1
|
Heifner JJ, Lacau GE, Forro SD, Davis TA, Mercer DM, Rubio F. The impact of anatomic alignment on radiocapitellar pressure following radial head arthroplasty. J Shoulder Elbow Surg 2024; 33:2033-2038. [PMID: 38609004 DOI: 10.1016/j.jse.2024.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 02/19/2024] [Accepted: 02/24/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND The incidence of radial head fractures is increasing, and radial head arthroplasty (RHA) is being more frequently used as treatment for irreparable fractures. Our objective was to compare radiocapitellar pressure between the native joint and 2 radial head prosthesis conditions: (1) a prosthetic head that was aligned to the forearm axis of rotation and (2) the same prosthesis with an axisymmetric nonaligned head. METHODS Ten cadaveric specimens received a pressfit radial head prosthesis (Align; Skeletal Dynamics) for both prosthetic testing conditions. Anatomic alignment (AL) was defined as the prosthetic head aligned to the forearm axis of rotation. Axisymmetric alignment (AX) was defined as the prosthetic radial head aligned to the axis of the prosthetic stem. Axial load was applied with the elbow in extension and the forearm pronated. Data were collected using a Tekscan 4000 sensor. RESULTS The mean pressure in the AL and AX groups were significantly higher than the mean pressure in the native joint. Compared with the native joint, the mean pressure was 19% higher in the AL group and 56% higher in the AX group. Peak pressure beyond 5 MPa occurred in 0 specimens in the native joint group, in 1 specimen (10%) in the AL group, and in 5 specimens (50%) in the AX group. DISCUSSION Our results demonstrated that a pressfit radial head prosthesis aligned with the forearm axis of rotation yields capitellar pressures that were more similar to the native condition than a nonaligned pressfit prosthesis. These findings suggest that anatomic alignment may optimize capitellar wear properties, improving the long-term durability of radial head arthroplasty.
Collapse
Affiliation(s)
| | | | - Stephen D Forro
- Department of Orthopedic Surgery, Larkin Hospital, Miami, FL, USA
| | - Ty A Davis
- Department of Orthopedic Surgery, Larkin Hospital, Miami, FL, USA
| | - Deana M Mercer
- Department of Orthopaedics, University of New Mexico, Albuquerque, NM, USA
| | - Francisco Rubio
- Department of Orthopedic Surgery, Larkin Hospital, Miami, FL, USA
| |
Collapse
|
2
|
France T, Lockwood W, Gu S, Tucker N, Baldini T, Lauder A, Catalano LW. Radiocapitellar and Ulnotrochlear Pressures Increase in a Radial Head Fracture Model: A Cadaveric Biomechanical Analysis. J Bone Joint Surg Am 2024; 106:600-607. [PMID: 38147503 DOI: 10.2106/jbjs.23.00417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
BACKGROUND Changes in intra-articular pressure have not been previously described in relation to the management of radial head fractures. We hypothesized that pressure within the radiocapitellar and ulnotrochlear joints would increase with progressive radial head resection, mimicking a displaced radial head fracture, in a cadaveric model. METHODS Ten cadaveric specimens were tested. Intra-articular pressure sensors were used to measure pressure within the radiocapitellar and ulnotrochlear joints with the forearm in full supination. The elbow was loaded to 100 N in extension, 45° of flexion, and 90° of flexion under the following conditions: (1) intact radial head, (2) 20% radial head resection, (3) 40% radial head resection, and (4) 100% radial head resection. RESULTS The distribution of pressure between the radiocapitellar and ulnotrochlear joints did not change with sequential, partial resection of the radial head (radiocapitellar joint, between 48.92% and 53.79%; ulnotrochlear joint, between 46.21% and 51.08%). After 20% resection, radiocapitellar peak contact pressure (PCP) increased by 22% (from 1,410 to 1,721.5 kPa) and ulnotrochlear PCP increased by 36% (from 1,319 to 1,797.5 kPa). After 40% resection, radiocapitellar PCP increased by 123% (from 1,410 to 3,145 kPa; p = 0.0003) and ulnotrochlear PCP increased by 105% (from 1,319 to 2,702 kPa; p = 0.007). Ulnotrochlear PCP increased by a total of 159% after complete radial head resection (from 1,319 to 3,415.5 kPa; p = 0.003). CONCLUSIONS Pressures in the radiocapitellar and ulnotrochlear joints were equally distributed with an intact radial head and after partial resection. Radiocapitellar and ulnotrochlear pressures increased with increasing radial head resection, significantly exceeding 100% of normal after radial head resection of 40% of the anterolateral diameter. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Thomas France
- Department of Orthopedics, University of Colorado, Aurora, Colorado
| | | | - Songyuan Gu
- University of Colorado School of Medicine, Aurora, Colorado
| | - Nick Tucker
- Department of Orthopedics, University of Colorado, Aurora, Colorado
| | - Todd Baldini
- Department of Orthopedics, University of Colorado, Aurora, Colorado
| | - Alexander Lauder
- University of Colorado School of Medicine, Aurora, Colorado
- Department of Orthopedics, Denver Health Medical Center, Denver, Colorado
| | - Louis W Catalano
- Department of Orthopedics, University of Colorado, Aurora, Colorado
| |
Collapse
|
3
|
Walsh A, Zhang Y, McGough J, Kim J, Hausman M. Open Reduction Internal Fixation of Simple Versus Comminuted Radial Head Fractures: Comparison of Clinical Outcomes. J Hand Surg Am 2023; 48:1059.e1-1059.e9. [PMID: 35545488 DOI: 10.1016/j.jhsa.2022.02.020] [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: 12/23/2020] [Revised: 01/10/2022] [Accepted: 02/23/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Current teaching suggests that modified Mason type III and IV fractures of the radial head involving more than 3 fragments should be treated with radial head arthroplasty. The purpose of this study was to compare the outcome of simple (2 or fewer intra-articular pieces) versus comminuted (3 or more intra-articular pieces) radial head fractures treated with open reduction internal fixation (ORIF). METHODS This was a retrospective review of 35 patients with modified Mason type III and IV fractures treated with ORIF. For the purpose of our study, simple fractures were defined as having 2 or fewer intra-articular fragments. Comminuted fractures were defined as having 3 or more intra-articular fragments. The primary outcomes were Broberg and Morrey rating system and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores. Reoperation rates and complications were also noted. RESULTS Thirty-five patients were evaluated, with a mean follow-up of 39.3 months. Thirteen patients had radial head fractures consisting of 2 or fewer intra-articular fragments. Twenty-two patients had radial head fractures consisting of 3 or more intra-articular fragments. Ages and follow-up times were similar in the 2 groups. Similar QuickDASH and Broberg and Morrey scores were seen when evaluating subgroups of 2, 3, and 4 fragment fractures. One patient from each group underwent revision surgery for symptomatic hardware. CONCLUSIONS In our series, we found similar clinical outcome scores and reoperation rates between simple and comminuted radial head fractures treated with ORIF. Fractures with more than 3 intra-articular fragments can be considered for ORIF. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
| | | | | | - Jaehon Kim
- Pan Am Clinic, Winnipeg, Manitoba, Canada
| | | |
Collapse
|
4
|
Treatment of comminuted radial head fractures with personalized radial head prosthesis produced with 3-dimensional printing technology. J Shoulder Elbow Surg 2023; 32:463-474. [PMID: 36403925 DOI: 10.1016/j.jse.2022.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 09/30/2022] [Accepted: 10/12/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The radial head is the forearm's pivot point for supination-pronation. Although radial head resection can be performed in comminuted radial head fractures, radial head prosthesis has gained popularity in order to prevent possible complications such as progressive valgus instability in the elbow and secondary ulnocarpal impaction that may develop due to proximal displacement of the radius. As for radial head prostheses, standard prosthetic designs do not provide the same results in everyone, and the alignment of the radial head and radial neck angle cannot be fully achieved. We believe that the radial head must be reconstructed with a complete anatomical implant. We designed and applied personalized prostheses to our patients, and in this study, we wished to share the 2-year results of these patients. METHODS In this study, 23 patients who had comminuted radial head fractures had personalized radial head prostheses inserted. Preoperative variables such as type of injury, age, side, additional ligament injury, operation time, number of radial head parts, neck angle of individual prosthesis, stem length, and stem diameter were noted. The mean operating time was 26 ± 9 minutes. One month postoperatively, after physical therapy, elbow range of motion, loss of strength compared to the opposite joint, Mayo elbow scores, QuickDASH scores, and patient satisfaction were evaluated. Patients were evaluated 2 years postoperatively. RESULTS QuickDASH and Mayo elbow scores were satisfactorily good (mean QuickDASH score: 9.091, mean Mayo score: 91.08). According to the results of the patient satisfaction questionnaire, 16 of the 23 patients reported excellent satisfaction, 5 patients good satisfaction, and 2 patients moderate satisfaction. None of the patients reported poor results. DISCUSSION Since personalized radial head prosthesis consists of a single monoblock, its surgical application consists of a single step and has a short operating time. As the applications in the literature increase and more studies are conducted, this subject will be better understood. Our study demonstrated that these patients, whose anatomies were individually replicated, achieved good range of motion and patient satisfaction. In fact, none of the patients reported negative results. In comminuted radial head fractures, surgical implantation of personalized radial head prosthesis is a treatment modality with easy application, short operating time, and good functional results.
