the RHAs using Pyrocarbon radial head prostheses. The systematic review was designed in accordance with the PRISMA guidelines and included studies were appraised using the MINORS tool. Complications and RHA revision rates were assessed. Functional outcomes were reviewed using PROMs (like MEPI, DASH and BMS), post-op range of motion (using goniometer) and grip strength (using the dynamometer). Postoperative radiological outcomes like peri-prosthetic lucency, radial neck osteolysis, radio-capitellar congruence, capitellar erosion, overstuffing/understuffing and osteoarthritis were reported using radiographs. RESULTS A total of 12 studies cumulatively reporting 353 patients who underwent Pyrocarbon RHAs were included in the review. The mean age of patients across the studies ranged from 47 to 54 years of which 50.5% were males. The majority of radial head replacements were done for acute trauma (87.5%) with the remainder done for arthritis (1.7%) and trauma sequelae (10.8%). Mean follow-up period in the selected studies ranged from 18 to 110 months with minimum follow-up across all studies being 12 months. Modular Pyrocarbon (MoPyC, Tornier™) was the implant of choice in ten studies while two studies used the Ascension Pyrocarbon radial head (Ascension Orthopaedics™). Ten studies demonstrated mean MEPI ranging from 75.5 to 96. Mean extension deficit ranged from 6 to 19 degrees, mean flexion from 120 to 140 degrees, mean pronation from 71 to 87 degrees and mean supination from 63 to 85 degrees. Relative grip strength ranged from 69 to 96% of the contralateral limb. Revisions due to implant-related reasons (intra-prosthetic dissociation, prosthetic fracture, peri-prosthetic loosening, radio-capitellar subluxation and understuffed/overstuffed elbow) was 6.8% (24/353). Radial stress shielding and peri-prosthetic lucency was reported in 10 to 100% of patients across different studies but symptomatic implant loosening leading to revision remained rare (2%, 7/353). Radio-capitellar congruence was reported in 81% to 100% cases while capitellar erosion ranged from 0% to 89%. Pyrocarbon implants specific complications included head-neck intra-prosthetic decoupling (1.1%) and pyrocarbon head fractures (0.9%). In total, 5.7% cases underwent re-surgery due to non-RHA related reasons. DISCUSSION The pyrocarbon RHA shows good functional outcome, range of motion and low revision rates. This aligns with the working hypothesis of this review. However, pyrocarbon radial head implants have implant-specific complications like pyrocarbon radial head fractures and intra-prosthetic decoupling between stem and head. Despite promising in vitro biomechanical properties, capitellar wear is still a common finding with pyrocarbon RHAs. Despite these factors, pyrocarbon radial head implants are a viable option for radial head arthroplasty. LEVEL OF EVIDENCE II; Systematic review.
Collapse
Affiliation(s)
- Atif Ayuob
- Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom.
| | - Zain Ur-Rahman
- Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom
| | - Robert W Jordan
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Peter D'Alessandro
- Orthopaedic Research Foundation of Western Australia, Perth, Australia; Medical School, University of Western Australia, Perth, Australia
| | | | - Shahbaz S Malik
- Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom
| |
Collapse
|
2
|
Giannetti S, Smimmo A, Torre G, Stancati A, Pagano E, Santucci A. Percutaneous treatment of radial neck fractures in adult patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1413-1418. [PMID: 38227012 DOI: 10.1007/s00590-023-03811-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/15/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION Radial neck fractures in adults are rare, but outcomes are often poor. Closed reduction and internal fixation (CRIF) technique has been advocated for the treatment of minimally displaced fractures in children, with a few reports on adult subjects. The aim of the present paper is to investigate mid-term results of a CRIF technique in adults with retrograde intramedullary K-wires in Mason's type II and III fractures. The proposed technique yields to good anatomical reduction of displaced neck fractures, faster rehabilitation, and easier hardware removal after fracture consolidation. MATERIAL AND METHODS A consecutive series of 17 patients were treated with closed reduction and intramedullary osteosynthesis, and outcomes were retrospectively evaluated. Elbow X-ray (XR) and CT scan were obtained preoperatively. Objective assessment before surgery and at an average 36-month follow-up included active and passive elbow range of motion (ROM). Functional evaluation was carried out through the collection of the Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder, and Hand (DASH) score, and Elbow Self-Assessment Score (ESAS). XR at last follow-up was evaluated. RESULTS The cohort included 10 males and seven females, with a mean age of 32 years. Patients returned for a follow-up evaluation at a mean of 36 months (range 6-43 m) form the surgery. The DASH score revealed good to excellent outcomes with a mean of 6.32 ± 10.24 points at last follow-up. The ESAS was 98.35 ± 1.89, indicating a non-restricted elbow function. Acceptable radiographic healing was achieved in all patients. CONCLUSIONS The advocated technique is promising for obtaining good reduction and stabilization, and good to excellent satisfaction for patients. Given the challenging technique, the learning curve could be long and initial results unsatisfactory. More research with larger cohorts and improved study design could be carried out, comparing the technique with the current choice of treatment (ORIF, radial head resection).