Collapse
|
5
|
Berkmortel CJ, Szmit J, Langohr GD, King GJW, Johnson JA. The effect of hemiarthroplasty implant modulus on contact mechanics: an experimental investigation. J Shoulder Elbow Surg 2021; 30:2845-2851. [PMID: 34293420 DOI: 10.1016/j.jse.2021.06.009] [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: 03/28/2021] [Revised: 06/05/2021] [Accepted: 06/12/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hemiarthroplasties cause damage to the cartilage that they articulate against, which is a major limitation to their use. This study investigated the use of lower-stiffness materials to determine whether they improve hemiarthroplasty contact mechanics and thus reduce the risk of cartilage damage. METHODS Eleven fresh-frozen cadaveric upper extremities were disarticulated and fixed in a custom-built jig that applied a static load of 50 N to the radiocapitellar joint. Flexion angles of 0°, 45°, 90°, and 135° were tested with radial head implants made of cobalt-chrome (CoCr) and ultrahigh-molecular-weight polyethylene (UHMWPE) compared with the native radial head. A Tekscan thin-film sensor was used to measure the contact area and contact pressure between the radius and capitellum. RESULTS UHMWPE and CoCr were too stiff in the application of hemiarthroplasty, resulting in lower contact areas and higher contact pressures relative to the native joint. The native contact area was, on average, 42 ± 20 mm2 larger than that of UHMWPE (P < .001) and 55 ± 24 mm2 larger than that of CoCr (P < .001). UHMWPE had a contact area 13 ± 10 mm2 greater than that of CoCr (P = .014). DISCUSSION AND CONCLUSION This study shows that even though UHMWPE has a stiffness several times lower than CoCr, the use of this material in hemiarthroplasty led to only a minor improvement in contact mechanics. Neither implant restored contact similar to the native articulation. Investigations into new materials to improve the contact mechanics of hemiarthroplasty should focus on materials with a lower stiffness than UHMWPE.
Collapse
Affiliation(s)
- Carolyn J Berkmortel
- Department of Mechanical and Materials Engineering, Western University, London, ON, Canada
| | - Jakub Szmit
- Bioengineering Laboratory, Roth McFarlane Hand and Upper Limb Centre, Lawson Health Research Institute, St Joseph's Health Care, London, ON, Canada; Department of Surgery, Western University, London, ON, Canada
| | - G Daniel Langohr
- Department of Mechanical and Materials Engineering, Western University, London, ON, Canada; Bioengineering Laboratory, Roth McFarlane Hand and Upper Limb Centre, Lawson Health Research Institute, St Joseph's Health Care, London, ON, Canada
| | - Graham J W King
- Bioengineering Laboratory, Roth McFarlane Hand and Upper Limb Centre, Lawson Health Research Institute, St Joseph's Health Care, London, ON, Canada; Department of Surgery, Western University, London, ON, Canada
| | - James A Johnson
- Department of Mechanical and Materials Engineering, Western University, London, ON, Canada; Bioengineering Laboratory, Roth McFarlane Hand and Upper Limb Centre, Lawson Health Research Institute, St Joseph's Health Care, London, ON, Canada; Department of Surgery, Western University, London, ON, Canada.
| |
Collapse
|
6
|
Wegmann K, Hackl M, Leschinger T, Burkhart KJ, Müller LP. Overlengthening of the radial column in radial head replacement: a review of the literature and presentation of a classification system. Arch Orthop Trauma Surg 2021; 141:1525-1539. [PMID: 33057805 PMCID: PMC8354917 DOI: 10.1007/s00402-020-03619-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 09/30/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Radial head arthroplasty is a common procedure in elbow surgery. It has been shown to be of benefit for the patients, but there also are relevant complications that should be prevented if possible. One significant complication is overlengthening of the radial head prosthesis. In overlengthening, the head of the prosthesis overextends the physiological level of the native radial head and leads to overcompression in the radiohumeral joint. Rapid erosion and arthritic changes may then impede the clinical outcome. The incidence of overlengthening is not precisely known, but estimations range to up to 20% of all implanted prostheses. METHODS The present review discusses the available body of literature on overlengthening and lines out a classification system that may be used to guide treatment algorithms. The classification is based on the personal experiences of the author during their clinical practice. RESULTS In low-grade overlengthening (type I) conservative treatment can be an option. In Types II-IV usually revision surgery is needed. Depending on the state of the capitulum and joint stability, it is possible re-implant a prosthesis, or rely on implant removal alone. DISCUSSION The present review aimed at shedding light into overlengthening as a complication radial head replacement and to help identify and treat it.
Collapse
Affiliation(s)
- K Wegmann
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Kerpener Street 62, 50937, Cologne, Germany.
| | - M Hackl
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - T Leschinger
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | | | - L P Müller
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| |
Collapse
|
7
|
Berkmortel C, Langohr GDG, King G, Johnson J. Hemiarthroplasty implants should have very low stiffness to optimize cartilage contact stress. J Orthop Res 2020; 38:1719-1726. [PMID: 32017162 DOI: 10.1002/jor.24610] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/15/2019] [Accepted: 01/21/2020] [Indexed: 02/04/2023]
Abstract
Hemiarthroplasty is often preferred to total arthroplasty as it preserves native tissue; however, accelerated wear of the opposing cartilage is problematic. This is thought to be caused by the stiffness mismatch between the implant and cartilage-bone construct. Reducing the stiffness of the implant by changing the material has been hypothesized as a potential solution. This study employs a finite element model to study a concave-convex hemiarthroplasty articulation for various implant materials (cobalt-chrome, pyrolytic carbon, polyether ether ketone, ultra-high-molecular-weight polyethylene, Bionate-55D, Bionate-75D, and Bionate-80A). The effect of the radius of curvature and the degree of flexion-extension was also investigated to ensure any relationships found between materials were generalizable. The implant material had a significant effect (P < .001) for both contact area and maximum contact pressure on the cartilage surface. All of the materials were different from the native state except for Bionate-80A at two of the different flexion angles. Bionate-80A and Bionate-75D, the materials with the lowest stiffnesses, were the closest to the native state for all flexion angles and radii of curvature. No evident difference between materials occurred unless the modulus was below that of Bionate-55D (288 MPa), suggesting that hemiarthroplasty materials need to be less stiff than this material if they are to protect the opposing cartilage. This is clinically significant as the findings suggest that the development of new hemiarthroplasty implants should use materials with stiffnesses much lower than currently available devices.
Collapse
Affiliation(s)
- Carolyn Berkmortel
- Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada
| | - G Daniel G Langohr
- Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada.,Bioengineering Laboratory, Roth McFarlane Hand and Upper Limb Centre, Lawson Health Research Institute, St Joseph's Health Care, Western University, Bone and Joint Institute, London, Ontario, Canada.,Department of Surgery, Western University, London, Ontario, Canada
| | - Graham King
- Bioengineering Laboratory, Roth McFarlane Hand and Upper Limb Centre, Lawson Health Research Institute, St Joseph's Health Care, Western University, Bone and Joint Institute, London, Ontario, Canada.,Department of Surgery, Western University, London, Ontario, Canada
| | - James Johnson
- Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada.,Bioengineering Laboratory, Roth McFarlane Hand and Upper Limb Centre, Lawson Health Research Institute, St Joseph's Health Care, Western University, Bone and Joint Institute, London, Ontario, Canada.,Department of Surgery, Western University, London, Ontario, Canada
| |
Collapse
|
8
|
Szmit J, King GJW, Johnson JA, Langohr GDG. The effect of stem fit on the radiocapitellar contact mechanics of a metallic axisymmetric radial head hemiarthroplasty: is loose fit better than rigidly fixed? J Shoulder Elbow Surg 2019; 28:2394-2399. [PMID: 31371158 DOI: 10.1016/j.jse.2019.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radial head hemiarthroplasty is commonly used to manage comminuted displaced fractures. Regarding implant fixation, current designs vary, with some prostheses aiming to achieve a tight "fixed" fit and others using a smooth stem with an over-reamed "loose" fit. The purpose of this study was to evaluate the effect of radial head hemiarthroplasty stem fit on radiocapitellar contact using a finite element model that simulated both fixed (size-for-size) and loose (1-, 2-, and 3-mm over-reamed) stem fits. It was hypothesized that a loose stem fit would improve radiocapitellar contact mechanics, with an increased contact area and decreased contact stress, by allowing the implant to find its "optimal" position with respect to the capitellum. METHODS Finite element models of the elbow were produced to compare the effects of stem fit on radiocapitellar contact of a metallic axisymmetric radial head implant. Radiocapitellar contact mechanics (contact area and maximum contact stress) were computed for 0°, 45°, 90°, and 135° of elbow flexion with the forearm in neutral rotation, pronation, and supination. RESULTS The data suggest that the loose smooth stem radial head implant may be functioning like a bipolar implant in optimizing radiocapitellar contact. Over-reaming of 3 mm produced a larger amount of stress concentration on the capitellum, suggesting there may be a limit to how loose a smooth stem implant should be implanted. CONCLUSIONS The loose 1 to 2 mm over-reamed stem provided optimal contact mechanics of the metallic axisymmetric radial head implant compared with the fixed stem.