Collapse
Affiliation(s)
- Silvio Giannetti
- Casa Di Cura Villa Stuart, Via Trionfale, 5952, 00135, Roma, Italy
| | | | - Guglielmo Torre
- Casa Di Cura Villa Stuart, Via Trionfale, 5952, 00135, Roma, Italy
| | - Andrea Stancati
- Casa Di Cura Villa Stuart, Via Trionfale, 5952, 00135, Roma, Italy
| | - Ernesto Pagano
- Casa Di Cura Villa Stuart, Via Trionfale, 5952, 00135, Roma, Italy
| | - Attilio Santucci
- Casa Di Cura Villa Stuart, Via Trionfale, 5952, 00135, Roma, Italy
| |
Collapse
|
3
|
Müller M, Mann V, Zapf J, Kirchhoff K, Zyskowski M, Biberthaler P, Kirchhoff C, Wurm M. Functional Postoperative Outcome for 92 Cases of Radial Head Fractures: A PROM-Based Retrospective Study. J Clin Med 2023; 12:5870. [PMID: 37762809 PMCID: PMC10532215 DOI: 10.3390/jcm12185870] [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: 07/27/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Background: Fractures of the radial head are common injuries, whereas, in the case of displaced fractures, surgical treatment using screw or plate osteosynthesis, excision, or replacement of the radial head is required. However, data about patient-related outcomes (PROM) for different types of radial head fractures is limited in the current literature. Therefore, this study was conducted to evaluate the functional outcome after operatively treated radial head fractures and to further correlate these results with the initial modified Mason classification. Methods: In this retrospective study, all suitable patients with surgical treatment of a radial head fracture were identified. Only patients with Mason II-IV fractures were included. All patients completed the Elbow Self-Assessment Score (ESAS) questionnaire. Data on fracture classification, type of surgery, and revision operations (if needed) were assessed. Results: A total of 92 patients suffering from fractures of the radial head (57 Mason II, 35 Mason III-fractures) who were operatively treated at our institution were enrolled. There were 42 (47.7%) female and 50 (54.3%) male patients with an average age of 47.5 ± 14.1 years. Screw osteosynthesis was performed in 67 patients, plate osteosynthesis in 20 patients, and five patients received radial head arthroplasty. The average ESAS score accounted for 89.7 ± 16.7. Mason II fractures showed significantly better functional results with higher ESAS scores (92.3 ± 13.9 vs. 85.4 ± 20.1) as well as significantly lower rates of necessary implant removal (0 vs. 5 (14.3%) than Mason III fractures. Screw osteosynthesis showed significantly better functional ESAS scores, 91.0 ± 16.5, than plate osteosynthesis, with 85.3 ± 17.6 (p = 0.041), but was predominantly used in Mason II fractures. Conclusions: Surgical treatment using screw- and plate osteosynthesis of radial head fractures provides a good overall outcome. The postoperative function is associated with the initial Mason classification as the patients' reported outcome was worse in Mason III fractures compared to Mason type II fractures. In this context, the ESAS score can be considered a useful tool for the assessment of the patient-based functional outcome.
Collapse
Affiliation(s)
- Michael Müller
- Department of Trauma Surgery, Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany (J.Z.); (M.Z.); (M.W.)