Collapse
|
9
|
Moungondo FGP, Andrzejewski A, van Riet RRP, Feipel V, Rooze M, Schuind FA. Joint contact areas after radial head arthroplasty: a comparative study of 3 prostheses. J Shoulder Elbow Surg 2019; 28:1546-1553. [PMID: 31029518 DOI: 10.1016/j.jse.2019.01.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 01/17/2019] [Accepted: 01/21/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Contact stresses of radial head prostheses remain a concern, potentially leading to early capitellar cartilage wear and erosion. In particular, point contact or edge loading could have a detrimental effect. The purpose of this study was to compare 3 different types of radial head prostheses in terms of joint contact areas with each other and with the native situation. The hypothesis was that the joint contact areas would be lower after monopolar arthroplasty. METHODS Seven fresh-frozen cadaveric upper limbs were used. Radiocapitellar contact areas of a monopolar design, a straight-neck bipolar design, and an angled-neck bipolar design were compared with each other and with the native joint. After standardized preparation, polysiloxane was injected into the loaded radiocapitellar joint to create a cast from which the joint contact area was measured. Measurements were performed at 3 angles of elbow flexion and in 3 different forearm positions. RESULTS In the native elbow, contact areas were highest in supination. Elbow flexion had no significant effect on native and prosthetic joint contact areas. Contact areas were decreased for all types of arthroplasties compared with the native joint (from 11% to 53%). No significant contact area difference was found between the 3 designs. However, bipolar prostheses showed lateral subluxation in neutral forearm rotation, resulting in a significant decrease in the contact areas from pronation to the neutral position. CONCLUSIONS All types of radial head prostheses tested showed a significant decrease in radiocapitellar contact area compared with the native joint. Bipolar designs led to subluxation of the radial head, further decreasing radiocapitellar contact.
Collapse
Affiliation(s)
- Fabian G P Moungondo
- Department of Orthopaedics and Traumatology, Université Libre de Bruxelles, Erasme University Hospital, Brussels, Belgium; Université Libre de Bruxelles, Brussels, Belgium.
| | - Aurélie Andrzejewski
- Department of Orthopaedics and Traumatology, Université Libre de Bruxelles, Erasme University Hospital, Brussels, Belgium; Université Libre de Bruxelles, Brussels, Belgium
| | | | - Véronique Feipel
- Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Anatomy, Biomechanics and Organogenesis, Université Libre de Bruxelles, Brussels, Belgium
| | - Marcel Rooze
- Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Anatomy, Biomechanics and Organogenesis, Université Libre de Bruxelles, Brussels, Belgium
| | - Frédéric A Schuind
- Department of Orthopaedics and Traumatology, Université Libre de Bruxelles, Erasme University Hospital, Brussels, Belgium; Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
10
|
Sun Y, Hong H, Adikrishna A, Kim YJ, Jeon IH. Contact Mechanics of Anatomic Radial Head Prosthesis: Comparison Between Native Radial Head and Anatomic Radial Head Prostheses in the Dynamic Mode. J Hand Surg Am 2019; 44:517.e1-517.e7. [PMID: 30292716 DOI: 10.1016/j.jhsa.2018.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 06/26/2018] [Accepted: 08/08/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The biomechanical characteristics of anatomic radial head prostheses have not been completely investigated. We compared and analyzed the contact kinematic characteristics of the native radial head and radial head prostheses replicating the native head contour, using a real-time flexion simulation model. METHODS Ten fresh-frozen cadavers were used in this pilot study. A simulating dynamic motion mode from 0° to 130° of elbow flexion was applied. Radiocapitellar contact pressure and area were measured using a real-time digitized pressure sensor. Further, contact area and pressure curves were obtained during flexion, using a motion-tracking device. RESULTS The mean contact area, mean contact pressure, and peak contact pressure of the native radial head and radial head prosthesis were 39 mm2, 0.0078 kgf/mm2, 0.0123 kgf/mm2, and 33 mm2, 0.0093 kgf/dm2, 0.0148 kgf/mm2, respectively. The contact area and pressure curves were parabolic nonlinear for the radial head prosthesis and more linear for the native radial head. CONCLUSIONS The radial head prosthesis mimics the mechanics of the native radial head in terms of mean contact area, mean contact pressure, and peak contact pressure; however, different patterns of contact pressure and area curves during elbow flexion-extension were observed. CLINICAL RELEVANCE We found that the biomechanics of the anatomic radial head prostheses used in the study were similar to those of the native radial head.
Collapse
Affiliation(s)
- Yucheng Sun
- Department of Orthopedic Surgery, ASAN Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Hanpyo Hong
- Department of Orthopedic Surgery, ASAN Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Arnold Adikrishna
- Department of Orthopedic Surgery, ASAN Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Yoon-Jeong Kim
- Department of Orthopedic Surgery, ASAN Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, ASAN Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
| |
Collapse
|
11
|
Abstract
OBJECTIVE To evaluate the effect of intentional undersizing of prosthetic radial head implant diameters on joint contact pressures. METHODS Eight fresh-frozen cadaveric elbows were aligned in neutral extension and loaded with 100 N using a custom testing apparatus. Radiocapitellar contact pressures were recorded using a Tekscan thin-film pressure sensor. Prosthetic radial head replacement was performed with 2 prostheses: the Anatomic Radial Head and the Evolve Proline Radial Head prostheses. Each design was sized according to the manufacturer's recommendations and then again using 2-mm smaller radial heads. RESULTS Average and peak pressures were significantly higher with the Evolve than the Anatomic prostheses (P < 0.03 and 0.02, respectively). Peak pressures decreased from 4.2 ± 0.5 MPa to 2.9 ± 0.3 MPa for the Anatomic Radial Heads and from 5.6 ± 0.5 MPa to 3.9 ± 0.6 MPa when the Evolve Radial Heads were undersized by 2 mm. The mean pressures of the Anatomic Radial Heads (1.4 ± 0.1 MPa) did not change significantly with undersizing (1.3 ± 0.1 MPa, P = 0.12), whereas the mean pressures of the Evolve Radial Heads (1.6 ± 0.1 MPa) were significantly reduced with undersizing (1.4 ± 0.1 MPa, P < 0.02). CONCLUSION Both mean and peak pressures were initially high for the Evolve Radial Head sized based on the short axis diameter and were improved with further undersizing by 2 mm. Peak, but not mean, contact pressures were improved by undersizing the Anatomic prosthesis based on the long axis diameter. CLINICAL RELEVANCE These findings support the clinical recommendation of some surgeons to undersize the Evolve prosthesis by 2-mm smaller diameter than the current manufacturer's suggestion and give reason to consider doing the same for the Anatomic prosthesis.
Collapse
|
12
|
Chytas ID, Antonopoulos C, Cheva A, Givissis P. Capitellar erosion after radial head arthroplasty: A comparative biomechanical study of operated radial head fractures on cadaveric specimens. Orthop Traumatol Surg Res 2018; 104:853-857. [PMID: 29581069 DOI: 10.1016/j.otsr.2018.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 01/10/2018] [Accepted: 02/06/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND We asked whether open reduction and internal fixation (ORIF) or radial head arthroplasty (RHA), common techniques used for the confrontation of displaced or comminuted radial head fractures, are correlated with cartilage wear of the capitulum. HYPOTHESIS We hypothesized that neither ORIF nor RHA are correlated with capitellar cartilage wear. MATERIAL AND METHODS On 5 cadaveric elbow specimens, osteotomies were employed to simulate radial head comminuted fractures followed with ORIF by Herbert screws. Radial heads were also excised from other 5 cadaveric elbow specimens and were replaced by metallic monopolar implants. Finally, 2 elbows were not operated and used as a control group. Custom-made rotary machines, working unstoppably, generated 700,000 pronation and supination forearm movements at a 110° arc of motion. The elbow joints were examined with pre- and postoperative magnetic resonance imaging (MRI) scans and the articular surfaces of the capitula were resected and sent for histopathology study. RESULTS In the 2 cadaveric elbows of the control group and the 4 elbows treated with ORIF, no cartilage damage was found. The fifth one displayed cartilage fissures, which were, classified according to International Cartilage Repair Society (ICRS) grading system as grade I cartilage damage. On the contrary, all 5 elbows treated with RHA sustained complete cartilage loss, exposure of the subchondral bone and were classified as ICRS grade IV cartilage damage. DISCUSSION Our study suggests that metallic monopolar RHA after a displaced or comminuted radial head fracture carries a high risk of rapidly evolving cartilage loss of the capitulum.
Collapse
Affiliation(s)
- I D Chytas
- 1st Orthopaedic Department of Aristotle University, "G. Papanikolaou" General Hospital, Papanikolaou avenue, 019, Exohi, 57010 Thessaloniki, Greece.
| | - C Antonopoulos
- School of Electrical and Computer Engineering of Aristotle University, 54124 Thessaloniki, Greece
| | - A Cheva
- Pathology Laboratory of "G. Papanikolaou" General Hospital, Exohi, 57010 Thessaloniki, Greece
| | - P Givissis
- 1st Orthopaedic Department of Aristotle University, "G. Papanikolaou" General Hospital, Papanikolaou avenue, 019, Exohi, 57010 Thessaloniki, Greece
| |
Collapse
|
13
|
Vaquero-Picado A, Núñez de Armas J, Antuña S, Barco R. Morphometry of the radiocapitellar joint: is humeral condyle diameter a reliable predictor of the size of the radial head prosthesis? J Shoulder Elbow Surg 2018; 27:1092-1096. [PMID: 29548543 DOI: 10.1016/j.jse.2018.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 01/14/2018] [Accepted: 01/22/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS Radial head arthroplasty (RHA) is a reliable procedure to manage complex injuries of the elbow, but complications due to inadequate sizing have been observed. Radiocapitellar morphometry has been studied widely, but RHA preoperative planning is not yet well defined. We hypothesized that specific morphologic parameters of the radiocapitellar joint measured with simple clinical software for radiographic analysis could be useful tools for clinical practice to predict RHA size preoperatively. METHODS Radiologic radiocapitellar joint dimensions (humeral condyle diameter [HCDi], radial head diameter [RHDi], and radial head height) were analyzed on true anteroposterior and lateral radiographs, using commercial picture archiving and communication system software, in 43 patients with non-osseous pathology of the elbow and 24 patients with RHA. Interobserver concordance was studied, and a regression model to relate different parameters was developed. RESULTS Interobserver concordance was greater than 0.8 for HCDi and RHDi on the lateral view and RHDi on the anteroposterior view for the general population. The parameter with the best correlation with the radial head arthroplasty diameter (RHADi) size was HCDi on the lateral view. A regression model was calculated and defined as follows: RHADi = 6.99 + 0.733 × HCDi on lateral view. This model allows prediction of RHADi in 67% of cases. CONCLUSION Radiologic radiocapitellar parameters show good interobserver reliability. RHADi can be calculated preoperatively from HCDi on the lateral view in 67% of cases.