| | | | | | | | | | | | | | | |
Collapse
|
4
|
Campbell BR, Rengifo S, Wickes CB, Amer KM, Ilyas AM. Radial Head Arthroplasty for Fracture: Implant Survivorship and Outcomes at Mean Follow-up of 8 Years. J Hand Surg Am 2023:S0363-5023(23)00253-8. [PMID: 37354192 DOI: 10.1016/j.jhsa.2023.04.020] [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: 01/05/2023] [Revised: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE The purpose of this study was to evaluate implant survivorship and clinical outcomes following radial head arthroplasty for fracture at long-term follow-ups. METHODS A retrospective analysis was conducted on adult patients who underwent primary uncemented radial head arthroplasty for radial head or neck fractures between 2012 and 2015. Medical records were reviewed to collect information regarding demographics, injury characteristics, reoperations, and revisions requiring implant removal. A bivariate analysis was conducted to identify potential risk factors for reoperation. A Kaplan-Meier curve was created to determine implant survival rates. Eligible patients were contacted to confirm any reoperations and obtain Quick Disability of the Arm, Shoulder, and Hand scores at long-term follow-ups. RESULTS A total of 89 patients were eligible for analysis and assessed at a mean of 97 months after surgery (range, 81-128). Reoperation rate was 16% (14 of 89 patients), including 5% of patients requiring implant removal or revision. However, 93% of reoperations occurred within the first 12 months of the index surgery. Fracture dislocations of the elbow had a higher rate of reoperation. A Kaplan-Meier curve demonstrated an implant survival rate of 96% at 10-year follow-up. Of the patients who responded, the mean Quick Disability of the Arm, Shoulder, and Hand score was 8.7 ± 10.3, with none requiring additional reoperations or revisions. There were otherwise similar outcome scores among patients requiring reoperation versus those who did not. CONCLUSIONS Although radial head arthroplasty for fractures has a high potential for reoperation within the first year, survival rates with uncemented implants remain high at 10 years, and patients report excellent Quick Disability of the Arm, Shoulder, and Hand scores at long-term follow-ups, despite any need for reoperation. Fractures with associated elbow dislocation may be at a higher risk for reoperation, and it is important to provide this prognostic information to patients who are likely to require arthroplasty for more extensive injuries. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Benjamin R Campbell
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Santiago Rengifo
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Catherine B Wickes
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Kamil M Amer
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Asif M Ilyas
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
| |
Collapse
|
5
|
Barret H, Mansat P, Langlais T, Favard L, Chammas M, Coulet B. After failed radial head arthroplasty, what are the options? Risk factors and results of revisions in a multicenter study. J Clin Orthop Trauma 2023; 38:102128. [PMID: 36860992 PMCID: PMC9969247 DOI: 10.1016/j.jcot.2023.102128] [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: 07/02/2022] [Revised: 12/08/2022] [Accepted: 02/11/2023] [Indexed: 03/03/2023] Open
Abstract
Introduction Few multicenter studies have analyzed the outcome of revision surgery of radial head arthroplasties (RHA) in the medium term follow up. The objective is twofold: to determine the factors associated with revision of RHAs and to analyze the results of revision with 2 surgical techniques: isolated removal of the RHA or revision with a new RHA (R-RHA). Hypothesis There are associated factors of RHA revision and RHA revision results in satisfactory clinical and functional outcomes. Methods Twenty-eight patients were included in this multicenter retrospective study, with all surgical indications for initial RHA being traumatic/post-traumatic. The mean age was 47 ± 13 years with a mean follow-up of 70 ± 48 months. This series included two groups: the isolated RHA removal group (n = 17) and the revision RHA with new radial head prosthesis (R-RHA) group (n = 11). Evaluation was clinical and radiological with univariate and multivariate analysis. Results Two factors associated with RHA revision were identified: a pre-existing capitellar lesion (p = 0.047) and a RHA placed for a secondary indication (<0.001). Revision for all 28 patients resulted in improved pain (pre-op Visual Analog Scale 4.7 ± 3 vs. post-op 1.57 ± 2.2, p < 0.001), mobilities (pre-op flexion 118 ± 20 vs. post-op 130 ± 13, p = 0.03; pre-op extension -30 ± 21 vs post-op -20 ± 15, p = 0.025; pre-op pronation 59 ± 12 vs post-op 72 ± 17, p = 0.04; pre-op supination 48 ± 2 vs post-op 65 ± 22, p = 0.027) and functional scores. Mobility and pain control were, for stable elbows, satisfactory in the isolated removal group. When the initial or revision indication was instability, the DASH (Disabilities of the Arm, Shoulder and Hand = 10 ± 5) and MEPS (Mayo Elbow Performance score = 85 ± 16) scores were satisfactory in the R-RHA group. Discussion In the case of a radial head fracture, RHA is a satisfactory first-line solution without pre-existing capitellar injury, its results being much weaker in the case of ORIF failure and fracture sequelae. In case of RHA revision, isolated removal or R-RHA adapted according to the pre-operative radio-clinical exam. Level of evidence IV.
Collapse
Affiliation(s)
- Hugo Barret
- Hand and Upper Limb Surgery Department, Lapeyronie University Hospital, Montpellier, France
| | - Pierre Mansat
- Department of Orthopaedic Surgery, Riquet Hospital, University of Toulouse, Toulouse, France
| | - Tristan Langlais
- Department of Orthopaedic Surgery, Riquet Hospital, University of Toulouse, Toulouse, France
| | - Luc Favard
- Trousseau University Hospital, Tours, France
| | - Michel Chammas
- Hand and Upper Limb Surgery Department, Lapeyronie University Hospital, Montpellier, France
| | - Bertrand Coulet
- Hand and Upper Limb Surgery Department, Lapeyronie University Hospital, Montpellier, France
| |
Collapse
|
6
|
Does stress shielding after radial head arthroplasty affect functional outcomes? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022:10.1007/s00590-022-03315-x. [PMID: 35763223 DOI: 10.1007/s00590-022-03315-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 06/06/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Various complications related to the prosthesis, such as implant loosening and stress shielding phenomenon, could develop after prosthetic replacement of the radial head. Stress shielding is known to occur around rigidly fixed implants. The purpose of this study was to evaluate the clinical influence and causative factors of the stress shielding phenomenon after radial head arthroplasty (RHA). METHODS Clinical records and radiographs of 56 patients with unreconstructable radial head fractures who received radial head replacement between 2009 and 2019 were reviewed. Exclusion criteria were infection, loosening, and follow-up of less than 24 months. After exclusion, 35 patients were enrolled. Patients were divided into two groups: an anatomical press-fit group (Anatomical Radial Head System; Acumed, Hillsboro, OR, USA) and a round bipolar cemented group (RHS; Tornier, Montbonnot Saint-Martin, France). Stress shielding around the prosthesis was assessed in the serial radiological examination. Clinical results were assessed using Mayo elbow performance score (MEPS), Quick Disabilities of the Arm, Shoulder, and Hand (q-DASH) score, range of motion (flexion-extension arc and pronation-supination arc), and visual analog scale score (VAS). Correlations between stress shielding phenomenon and demographic data and functional results were analyzed. RESULTS At an average follow-up of 43.06 (± 14.6) months, 14 (40%) out of 35 fixed stems demonstrated stress shielding. Our results showed that the rate of stress shielding was significantly higher in cases with a bilateral ligament injury and in the anatomical press-fit group (p = 0.028 and p = 0.0091, respectively). However, stress shielding around prostheses did not affect the clinical results (p > 0.05). CONCLUSION The stress shielding phenomenon around radial head prosthesis may vary according to prosthetic design and severity of ligament injuries. Stress shielding does not affect the mid-term outcomes in the treatment of acute fractures of the radial head. LEVEL OF EVIDENCE III Retrospective Cohort Comparison; Treatment Study.
Collapse
|
7
|
Chaijenkij K, Arirachakaran A, Kongtharvonskul J. Clinical outcomes after internal fixation, arthroplasty and resection for treatment of comminuted radial head fractures: a systematic review and network meta-analysis. Musculoskelet Surg 2021; 105:17-29. [PMID: 33026602 DOI: 10.1007/s12306-020-00679-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 08/05/2020] [Indexed: 05/13/2023]
Abstract
BACKGROUND Radial head fractures make up approximately 3% of all fractures, and they are the most common elbow fracture in adults. The treatment for comminuted radial head fracture remains controversial. This systematic review was conducted with the aim to compare postoperative outcomes among surgical treatments to identify which method is the best for comminuted radial head fractures. METHODS Relevant studies were identified from Medline and Scopus from inception to February 22, 2020, that reported Mayo Elbow Performance Index (MEPI) score and postoperative complications of either treatment. A network meta-analysis was applied to assess treatment outcomes. Probability of being the best treatment was estimated using surface under the cumulative ranking curves (SUCRA). RESULTS Twelve comparative studies and one randomized controlled trial (N = 526 patients) met the inclusion criteria. Interventions included open reduction and internal fixation (ORIF) (N = 210 patient), radial head arthroplasty (RHA) (N = 227 patients) and radial head resection (RHR) (N = 152 patients). A network meta-analysis showed that the MEPI of RHA was significantly higher when compared to ORIF and RHR, with a pooled mean MEPI of 7.28 (1.69, 12.86) and - 7.32 (- 13.21, - 1.43), respectively. In terms of complications, RHA and RHR had lower risk with RRs of 0.61 (0.29, 1.31) and 0.54 (0.24, 1.25) when compared to ORIF. The SUCRA probabilities of RHA and RHR were in the first rank with 99.2% in MEPI and 60.6% in complications, respectively. CONCLUSIONS This study suggests that RHA is the best treatment of choice for efficacy and safety in the treatment of comminuted radial head fracture, while RHR is the safest choice to minimize postoperative complications and enable patients to perform all daily life activities.