Collapse
Affiliation(s)
| | | | - Samuel Antuña
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Hospital Universitario La Paz, Madrid, Spain
| | - Raúl Barco
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Hospital Universitario La Paz, Madrid, Spain.
| |
Collapse
|
14
|
Willing R. Design optimisation improves the performance of custom distal humeral hemiarthroplasty implants. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING-IMAGING AND VISUALIZATION 2018. [DOI: 10.1080/21681163.2018.1446054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Ryan Willing
- Department of Mechanical Engineering, Thomas J. Watson School of Engineering and Applied Science, State University of New York, Binghamton, NY, USA
| |
Collapse
|
15
|
Arthrokinematics of the Distal Radioulnar Joint Measured Using Intercartilage Distance in an In Vitro Model. J Hand Surg Am 2018; 43:283.e1-283.e9. [PMID: 28951101 DOI: 10.1016/j.jhsa.2017.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 06/27/2017] [Accepted: 08/14/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Current techniques used to measure joint contact rely on invasive procedures and are limited to statically loaded positions. We sought to examine native distal radioulnar joint (DRUJ) contact mechanics using nondestructive imaging methods during simulated active and passive forearm rotation. METHODS Testing was performed using 8 fresh-frozen cadaveric specimens that were surgically prepared by isolating muscles involved in forearm rotation. A wrist simulator allowed for the evaluation of differences between active and passive forearm rotation. Three-dimensional cartilage surface reconstructions were created using volumetric data acquired from computed tomography. Using optically tracked motion data, the relative position of the cartilage models was rendered and used to measure DRUJ cartilage contact mechanics. The effects of forearm movement method and rotation angle on centroid coordinate data and DRUJ contact area were examined. RESULTS The DRUJ contact area was maximal at 10° supination. There was more contact area in supination than pronation for both active and passive forearm rotation. The contact centroid moved volarly with supination, with magnitudes of 10.5 ± 2.6 mm volar for simulated active motion and 8.5 ± 2.6 mm volar for passive motion. Along the proximal-distal axis, the contact centroid moved 5.7 ± 2.4 mm proximal during simulated active motion. These findings were statistically significant. The contact centroid moved 0.2 ± 3.1 mm distal during passive motion (not significant). CONCLUSIONS It is possible to examine cartilage contact mechanics of the DRUJ nondestructively while undergoing simulated, continuous active and passive forearm rotation. The contact centroid moved volarly and proximally with supination. There were higher contact area values in supination compared with pronation, with a peak value at 10° supination. CLINICAL RELEVANCE This study documented normal DRUJ arthrokinematics using a nondestructive in vitro approach. It further reinforced the established biomechanical and clinical literature on contact patterns at the native DRUJ during forearm rotation.
Collapse
|
16
|
Burkhart KJ, Gohlke F, Nietschke R, Schneider MM, Hollinger B. [Destruction of the radial head : Endoprosthesis, autologous reconstruction or anconeus arthroplasty?]. DER ORTHOPADE 2017; 46:981-989. [PMID: 29071514 DOI: 10.1007/s00132-017-3492-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Radiocapitellar arthritis or defects most often result from trauma. Most of the patients are young and have high functional demands with high load capacities. Therefore, endoprosthetic options should be postponed for as long as possible. If conservative treatment cannot relieve symptoms sufficiently, radial head preservation, resection or replacement options are at the surgeon's disposal. In early stages of radiocapitellar arthritis, radial head preservation options can be taken into account. The chances ofgood results decrease with increasing cartilage damage. TREATMENT OPTIONS In addition to radial head preservation options this article discusses radial head resection with and without anconeus interposition and radial head as well as radiocapitellar replacement. Clinical data are rare. The advantages and disadvantages of each option must be discussed with the patient and the decision should be made individually on the basis of patient specific factors. The aim must be to postpone endoprosthetic options - especially total elbow arthroplasty - for as long as possible, while assuring a functional range of motion with an acceptable pain level.
Collapse
Affiliation(s)
- K J Burkhart
- Ellenbogen- und Schulterchirurgie, Arcus Sportklinik, ARCUS Kliniken, Rastatter Str. 17-19, 75179, Pforzheim, Deutschland.
| | - F Gohlke
- Klinik für Schulterchirurgie, Rhön-Klinikum, Bad Neustadt/Saale, Deutschland
| | - R Nietschke
- Ellenbogen- und Schulterchirurgie, Arcus Sportklinik, ARCUS Kliniken, Rastatter Str. 17-19, 75179, Pforzheim, Deutschland
| | - M M Schneider
- Ellenbogen- und Schulterchirurgie, Arcus Sportklinik, ARCUS Kliniken, Rastatter Str. 17-19, 75179, Pforzheim, Deutschland
| | - B Hollinger
- Ellenbogen- und Schulterchirurgie, Arcus Sportklinik, ARCUS Kliniken, Rastatter Str. 17-19, 75179, Pforzheim, Deutschland
| |
Collapse
|
17
|
An In Vitro Study of the Role of Implant Positioning on Ulnohumeral Articular Contact in Distal Humeral Hemiarthroplasty. J Hand Surg Am 2017; 42:602-609. [PMID: 28450102 DOI: 10.1016/j.jhsa.2017.03.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 03/25/2017] [Accepted: 03/31/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the effect of implant positioning on ulnohumeral contact using patient-specific distal humeral (DH) implants. METHODS Seven reverse-engineered DH implants were manufactured based on computed tomography scans of their osseous geometry. Native ulnae were paired with corresponding native humeri and custom DH implants in a loading apparatus. The ulna was set at 90° of flexion and the humeral component (either native bone or reverse-engineered implant) was positioned from 5° varus to 5° valgus in 2.5° increments under a 100-N compressive load. Contact with the ulna was measured with both the native distal humerus and the reverse-engineered DH implant at all varus-valgus (VV) angles, using a joint casting method. Contact patches were digitized and analyzed in 4 ulnar quadrants. Output variables were contact area and contact pattern. RESULTS Mean contact area of the native articulation was significantly greater than with the distal humeral hemiarthroplasty (DHH) implants across all VV positions. Within the native condition, contact area did not significantly change owing to VV angulation. Within the DHH condition, contact area also did not significantly change owing to VV angulation. Conversely, in the DHH condition, contact pattern did significantly change. Medial ulnar contact pattern was significantly affected by VV angulation. Lateral ulnar contact was variably affected, but generally decreased as well. CONCLUSIONS Ulnar contact patterns were changed as a result of VV implant positioning using reverse-engineered DH implants, most notably on the medial aspect of the joint. Implant positioning plays a crucial role in producing contact patterns more like those observed in the native joint. CLINICAL RELEVANCE Recent clinical evidence reports nonsymmetrical ulnar wear after DHH. This work suggests that implant positioning is likely a contributing factor and that more exact implant positioning may lead to better clinical outcomes.
Collapse
|
18
|
Lalone EA, Shannon HL, Deluce SR, Giles JW, King GJW, Johnson JA. Effect of Radial Head Implant Shape on Radiocapitellar Joint Congruency. J Hand Surg Am 2017; 42:476.e1-476.e11. [PMID: 28450100 DOI: 10.1016/j.jhsa.2017.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 02/14/2017] [Accepted: 03/09/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Radial head arthroplasty is indicated in displaced fractures in which comminution precludes successful internal fixation. Many types of radial head implants have been developed varying in material, methods of fixation, and degrees of modularity and geometry. The purpose of this study was to investigate the effect of radial head implant shape on radiocapitellar joint congruency. METHODS Joint congruency was quantified in 7 cadaveric specimens employing a registration and inter-surface distance algorithm and 3-dimensional models obtained using computed tomography. Forearm rotation was simulated after computer-guided implantation of an axisymmetric radial head, a population-based quasi-anatomic radial head implant, and a reverse-engineered anatomic radial head implant. Inter-surface distances were measured to investigate the relative position of the radial head implant and displayed on 3-dimensional color-contour maps. Surface area was measured for inter-surface distances (1.5 mm) and compared for each radial head geometry. RESULTS There were no statistical differences in the contact surface area between radial head implants during active or passive forearm rotation. The joint was more congruent (larger contact surface area) during active forearm rotation compared with passive forearm rotation. CONCLUSIONS This study investigated the effect of implant geometry on the radiocapitellar joint contact mechanics by examining a commercially available radial head system (axisymmetric), a quasi-anatomic design, and an anatomic reverse-engineered radial head implant. We found no statistical differences in radiocapitellar joint contact mechanics as measured by 3-dimensional joint congruency in cadaveric specimens undergoing continuous simulated forearm rotation. CLINICAL RELEVANCE The importance of choosing an implant that matches the general size of the native radial head is recognized, but the degree to which it is necessary to create an implant that replicates the native anatomy to restore elbow stability and prevent cartilage degenerative changes remains unclear. This study concluded that the geometry of the implant did not have a statistically significant effect on joint contact mechanics; therefore, future work is needed to examine additional factors related to implant design, such as material choice and implant positioning to investigate their influence on joint contact mechanics.