Collapse
Affiliation(s)
- K Chaijenkij
- Orthopedic Department, College of Sports Science and Technology, Mahidol University, Bangkok, Thailand
| | - A Arirachakaran
- Orthopedics Department, Bumrungrad International Hospital, Bangkok, Thailand
| | - J Kongtharvonskul
- Sport and Orthopedic Center, Samitivej Hospital and Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand.
| |
Collapse
|
8
|
Marcheix PS, Cuenca C, Vergnenegre G, Mabit C, Hardy J, Charissoux JL. Factors influencing the mid-term radiological and functional outcomes of 41 post-fracture bipolar radial head arthroplasty cases at a mean follow-up of 87 months. Orthop Traumatol Surg Res 2021; 107:102818. [PMID: 33484903 DOI: 10.1016/j.otsr.2021.102818] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/25/2020] [Accepted: 05/05/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION When treating comminuted radial head fractures that cannot be adequately fixed, the next option is arthroplasty (radial head replacement). We hypothesized that the radiological and functional outcomes of bipolar mobile cup radial head arthroplasty is not influenced by the length of follow-up but instead by the correct positioning of the implant intraoperatively and by the presence of associated bone or ligament injuries. PATIENTS AND METHODS Between May 1998 and December 2016, 82 cases of radial head arthroplasty were performed at our hospital. The mean age of patients at the time of arthroplasty was 53 years (22-81). Ligament or bone injuries complicated the radial head fractures in 70% of patients. RESULTS For the final assessment, 41 patients were reviewed and included in the statistical analysis with a mean of 82 months (12-228). The mean MEPS at the final assessment was 88.7 (61-100). There were 23 excellent, 9 good, 9 average and 0 poor results. The average DASH score was 18.7 (0-55). The average VAS for pain was 1.0 (0-5). Five patients (12%) required surgical revision, including one implant change. Our statistical analysis found no relationship between follow-up time and functional outcomes. The appearance of periprosthetic radiolucent lines was not affected by the length of follow-up. Associated bone or ligament injuries significantly increased the probability of periprosthetic radiolucent lines, humeroulnar joint degeneration and decentering of the implanted cup. Radiological evidence of a suspended implant was associated with significantly worse functional outcomes. CONCLUSION This study confirms the long-term stability of the clinical outcomes of radial head arthroplasty. There was no relationship between worsening radiological appearance of the implant and the clinical outcomes. It is critical that this implant not be oversized or suspended, as this can trigger premature capitellar erosion and painful stiffness of the operated elbow. LEVEL OF EVIDENCE IV; systematic retrospective analysis.
Collapse
Affiliation(s)
- Pierre-Sylvain Marcheix
- Department of orthopedic surgery, Dupuytren university hospital, 2, avenue Martin Luther-King, 87042 Limoges, France.
| | - Céline Cuenca
- Department of orthopedic surgery, Dupuytren university hospital, 2, avenue Martin Luther-King, 87042 Limoges, France
| | - Guillaume Vergnenegre
- Department of orthopedic surgery, Dupuytren university hospital, 2, avenue Martin Luther-King, 87042 Limoges, France
| | - Christian Mabit
- Department of orthopedic surgery, Dupuytren university hospital, 2, avenue Martin Luther-King, 87042 Limoges, France
| | - Jérémy Hardy
- Department of orthopedic surgery, Dupuytren university hospital, 2, avenue Martin Luther-King, 87042 Limoges, France
| | - Jean-Louis Charissoux
- Department of orthopedic surgery, Dupuytren university hospital, 2, avenue Martin Luther-King, 87042 Limoges, France
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Baek CS, Kim BS, Kim DH, Cho CH. Short- to mid-term outcomes of radial head replacement for complex radial head fractures. Clin Shoulder Elb 2020; 23:183-189. [PMID: 33330256 PMCID: PMC7726358 DOI: 10.5397/cise.2020.00325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/24/2020] [Accepted: 11/24/2020] [Indexed: 11/25/2022] Open
Abstract
Background The purpose of the current study was to investigate short- to mid-term outcomes and complications following radial head replacement (RHR) for complex radial head fractures and to identify factors associated with clinical outcomes. Methods Twenty-four patients with complex radial head fractures were treated by RHR. The mean age of the patients was 49.8 years (range, 19–73 years). Clinical and radiographic outcomes were evaluated for a mean follow-up period of 58.9 months (range, 27–163 months) using the visual analog scale (VAS) score for pain, the Mayo elbow performance score (MEPS), the quick disabilities of the arm, shoulder and hand (Quick-DASH) score, and serial plain radiographs. Complications were also evaluated. Results At the final follow-up, the mean VAS score, MEPS, and Quick-DASH score were 0.6±1.1, 88.7±11.5, and 19.4±7.8, respectively. The mean range of motion was 132.7° of flexion, 4.7° of extension, 76.2° of pronation, and 77.5° of supination. Periprosthetic lucency was observed in six patients (25%). Heterotopic ossification was observed in four patients (16.7%). Arthritic change of the elbow joint developed in seven patients (29.2%). Capitellar wear was found in five patients (20.8%). Arthritic change of the elbow joint was significantly correlated with MEPS (P=0.047). Four cases of complications (16.6%) were observed, including two cases of major complications (one stiffness with heterotopic ossification and progressive ulnar neuropathy and one stiffness) and two cases of minor complications (two transient ulnar neuropathy). Conclusions RHR for the treatment of complex radial head fractures yielded satisfactory short- to mid-term clinical outcomes, though radiographic complications were relatively high.
Collapse
Affiliation(s)
- Chung-Sin Baek
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Beom-Soo Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Du-Han Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Chul-Hyun Cho
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| |
Collapse
|
11
|
Antoni M, Kempf JF, Clavert P. Comparison of bipolar and monopolar radial head prostheses in elbow fracture-dislocation. Orthop Traumatol Surg Res 2020; 106:311-317. [PMID: 32173303 DOI: 10.1016/j.otsr.2019.10.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 09/27/2019] [Accepted: 10/11/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The role of bipolar radial head prostheses (RHP) in elbow fracture-dislocation is controversial, with some reports of poorer stabilization than with monopolar designs. The aim of the present study was to compare mono- versus bi-polar RHPs in elbow fracture-dislocation. The study hypothesis was that mono- and bi-polar RHPs do not differ in clinical and radiological results, complications or revision rates. MATERIAL AND METHODS A single-center retrospective study included 58 patients, with a mean age of 55 years (range, 21-84 years). All received RHP for elbow dislocation with association: terrible triad, Monteggia fracture-dislocation, transolecranal dislocation or divergent dislocation. Two groups were compared: Mono-RHP, with monopolar prosthesis (n=40), and Bi-RHP, with bipolar prosthesis (n=18). All patients underwent clinical and radiological examination at last follow-up. RESULTS Mean follow-up was 42.7 months (range, 12-131 months). There were no significant (p>0.05) inter-group differences in range of motion or Mayo Elbow Performance Score. Mono- versus bi-polar design did not correlate with onset of complications (p=0.89), surgical revision (p=0.71), persistent or recurrent instability (p=0.59), or ulnohumeral (p=0.62) or capitulum (p=0.159) osteoarthritis at last follow-up. DISCUSSION AND CONCLUSION No differences were found between mono- and bi-polar RHPs in the treatment of elbow fracture-dislocation. Clinical and radiographic results were similar, as were complications and revision rates. The literature is inconclusive, reporting contradictory conclusions. We see no contraindications to bipolar RHPs in elbow dislocation with association, notably terrible triad injury. LEVEL OF EVIDENCE III, Retrospective case-control study.
Collapse
Affiliation(s)
- Maxime Antoni
- Service de chirurgie du membre supérieur, Pôle de Chirurgie Orthopédique et de Traumatologie, hôpital de Hautepierre 2; CHU Strasbourg, 1, avenue Molière, 67200 Strasbourg, France.
| | - Jean-François Kempf
- Service de chirurgie du membre supérieur, Pôle de Chirurgie Orthopédique et de Traumatologie, hôpital de Hautepierre 2; CHU Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - Philippe Clavert
- Service de chirurgie du membre supérieur, Pôle de Chirurgie Orthopédique et de Traumatologie, hôpital de Hautepierre 2; CHU Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| |
Collapse
|
12
|
High Risk of Further Surgery After Radial Head Replacement for Unstable Fractures: Longer-term Outcomes at a Minimum Follow-up of 8 Years. Clin Orthop Relat Res 2019; 477:2531-2540. [PMID: 31389899 PMCID: PMC6903861 DOI: 10.1097/corr.0000000000000876] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The evidence for treating acute, unreconstructable radial head fractures in unstable elbows with radial head replacement predominantly consists of short- to mid-term follow-up studies with a heterogenous mix of implants and operative techniques. Data on longer-term patient-reported outcomes after radial head replacement is lacking. QUESTIONS/PURPOSES (1) What proportion of patients undergo revision or implant removal after radial head replacement? (2) At a minimum of 8 years follow-up, what are the patient-reported outcomes (QuickDASH, Oxford Elbow Score, and EuroQol-5D)? (3) What factors are associated with a superior long-term patient-reported outcome, according to the QuickDASH? METHODS Between September 1994 and September 2010, we surgically treated 157 patients for acute radial head fractures. We excluded patients where the radial head was excised (n = 21), internally fixed (n = 15), or replaced as a secondary procedure after failed internal fixation (n = 2). A total of 119 patients who underwent radial head replacement surgery for an acute unreconstructable fracture were included, with a mean age of 50 years (range 15 to 93 ± 19 years), and 53% of patients (63) were women. All but two implants were uncemented, loose-fitting, monopolar prostheses, of which 86% (102) were metallic and 14% (17) were silastic. Implants were only cemented if they appeared unstable within the proximal radius. Silastic implants were used in the earlier series and replaced by metallic implants starting in 2000. We reviewed electronic records to document postoperative complications and prosthesis revision and removal. A member of the local research team (THC, CDC) who was not previously involved in patient care contacted patients to confirm complications, reoperations and to obtain long-term patient-reported outcomes scores. Nineteen patients had died at the point of outcome score collection. Of the remaining 100 patients, 80 were contacted (67% of total cohort), at a median of 11 years (range 8 to 24 years) after injury. The primary outcome measure