Collapse
Affiliation(s)
- Emily A Lalone
- Bioengineering Laboratory, Roth McFarlane Hand and Upper Limb Centre, St Joseph's Hospital, London, Canada
| | - Hannah L Shannon
- Bioengineering Laboratory, Roth McFarlane Hand and Upper Limb Centre, St Joseph's Hospital, London, Canada
| | - Simon R Deluce
- Bioengineering Laboratory, Roth McFarlane Hand and Upper Limb Centre, St Joseph's Hospital, London, Canada
| | - Joshua W Giles
- Bioengineering Laboratory, Roth McFarlane Hand and Upper Limb Centre, St Joseph's Hospital, London, Canada
| | - Graham J W King
- Bioengineering Laboratory, Roth McFarlane Hand and Upper Limb Centre, St Joseph's Hospital, London, Canada; Department of Surgery, University of Western Ontario, London, Canada
| | - James A Johnson
- Bioengineering Laboratory, Roth McFarlane Hand and Upper Limb Centre, St Joseph's Hospital, London, Canada; Department of Mechanical and Materials Engineering, University of Western Ontario, London, Canada.
| |
Collapse
|
19
|
Sahu D, Fitzsimmons JS, Thoreson AR, An KN, O'Driscoll SW. Radiocapitellar contact characteristics during prosthetic radial head subluxation. J Shoulder Elbow Surg 2017; 26:170-177. [PMID: 27727059 DOI: 10.1016/j.jse.2016.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 06/15/2016] [Accepted: 07/01/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Metallic radial head prostheses are often used in the management of comminuted radial head fractures and elbow instability. We hypothesized that during radiocapitellar subluxation, the contact pressure characteristics of an anatomic radial head prosthesis will more closely mimic those of the native radial head compared with a monopolar circular or a bipolar circular radial head design. MATERIALS AND METHODS With use of 6 fresh frozen cadaver elbows, mean radiocapitellar contact pressures, contact areas, and peak pressures of the native radial head were assessed at 0, 2, 4, and 6 mm of posterior subluxation. These assessments were repeated after the native radial head was replaced with anatomic, monopolar circular and bipolar circular prostheses. RESULTS The joint contact pressures increased with the native and the prosthetic radial head subluxation. The mean contact pressures for the native radial head and anatomic prosthesis increased progressively and significantly from 0 to 6 mm of subluxation (native, 0.6 ± 0.0 MPa to 1.9 ± 0.2 MPa; anatomic, 0.7 ± 0.0 MPa to 2.1 ± 0.3 MPa; P < .0001). The contact pressures with the monopolar and bipolar prostheses were significantly higher at baseline and did not change significantly further with subluxation (monopolar, 2.0 ± 0.1 MPa to 2.2 ± 0.2 MPa [P = .31]; bipolar, 1.7 ± 0.1 MPa to 1.9 ± 0.1 MPa [P = .12]). The pattern of increase in contact pressures with the anatomic prosthesis mimicked that of the native radial head. Conversely, the circular prostheses started out with higher contact pressures that stayed elevated. CONCLUSION The articular surface design of a radial head prosthesis is an important determinant of joint contact pressures.
Collapse
Affiliation(s)
- Dipit Sahu
- Department of Orthopaedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - James S Fitzsimmons
- Department of Orthopaedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Andrew R Thoreson
- Department of Orthopaedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Kai-Nan An
- Department of Orthopaedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Shawn W O'Driscoll
- Department of Orthopaedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
20
|
Bigazzi P, Biondi M, Ceruso M. Radiocapitellar prosthetic arthroplasty in traumatic and post-traumatic complex lesions of the elbow. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:851-858. [PMID: 27544680 DOI: 10.1007/s00590-016-1837-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 08/11/2016] [Indexed: 10/21/2022]
Abstract
Radiocapitellar prosthetic arthroplasty is a fascinating new option in the treatment of complex lesions of the elbow. The device has been developed in order to treat primitive and post-traumatic radiocapitellar degenerative arthritis, while preserving the ulnohumeral joint of the elbow. Compared to a radial head resection, it avoids valgus and axial instability of the elbow and forearm preventing ulnohumeral degeneration. Seven patients have been reviewed with a mean of follow-up of 40 months. Two of them presented with an acute trauma and five of them with a post-traumatic degenerative arthritis involving the radial compartment of the elbow. The patients' evaluation was performed using DASH and Mayo elbow performance score (MEPS). Implant overstuffing, loosening and degenerative changes of the ulnohumeral joint have been monitored with X-ray controls. All patients presented with a marked improvement in elbow function, no signs of overstuffing or ulnohumeral degeneration were observed. Two patients developed a clinically asymptomatic aseptic loosening of the radial press-fit stem. The radiocapitellar prosthetic arthroplasty shows convincing results in the treatment of symptomatic radiocapitellar degenerative arthritis. It has also been effective in acute trauma scenarios in the presence of major osteoarticular wearing or loss of the entire radiocapitellar joint.
Collapse
Affiliation(s)
- Prospero Bigazzi
- Hand Surgery and Reconstructive Microsurgery Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Marco Biondi
- Orthopaedic Clinic, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Massimo Ceruso
- Hand Surgery and Reconstructive Microsurgery Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| |
Collapse
|
21
|
Langohr GDG, Willing R, Medley JB, King GJW, Johnson JA. The Effect of Radial Head Hemiarthroplasty Geometry on Proximal Radioulnar Joint Contact Mechanics. J Hand Surg Am 2016; 41:745-52. [PMID: 27241850 DOI: 10.1016/j.jhsa.2016.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 01/19/2016] [Accepted: 05/01/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the joint contact area and peak contact stress of different radial head (RH) hemiarthroplasty articular profiles for the proximal radioulnar joint (PRUJ) to the native radial head with the hypothesis that the side radius and side angle closest to the native mating ulnar articular profile would provide the best contact mechanics. METHODS Finite element models generated from the computed tomography geometry of 14 native elbows (73 ± 17.5 years) were subjected to 12 different RH profiles having varying side radii (flat [r = ∞ mm], 16.25, 8.12, and 4.50 mm) and side angles (0°, 5°, and 10°) under a constant compressive 20-N medial load. Contact areas and peak contact stresses were computed and compared with the native joint. RESULTS On average, RH implants significantly reduced PRUJ contact area by 55% ± 16% and increased peak contact stress by 337% ± 241% compared with the native RH. The prosthesis side radius had significant effects on both contact area and stress, but side angle did not. The 16.25-mm radii produced the largest contact areas, and the 4.50-mm radius model generated the smallest contact areas. As the side radius was decreased, peak contact stress was reduced as the contact migrated toward the center of the native ulnar articulation, although the 8.12-mm radius achieved the lowest peak contact stress. CONCLUSIONS Whereas RH hemiarthroplasty side radius can affect both contact area and peak contact stress, the magnitude of the effect on contact area is relatively small compared with that of the peak contact stress. Furthermore, although a flat RH side profile with a side angle of 5° more closely matched the side profile of the native ulnas used in the present study, the optimal profile was found to be a smaller radius of 8.12 mm. CLINICAL RELEVANCE Optimizing PRUJ contact mechanics after metallic RH hemiarthroplasty may contribute to better clinical outcomes by reducing the potential for native cartilage degeneration.
Collapse
Affiliation(s)
- G Daniel G Langohr
- Roth
- McFarlane Hand and Upper Limb Center, St Joseph's Health Care, University of Western Ontario, London, Ontario, Canada
| | - Ryan Willing
- Binghamton University, State University of New York, Binghamton, NY
| | | | - Graham J W King
- Roth
- McFarlane Hand and Upper Limb Center, St Joseph's Health Care, University of Western Ontario, London, Ontario, Canada
| | - James A Johnson
- Roth
- McFarlane Hand and Upper Limb Center, St Joseph's Health Care, University of Western Ontario, London, Ontario, Canada.
| |
Collapse
|
22
|
Abstract
Radial head fractures are the most common fractures around the elbow. Because they are often accompanied by ligamentous injuries, we recommend considering them to be osteoligamentous injuries rather than simple fractures, even in undisplaced or minimally displaced fractures. Surgeons should always suspect and actively exclude concomitant ligament tears. The incidence of these associated injuries increases with greater severity of the radial head fracture. However, the standard Mason classification system does not adequately address this problem, and all attempts to establish a new classification system that provides concise treatment algorithms have failed. This article discusses the current treatment options and the current controversies in nonsurgical therapy, open reduction and internal fixation (ORIF) and radial head replacement.
Collapse
Affiliation(s)
- Klaus Josef Burkhart
- Department for Shoulder Surgery, Rhön-Clinic, Bad Neustadt, Salzburger Leite 1, 97616 Bad Neustadt/Saale, Germany.
| | - Kilian Wegmann
- Department for Trauma, Hand and Elbow Surgery, University of Cologne, Kerpener Straße 62, 50937 Köln, Germany
| | - Lars P Müller
- Department for Trauma, Hand and Elbow Surgery, University of Cologne, Kerpener Straße 62, 50937 Köln, Germany
| | - Frank E Gohlke
- Department for Shoulder Surgery, Rhön-Clinic, Bad Neustadt, Salzburger Leite 1, 97616 Bad Neustadt/Saale, Germany
| |
Collapse
|
23
|
Langohr GDG, Willing R, Medley JB, King GJW, Johnson JA. Contact analysis of the native radiocapitellar joint compared with axisymmetric and nonaxisymmetric radial head hemiarthroplasty. J Shoulder Elbow Surg 2015; 24:787-95. [PMID: 25725964 DOI: 10.1016/j.jse.2014.12.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 12/04/2014] [Accepted: 12/06/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radial head (RH) implants are manufactured from stiff materials, resulting in reduced radiocapitellar contact area that may lead to cartilage degeneration. Although the native RH is nonaxisymmetric, most implants are axisymmetric, potentially contributing to altered contact mechanics. This study compared the joint contact area (Ac) and maximum contact stress (σmax) of axisymmetric and nonaxisymmetric RH implants to the native radiocapitellar joint. METHODS The contact mechanics of intact elbows derived from cadaveric computed tomography data (n = 15) were compared with axisymmetric (size: 18, 20, 22 mm) and nonaxisymmetric (size: 16 × 18, 18 × 20, 20 × 22 mm) RH hemiarthroplasty reconstructed elbows using Abaqus finite element software. Under a 100 N load, Ac and σmax were computed for ±90° pronation-supination and 0°, 45°, 90°, and 135° flexion. RESULTS Compared with native, both hemiarthroplasty models produced significantly lower Ac and higher σmax (P < .001). In the best orientation, the nonaxisymmetric RH provided significantly larger Ac at 0° and 135° flexion (P = .03, P = .007) and reduced levels of σmax at 45° and 90° flexion (P = .003, P < .001). However, there was also a worst orientation that reduced Ac and increased σmax for all flexion angles (P < .003 for all). The native RH was less sensitive to rotation than the nonaxisymmetric RH in terms of σmax (P < .001). The axisymmetric RH was not sensitive to rotation. CONCLUSIONS Whereas a nonaxisymmetric RH can provide improved contact mechanics at certain forearm rotations and flexions, there are also orientations where Ac is reduced and σmax is increased. Axisymmetric designs are more consistent throughout forearm rotation and therefore may be more forgiving than the nonaxisymmetric RH implant design used in this study.
Collapse
Affiliation(s)
- G Daniel G Langohr
- Bioengineering Research Laboratory, Roth
- McFarlane Hand and Upper Limb Center, St. Joseph's Health Care, University of Western Ontario, London, ON, Canada
| | - Ryan Willing
- Department of Mechanical Engineering, Binghamton University, Binghamton, NY, USA
| | | | - Graham J W King
- Bioengineering Research Laboratory, Roth
- McFarlane Hand and Upper Limb Center, St. Joseph's Health Care, University of Western Ontario, London, ON, Canada
| | - James A Johnson
- Bioengineering Research Laboratory, Roth
- McFarlane Hand and Upper Limb Center, St. Joseph's Health Care, University of Western Ontario, London, ON, Canada.
| |
Collapse
|
24
|
O'Driscoll SW, Bachman DR. Letter regarding "Radiocapitellar joint contact pressures following radial head arthroplasty". J Hand Surg Am 2015; 40:863-4. [PMID: 25813933 DOI: 10.1016/j.jhsa.2014.12.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 12/10/2014] [Indexed: 02/02/2023]
|
25
|
Irish SE, Langohr GDG, Willing R, King GJ, Johnson JA. Implications of radial head hemiarthroplasty dish depth on radiocapitellar contact mechanics. J Hand Surg Am 2015; 40:723-9. [PMID: 25813921 DOI: 10.1016/j.jhsa.2015.01.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 01/21/2015] [Accepted: 01/21/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the effect of radial head implant dish depth on radiocapitellar joint contact mechanics. METHODS Computed tomography images of 13 fresh-frozen cadaveric humeri were reconstructed into 3-dimensional finite element models with accurate cartilage geometry. Native humeri were paired with the corresponding native radial heads and axisymmetric radial head prosthesis models of the following dish depths: 1.0 mm, 1.5 mm, 2.0 mm, 2.5 mm, and 3.0 mm. Radiocapitellar contact mechanics were quantified at 4 different flexion angles (0°, 45°, 90°, and 135°) with a 100-N axial load applied to the radial head using a modeling protocol previously validated by cadaveric studies. The radial head was permitted to translate freely to its optimal position while the humerus was fully constrained. Output variables were contact area and peak contact stress. RESULTS All prostheses had significantly decreased contact area and increased peak contact stress at all flexion angles relative to the native radiocapitellar joint. Contact area increased with prosthesis dish depth until reaching a plateau with a predicted local maximum at a mean depth of 3.2 ± 0.7 mm. Peak contact stress was elevated for both the shallowest and deepest models and reached a predicted local minimum at a mean depth of 1.8 ± 0.3 mm. CONCLUSIONS Contact area and peak contact stress were dependent on radial head prosthesis dish depth. There was an optimal implant dish depth for radiocapitellar contact mechanics at approximately 2 mm. CLINICAL RELEVANCE Optimizing radiocapitellar contact mechanics using rigorous and systematic prosthesis design techniques may lead to better clinical outcomes due to reduced capitellar cartilage degradation.
Collapse
Affiliation(s)
- S Elizabeth Irish
- Roth McFarlane Hand and Upper Limb Centre Bioengineering, St. Joseph's Health Centre, London, Ontario, Canada.
| | - G Daniel G Langohr
- Roth McFarlane Hand and Upper Limb Centre Bioengineering, St. Joseph's Health Centre, London, Ontario, Canada
| | - Ryan Willing
- Roth McFarlane Hand and Upper Limb Centre Bioengineering, St. Joseph's Health Centre, London, Ontario, Canada
| | - Graham J King
- Roth McFarlane Hand and Upper Limb Centre Bioengineering, St. Joseph's Health Centre, London, Ontario, Canada
| | - James A Johnson
- Roth McFarlane Hand and Upper Limb Centre Bioengineering, St. Joseph's Health Centre, London, Ontario, Canada
| |
Collapse
|
26
|
Effect of radial head implant shape on joint contact area and location during static loading. J Hand Surg Am 2015; 40:716-22. [PMID: 25813920 DOI: 10.1016/j.jhsa.2014.12.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 12/09/2014] [Accepted: 12/09/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the effect of implant shape on radiocapitellar joint contact area and location in vitro. METHODS We used 8 fresh-frozen cadaveric upper extremities. An elbow loading simulator examined joint contact in pronation, neutral rotation, and supination with the elbow at 90° flexion. Muscle tendons were attached to pneumatic actuators to allow for computer-controlled loading to achieve the desired forearm rotation. We performed testing with the native radial head, an axisymmetric implant, a reverse-engineered patient-specific implant, and a population-based quasi-anatomic implant. Implants were inserted using computer navigation. Contact area and location were quantified using a casting technique. RESULTS We found no significant difference between contact locations for the native radial head and the 3 implants. All of the implants had a contact area lower than the native radial head; however, only the axisymmetric implant was significantly different. There was no significant difference in contact area between implant shapes. CONCLUSIONS The similar contact areas and locations of the 3 implant designs suggest that the shape of the implant may not be important with respect to radiocapitellar joint contact mechanics when placed optimally using computer navigation. Further work is needed to explore the sensitivity of radial head implant malpositioning on articular contact. The lower contact area of the radial head implants relative to the native radial head is similar to previous benchtop studies and is likely the result of the greater stiffness of the implant. CLINICAL RELEVANCE Radial head implant shape does not appear to have a pronounced influence on articular contact, and both axisymmetric and anatomic metal designs result in elevated cartilage stress relative to the intact state.
Collapse
|
27
|
Bachman DR, Thaveepunsan S, Park S, Fitzsimmons JS, An KN, O'Driscoll SW. The effect of prosthetic radial head geometry on the distribution and magnitude of radiocapitellar joint contact pressures. J Hand Surg Am 2015; 40:281-8. [PMID: 25542439 DOI: 10.1016/j.jhsa.2014.11.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 11/04/2014] [Accepted: 11/04/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine if radiocapitellar contact pressures would be elevated with nonanatomical (circular) prostheses over those mimicking native anatomy and if such pressures would be related to the depth and contour of the articular dish and to the pattern of prosthetic articulation against the lateral trochlear ridge. METHODS Three commercially available circular radial head designs were compared with an anatomical radial head and 2 modified anatomical prototype radial head designs in 10 cadaveric specimens. Each prosthesis and specimen combination was loaded in neutral rotation and maximal extension with a custom testing apparatus while measuring contact areas and pressures using thin-film pressure sensors. RESULTS Anatomical radial head prototype 2 had similar radiocapitellar contact areas and mean pressures as the native radial head; all other designs showed significant decreases in contact area and increased mean pressures. Peak contact pressures were also measured and were significantly elevated with all prostheses tested. Anatomical designs are statistically more likely to mimic normal contact with the lateral trochlear ridge and its adjacent sulcus than circular prostheses. They are also significantly less likely to have contact pressures above the 5 MPa threshold that is thought to be harmful to cartilage. The depth of the articular dish had a significant effect on contact area and pressure. CONCLUSIONS Commercially available radial head prostheses demonstrated reduced radiocapitellar contact areas and elevated contact pressures during compressive loading. These were significantly greater with symmetrical circular prostheses than with asymmetrical elliptical designs. The prosthesis that best mimicked native contact behavior was the anatomical radial head prototype 2 owing to its design for articulating with the capitellum, the lateral trochlear ridge, and the sulcus between. CLINICAL RELEVANCE Because radial head prostheses have the potential to cause capitellar erosion or arthritic change, those with lower contact pressures may lead to fewer such complications.