was the QuickDASH score. RESULTS Of 119 patients, 25% (30) underwent reoperation, with three patients undergoing revision and 27 patients undergoing prosthesis removal at a median of 7 months (range 0 to 125 months). Twenty-one of 30 procedures (70%) occurred within 1 year after implantation. Kaplan-Meier survivorship analysis demonstrated a cumulative implant survival rate of 71%. In the 80 patients contacted, the mean QuickDASH score was 13 ± 14, the mean Oxford Elbow Score was 43 ± 6, and the median EuroQol-5D score was 0.8 (-0.3 to 1.0). After controlling for covariates, we found that prothesis revision or removal (p = 0.466) and prosthesis type (p = 0.553) were not associated with patient-reported outcome, according to the QuickDASH. CONCLUSIONS The management of acute unreconstructable fractures of the radial head in unstable elbow injuries with radial head replacement has a high risk of reoperation. Patients must be counselled regarding this risk of secondary intervention, of which the peak risk appears to be within 1 year after implantation. Despite this, patients report low disability according to the QuickDASH at a minimum follow-up of 8 years. LEVEL OF EVIDENCE Level IV, therapeutic study.
Collapse
|
13
|
Lee YS, Kang YH, Chung YG, Shin SH. Open reduction and internal fixation for Mason type III radial head fractures: Is it different from that for Mason type II fractures? J Orthop Surg (Hong Kong) 2019; 26:2309499018802506. [PMID: 30270793 DOI: 10.1177/2309499018802506] [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] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The objective of this study was to investigate whether the outcomes of Mason type III radial head fractures (RHFs) treated by open reduction and internal fixation (ORIF) were comparable to those of Mason type II RHFs treated by ORIF. METHODS A total of 87 surgically treated RHF patients were reviewed. Their fractures were Mason type II in 39 patients (all treated by ORIF) and Mason type III in 48 patients (40 treated by ORIF, 7 by radial head arthroplasty, and 1 by resection). Although ORIF was preferred for Mason type III RHFs in our series, an arthroplasty was performed when the fracture accompanied severe associated injuries or multiple traumas. Radiological and functional outcomes were evaluated and complications were reviewed. RESULTS When Mason type II and Mason type III in general were compared, QuickDASH score, a shortened version of the Disabilities of the Arm, Shoulder and Hand (DASH) score, and forearm rotation were significantly worse in Mason type III. However, when comparing Mason type II and Mason type III treated by ORIF in which the proportion of associated injuries were not significantly different, there was no significant difference in QuickDASH score, range of extension/flexion, or complication rate. Forearm rotations were significantly more limited in Mason type III treated by ORIF (7° for pronation and 7° for supination), and Mason type had an independent effect on forearm rotations in multivariate analysis. CONCLUSION ORIF for Mason type III fractures with low level of associated injury can be as good as that for Mason type II fractures, except for less forearm rotation.
Collapse
Affiliation(s)
| | | | | | - Seung-Han Shin
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
14
|
Chen HW, Tian JL, Zhang YZ. Therapeutic Effect of Resection, Prosthetic Replacement and Open Reduction and Internal Fixation for the Treatment of Mason Type III Radial Head Fracture. J INVEST SURG 2019; 34:30-38. [PMID: 31179793 DOI: 10.1080/08941939.2019.1602689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aim of the Study: Mason type III radial head fractures are a source of concern due to the severe injury and poor recovery. At present, radial head resection, open reduction and internal fixation (ORIF), and prosthetic replacement are three common treatment methods for these fractures. The clinical efficacy and postoperative complications are controversial, which makes it difficult for physicians to determine the most appropriate regimen. Herein, this present prospective, non-randomized, parallel-controlled study was conducted to compare the therapeutic effects and identify the most effective treatment method for Mason type III radial head fracture. Materials and Methods: We assessed patients with Mason type III radial head fracture treated with resection, prosthetic replacement, and ORIF to compare preoperative and postoperative pain condition, elbow joint function, curative effect, and complication rate. A visual analog scale was used to score pain. The elbow joint function was observed using the Broberg-Morrey elbow joint score. Results: No significant differences were found in patient demographics among the resection, prosthetic replacement, and ORIF groups. The prosthetic replacement and ORIF procedures were more complex and had higher technical requirements. Prosthetic replacement and ORIF enabled higher elbow joint scores and lower pain scores than resection. Excellent and good ratings were highest and complication rates were lowest in the prosthetic replacement group, followed by the ORIF group. Conclusion: Our results showed that prosthetic replacement is more effective than ORIF and radial head resection in relieving pain, functional recovery and reducing complications in the treatment of Mason type III radial head fractures.