Collapse
Affiliation(s)
| | | | - Sangeun Park
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | - Kai-Nan An
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | |
Collapse
|
28
|
Do the radial head prosthesis components fit with the anatomical structures of the proximal radioulnar joint? Surg Radiol Anat 2014; 37:743-7. [PMID: 25542245 DOI: 10.1007/s00276-014-1407-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 12/17/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The fitting accuracy of radial head components has been investigated in the capitulo-radial joint, and reduced contact after prosthetic replacement of the radial head has been observed. The kinematics of the proximal radioulnar joint (PRUJ) are affected by radial head arthroplasty as well, but have not yet been investigated in this regard. METHODS The elbow joints of 60 upper extremities of formalin-fixed body donors were disarticulated to obtain a good view of the PRUJ. Each specimen was mounted on the examining table and radial head position in the native PRUJ was assessed in neutral position, full pronation, and full supination. Measurements were repeated after implantation of mono- and bi-polar prostheses. RESULTS Analysis of the distribution of the joint contacts in the compartments showed significant differences after radial head replacement. In comparison to the native joint, after bipolar and monopolar radial head replacement, the physiological shift of the proximal radius was altered. DISCUSSION The physiological shift of the joint contact of the radial head from anterior to posterior during forearm rotation that was found in the native joint in our cadaver model was not observed after prosthetic replacement. With higher conformity and physiological kinematic of radial head prostheses, possibly lower shear forces and lower contact pressures would be generated. CLINICAL RELEVANCE The tested radial head prostheses do not replicate the physiological kinematics of the radial head. Further development in the prosthesis design has to be made. The meticulous reconstruction of the annular ligament seems to be of importance to increase joint contact.
Collapse
|
29
|
Willing R, Lapner M, King GJW, Johnson JA. In vitro assessment of the contact mechanics of reverse-engineered distal humeral hemiarthroplasty prostheses. Clin Biomech (Bristol, Avon) 2014; 29:990-6. [PMID: 25238687 DOI: 10.1016/j.clinbiomech.2014.08.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/27/2014] [Accepted: 08/13/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Distal humeral hemiarthroplasty alters cartilage contact mechanics, which may predispose to osteoarthritis. Current prostheses do not replicate the native anatomy, and therefore contribute to these changes. We hypothesized that prostheses reverse-engineered from the native bone shape would provide similar contact patterns as the native articulation. METHODS Reverse-engineered hemiarthroplasty prostheses were manufactured for five cadaveric elbows based on CT images of the distal humerus. Passive flexion trials with constant muscle forces were performed with the native articulation intact while bone motions were recorded using a motion tracking system. Motion trials were then repeated after the distal humerus was replaced with a corresponding reverse-engineered prosthesis. Contact areas and patterns were reconstructed using computer models created from CT scan images combined with the motion tracker data. The total contact areas, as well as the contact area within smaller sub-regions of the ulna and radius, were analyzed for changes resulting from hemiarthroplasty using repeated-measures ANOVAs. FINDINGS Contact area at the ulna and radius decreased on average 42% (SD 19%, P=.008) and 41% (SD 42%, P=.096), respectively. Contact area decreases were not uniform throughout the different sub-regions, suggesting that contact patterns were also altered. INTERPRETATION Reverse-engineered prostheses did not reproduce the same contact pattern as the native joints, possibly because the thickness of the distal humerus cartilage layer was neglected when generating the prosthesis shapes or as a consequence of the increased stiffness of the metallic implants. Alternative design strategies and materials for hemiarthroplasty should be considered in future work.
Collapse
Affiliation(s)
- Ryan Willing
- Bioengineering Research Laboratory, Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, The University of Western Ontario, London, ON, Canada; Department of Mechanical Engineering, Binghamton University, Binghamton, NY, USA.
| | - Michael Lapner
- Bioengineering Research Laboratory, Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, The University of Western Ontario, London, ON, Canada
| | - Graham J W King
- Bioengineering Research Laboratory, Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, The University of Western Ontario, London, ON, Canada
| | - James A Johnson
- Bioengineering Research Laboratory, Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, The University of Western Ontario, London, ON, Canada
| |
Collapse
|
30
|
Heijink A, Morrey BF, Eygendaal D. Radiocapitellar prosthetic arthroplasty: a report of 6 cases and review of the literature. J Shoulder Elbow Surg 2014; 23:843-9. [PMID: 24739796 DOI: 10.1016/j.jse.2014.01.042] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 01/16/2014] [Accepted: 01/27/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radiocapitellar prosthetic arthroplasty has recently been introduced to treat isolated degenerative arthritis of the radiocapitellar joint. Although this procedure is conceptually attractive and sound in situations in which radial head resection is inadequate, clinical experience is still limited. Its role in the treatment of isolated radiocapitellar degenerative arthritis in the ligamentous-intact elbow and forearm is not yet defined. Our purpose was to report the short-term results of 6 patients who were treated by radiocapitellar prosthetic arthroplasty for isolated radiocapitellar degenerative arthritis in the ligamentous-intact elbow, as well as to provide a review of the literature. METHODS Six patients were treated by radiocapitellar prosthetic arthroplasty for isolated degenerative arthritis of the radiocapitellar joint in the ligamentous-intact elbow. Their medical records were reviewed, and each patient was seen in the office. The mean follow-up period was 50 months (range, 30-64 months). RESULTS The implant survival rate was 100%. Pain improved in all patients and all patients were satisfied. The mean flexion-extension arc increased from 98° (range, 75°-115°) to 110° (range, 105°-120°) (P = .17), and the mean pronation-supination arc increased from 133° (range, 75°-115°) to 143° (range, 120°-170°) (P = .34). The mean Disabilities of the Arm, Shoulder and Hand score was 24.3 (range, 6.7-52.5). According to the Mayo Elbow Performance Score, there were 3 excellent and 3 good results. CONCLUSION The short-term follow-up results of radiocapitellar prosthetic arthroplasty for isolated radiocapitellar degenerative arthritis in the ligamentous-intact elbow and forearm seem favorable. LEVEL OF EVIDENCE Level IV, case series, treatment study.
Collapse
Affiliation(s)
- Andras Heijink
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands.
| | - Bernard F Morrey
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
| |
Collapse
|
31
|
Sahu D, Holmes DM, Fitzsimmons JS, Thoreson AR, Berglund LJ, An KN, O'Driscoll SW. Influence of radial head prosthetic design on radiocapitellar joint contact mechanics. J Shoulder Elbow Surg 2014; 23:456-62. [PMID: 24630544 DOI: 10.1016/j.jse.2013.11.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 11/14/2013] [Accepted: 11/22/2013] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Our aim was to test whether anatomically designed metallic radial head implants could better reproduce native radiocapitellar contact pressure and areas than nonanatomic implants. METHODS The distal humerus and proximal radius from 6 cadaveric upper extremities were serially tested in supination with 100 N of compression force at 4 angles of flexion (0°, 30°, 60°, and 90°). By use of a thin flexible pressure transducer, contact pressures and areas were measured for the native radial head, an anatomic implant, a nonanatomic circular monopolar implant, and a bipolar nonanatomic implant. The data (mean contact pressure and mean contact area) were modeled using a 2-factor repeated-measures analysis of variance with P ≤ .05 considered to be significant. RESULTS The mean contact areas for the prosthetic radial heads were significantly less than those seen with the intact radial heads at every angle tested (P < .01). The mean contact pressures increased significantly with all prosthetic radial head types as compared with the native head. The mean contact pressures increased by 29% with the anatomic prosthesis, 230% with the monopolar prosthesis, and 220% with the bipolar prosthesis. Peak pressures of more than 5 MPa were more commonly observed with both the monopolar and bipolar prostheses than with the anatomic or native radial heads. CONCLUSIONS The geometry of radial head implants strongly influences their contact characteristics. In a direct radius-to-capitellum axial loading experiment, an anatomically designed radial head prosthesis had lower and more evenly distributed contact pressures than the nonanatomic implants that were tested.
Collapse
Affiliation(s)
- Dipit Sahu
- Department of Orthopaedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - David M Holmes
- Department of Orthopaedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - James S Fitzsimmons
- Department of Orthopaedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Andrew R Thoreson
- Department of Orthopaedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Lawrence J Berglund
- Department of Orthopaedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Kai-Nan An
- Department of Orthopaedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Shawn W O'Driscoll
- Department of Orthopaedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
32
|
Willing R, Lapner M, Lalone EA, King GJ, Johnson JA. Development of a computational technique to measure cartilage contact area. J Biomech 2014; 47:1193-7. [DOI: 10.1016/j.jbiomech.2014.01.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 01/22/2014] [Accepted: 01/23/2014] [Indexed: 11/24/2022]
|
33
|
Lanting BA, Ferreira LM, Johnson JA, Athwal GS, King GJW. The effect of excision of the radial head and metallic radial head replacement on the tension in the interosseous membrane. Bone Joint J 2013; 95-B:1383-7. [DOI: 10.1302/0301-620x.95b10.31844] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We measured the tension in the interosseous membrane in six cadaveric forearms using an in vitro forearm testing system with the native radial head, after excision of the radial head and after metallic radial head replacement. The tension almost doubled after excision of the radial head during simulated rotation of the forearm (p = 0.007). There was no significant difference in tension in the interosseous membrane between the native and radial head replacement states (p = 0.09). Maximal tension occurred in neutral rotation with both the native and the replaced radial head, but in pronation if the radial head was excised. Under an increasing axial load and with the forearm in a fixed position, the rate of increase in tension in the interosseous membrane was greater when the radial head was excised than for the native radial head or replacement states (p = 0.02). As there was no difference in tension between the native and radial head replacement states, a radial head replacement should provide a normal healing environment for the interosseous membrane after injury or following its reconstruction. Load sharing between the radius and ulna becomes normal after radial head Replacement. As excision of the radial head significantly increased the tension in the interosseous membrane it may potentially lead to its attritional failure over time. Cite this article: Bone Joint J 2013;95-B:1383–7.
Collapse
Affiliation(s)
- B. A. Lanting
- London Health Sciences Center, University
Hospital, LHSC, London, Ontario, N6C
5A5, Canada
| | - L. M. Ferreira
- St. Joseph’s Health Care, St.
Joseph’s Health Centre, 268 Grosvenor St., London, Ontario, N6A
4L6, Canada
| | - J. A. Johnson
- St. Joseph’s Health Care, St.