Collapse
Affiliation(s)
- Hong-Wei Chen
- Department of Orthopedic Surgery, Yiwu Central Hospital, the Affiliated Yiwu Hospital of Wenzhou Medical University, Yiwu, P.R. China
| | - Jia-Liang Tian
- Department of Orthopedic, Guizhou Provincial People's Hospital, Guiyang, P.R. China
| | - Yong-Zhao Zhang
- Department of Orthopedics, The 210th Hospital of People's Liberation Army, Dalian, P.R. China
| |
Collapse
|
15
|
Abstract
RATIONALE A Mason type III radial head fracture, which is characterized by comminuted fragments of the radial head, is a severe injury. Open reduction and internal fixation (ORIF) is an alternative treatment method; however, the technique of using an on-table reduction in combination with surgical glue is rarely reported. PATIENT CONCERNS A 48-year-old man was admitted to our department with complaints of elbow pain after falling down. Elbow radiography and computed tomography (CT) demonstrated characteristics of fractures before the operation. DIAGNOSIS Radiographic images showed a Mason type III radial head fracture. INTERVENTIONS The patient underwent ORIF at our hospital. During the operation, the technique of on-table reconstruction combined with surgical glue was used. OUTCOMES The patient recovered well and was able to participate in his usual work. LESSONS Mason type III radial head fractures could be treated with ORIF, and a satisfactory result could be anticipated, thus avoiding a radial head replacement or resection. Anatomical reduction of a comminuted radial head could be obtained via an on-table reconstruction and application of surgical glue.
Collapse
Affiliation(s)
- Da-Wei Chen
- Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine
| | - Wan-Kun Hu
- Department of Orthopaedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center
| | - Jia-Qian Zhou
- Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Laflamme M, Grenier-Gauthier PP, Leclerc A, Antoniades S, Bédard AM. Retrospective cohort study on radial head replacements comparing results between smooth and porous stem designs. J Shoulder Elbow Surg 2017; 26:1316-1324. [PMID: 28606638 DOI: 10.1016/j.jse.2017.04.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/28/2017] [Accepted: 04/16/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND When necessary, radial head integrity after a fracture can be re-created by the use of a radial head arthroplasty if the radial head is judged irreparable. The purpose of this study was to compare the clinical and radiographic outcomes of metal modular radial head replacements with a smooth vs. a porous stem. METHODS A retrospective cohort study of radial head replacements performed in the first 4 weeks after a trauma in an adult patient at our institution between 2000 and 2014 was completed. Patients were divided into 2 groups: a porous stem group (ExploR; Biomet Orthopedics, Warsaw, IN, USA) and a smooth stem group (EVOLVE; Wright Medical Group, Memphis, TN, USA). Primary outcomes were the Disabilities of the Arm, Shoulder, and Hand and Mayo Elbow Performance Index scores. Secondary outcomes were the visual analog scale score for pain, range of motion, grip strength, and radiographic evaluations. RESULTS Of the 80 eligible patients, 57 agreed to participate (porous stem group, 36; smooth stem group, 21). Demographic data were similar between the 2 groups. Average follow-up was 6.3 years. Average Disabilities of the Arm, Shoulder, and Hand and Mayo Elbow Performance Index scores were similar between the 2 groups. Porous implants were more prone to osteolysis (64.3% vs. 23.5%; P = .01) and were associated with a greater loss of elbow flexion (6° vs. 1°; P = .02). The porous stem group showed a tendency toward more overstuffing (24.0% vs. 5.9%; P = .21). CONCLUSION Our results reveal that outcomes between smooth and porous stem metal modular radial head implants are equivalent. However, the smooth stem implant may represent the preferred option as it is associated with a lower rate of complications.
Collapse
Affiliation(s)
- Mélissa Laflamme
- Department of Orthopaedic Surgery, CHU de Québec-Centre Hospitalier de l'Université Laval (CHUL), Québec, QC, Canada.
| | | | - Alexandre Leclerc
- Department of Orthopaedic Surgery, CHU de Québec-Centre Hospitalier de l'Université Laval (CHUL), Québec, QC, Canada
| | | | - Anne-Marie Bédard
- Department of Orthopaedic Surgery, CHU de Québec-Centre Hospitalier de l'Université Laval (CHUL), Québec, QC, Canada
| |
Collapse
|
21
|
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]
|
22
|
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.
Collapse
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
| |
Collapse
|