Joseph’s Health Centre, 268 Grosvenor St., London, Ontario, N6A
4L6, Canada
| | - G. S. Athwal
- St. Joseph’s Health Care, St.
Joseph’s Health Centre, 268 Grosvenor St., London, Ontario, N6A
4L6, Canada
| | - G. J. W. King
- St. Joseph’s Health Care, St.
Joseph’s Health Centre, 268 Grosvenor St., London, Ontario, N6A
4L6, Canada
| |
Collapse
|
34
|
Katchky RN, King GJW, Johnson JA, Athwal GS. The bicipital tuberosity and distal radius are unreliable landmarks for radial head implant alignment. J Shoulder Elbow Surg 2013; 22:1242-7. [PMID: 23643585 DOI: 10.1016/j.jse.2013.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 01/31/2013] [Accepted: 02/18/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND As more anatomic asymmetric radial head implants emerge, it is necessary to determine the optimal landmarks to ensure correct rotational orientation. The bicipital tuberosity and distal radius are possible bony landmarks that can be used for rotational alignment of asymmetric prostheses; however, they have not been validated. The purpose of this study was to evaluate the reliability of the bicipital tuberosity and distal radius as rotational landmarks for orientation of asymmetric radial head prostheses. METHODS Measurements were made from computer tomography scans of 50 elbows in order to determine the rotational relationships between the radial head, bicipital tuberosity, biceps tendon footprint, and distal radius. RESULTS The maximum radial head diameter was oriented 65° ± 28° from the bicipital tuberosity, 119° ± 38° from the biceps tendon footprint, 82° ± 29° from the radial styloid, and 76° ± 28° from the volar surface of the distal radius. All of these landmarks had a significantly greater variance than a proposed acceptable clinical tolerance of 10° (P < .001). CONCLUSION The results demonstrate that the measured landmarks show no consistent rotational relationship with the maximum diameter of the radial head. In order to maximize the utility of more anatomic asymmetric radial head implant systems, further studies are necessary to identify more reliable rotational landmarks to ensure optimal implant positioning.
Collapse
Affiliation(s)
- Ryan N Katchky
- Hand and Upper Limb Centre, St. Joseph's Health Care, 268 Grosvenor St., London, Ontario, Canada
| | | | | | | |
Collapse
|
35
|
Abstract
Radial head arthroplasty is the treatment of choice for non-reconstructble radial head fractures. Solid prostheses made of metal or pyocarbon can restore valgus stability of the elbow independent of design or stem fixation. Short-term and mid-term results show mostly good to excellent results without any evident differences between the different prosthesis philosophies. In order to obtain good results it is important to implant the prosthesis correctly without overfilling and to judge concomitant ligament injuries correctly. This article discusses the anatomical and biomechanical basis of radial head arthroplasty as well as the surgical technique and radiological diagnosis of overfilling.
Collapse
|
36
|
Lalone EA, McDonald CP, Ferreira LM, Peters TM, King GW, Johnson JA. Development of an image-based technique to examine joint congruency at the elbow. Comput Methods Biomech Biomed Engin 2013; 16:280-90. [DOI: 10.1080/10255842.2011.617006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
37
|
Partial allograft replacement of the radial head in the management of complex fracture-dislocations of the elbow. J Shoulder Elbow Surg 2012; 21:396-404. [PMID: 22005129 DOI: 10.1016/j.jse.2011.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 06/30/2011] [Accepted: 07/10/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND There have been reports of total radial head allografts showing variable outcomes. This case series reports the novel use of an allograft for partial radial head replacement in the treatment of elbow fracture-dislocation. METHODS Eight patients underwent partial radial head allograft reconstruction to restore stability for complex fracture-dislocations involving fractures of the coronoid and radial head, with collateral ligament disruption. Two patients were treated acutely. Six were referred from other centers 2 to 48 weeks after injury following failure of primary treatment. In each case, it was not possible to perform stable open reduction-internal reduction of the radial head fracture, or the fracture fragment had already been excised. A fresh-frozen partial radial head allograft was used to replace the defect and restore the joint surface. The coronoid fracture and injury to collateral ligaments were also managed surgically. Patient charts, surgical records, and radiographs were reviewed. Patients were contacted at a mean of 79 months after treatment to answer questions to determine the Mayo Elbow Performance Score and the score on the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. RESULTS Clinical and radiologic reviews confirmed union of graft in all cases. None resorbed or collapsed. Three patients had resorption of the coronoid fragment resulting in poor outcomes, with one patient ultimately undergoing total elbow arthroplasty. CONCLUSION Partial radial head allograft may be a useful alternative to radial head prosthesis in unstable fracture-dislocations in which the radial head cannot be restored fully.
Collapse
|
38
|
Chanlalit C, Shukla DR, Fitzsimmons JS, An KN, O'Driscoll SW. Influence of prosthetic design on radiocapitellar concavity-compression stability. J Shoulder Elbow Surg 2011; 20:885-90. [PMID: 21652226 DOI: 10.1016/j.jse.2011.03.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 01/25/2011] [Accepted: 03/05/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radial head prostheses are available with multiple geometric properties. The effect of design features on radiocapitellar stability has not been investigated. HYPOTHESIS The shape (depth and radius of curvature) of the articulating dish of a radial head prosthesis affects radiocapitellar stability. MATERIALS AND METHODS Radiocapitellar stability due to concavity-compression was evaluated in 8 fresh frozen elbows before and after radial head replacement with 2 different designs of radial head implants (RH 1 and RH 2). Both functioned as monopolar implants. Peak forces resisting subluxation and force-displacement characteristics were compared between the 2 and to the native radial head. RESULTS Radial head design significantly affected radiocapitellar stability. RH 1, which had a deeper dish than RH 2, required significantly higher peak forces to subluxate the radiocapitellar joint. The peak subluxation forces and the slopes of the force-displacement curves were not significantly different from the native radial head for RH 1, but they were for RH 2. CONCLUSION The shape of the articular dish (depth, radius of curvature) of a monopolar radial head implant affects its contribution to radiocapitellar stability. An implant that mimics normal anatomy is more effective than a shallow radial head implant with a radius of curvature that is longer than normal.
Collapse
Affiliation(s)
- Cholawish Chanlalit
- Department of Orthopedics, Faculty of Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Srinakhrinwirot University, Bangkok, Thailand
| | | | | | | | | |
Collapse
|
39
|
Abstract
OBJECTIVES To describe the pattern of injury, surgical technique, and outcomes of Monteggia Type IID fracture dislocations. DESIGN Retrospective review of prospectively collected clinical and radiographic patient data in an orthopaedic trauma database. SETTING Level I university-based trauma center. PATIENTS/PARTICIPANTS All patients with Monteggia Type IID fracture-dislocations admitted from January 2000 to July 2005. INTERVENTION Review of patient demographics, fracture pattern, method of fixation, complications, additional surgical procedures, and clinical and radiographic outcome measures. MAIN OUTCOME MEASUREMENTS Clinical outcomes: elbow range of motion, complications. Radiographic outcomes: characteristic fracture fragments, quality of fracture reduction, healing time, degenerative changes, and heterotopic ossification. RESULTS Sixteen patients were included in the study. All fractures united. There were six complications in six patients, including three contractures with associated heterotopic ossification, one pronator syndrome and late radial nerve palsy, one radial head collapse, and one with prominent hardware. CONCLUSIONS Monteggia IID fracture-dislocations are complex injuries with typical specific fracture fragments. Anatomic fixation of all injury components and avoidance of complications where possible can lead to a good outcome in these challenging injuries.
Collapse
|
40
|
The impact of capitellar arthroplasty on elbow contact mechanics: Implications for implant design. Clin Biomech (Bristol, Avon) 2011; 26:458-63. [PMID: 21474220 DOI: 10.1016/j.clinbiomech.2011.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 01/12/2011] [Accepted: 01/13/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Radiocapitellar arthroplasty is indicated for capitellar deficiency. Although current implants employ a spherical capitellar surface, the capitellum is elliptical. This has implications for congruency and wear in capitellar arthroplasty. Our objective was to evaluate the contact mechanics of radiocapitellar arthroplasty. We hypothesized that capitellar replacement would decrease joint contact area relative to the native articulation; and an anatomical implant design would replicate more normal contact morphology than a spherical implant. METHODS Eight paired humeri and radii were potted in a custom jig. A compressive load of 85N was applied with the articulation flexed at 45° in neutral forearm rotation. Joint casts were made and the articular contact area and shape were quantified. Anatomical and spherical capitellar implants were tested against the native radial head (hemiarthroplasty). FINDINGS The contact areas for the anatomical and spherical hemiarthroplasties were 59 and 51% of the native articulation (P<0.005), while the unicompartmental arthroplasties' contact areas were 84 and 89% (anatomical, spherical) of the native articulation (P<0.01). No implant was superior in recreating the native contact shape. INTERPRETATION Placement of any capitellar implant resulted in a large decrease in contact area when articulating with a native radial head. This suggests that the radial head cartilage would see a marked increase in contact pressure relative to the native articulation. The unicompartmental arthroplasties demonstrated an even larger reduction in contact area, raising concern about accelerated surface wear. Further investigation needs to correlate these contact mechanics to cartilage wear and implant longevity.
Collapse
|
41
|
Abstract
BACKGROUND The importance of the radial head to elbow function and stability is increasingly apparent. Although preservation of the native radial head is preferred, severely comminuted fractures may necessitate resection or arthroplasty. Silastic radial head arthroplasty has been condemned on the basis of several sporadic reports of silicone synovitis. However, problems of "overstuffing," cartilage wear, and motion loss are becoming apparent with metal prostheses, indicating this also is not an ideal solution. Thus, the choices remain controversial. QUESTIONS/PURPOSES We asked whether intact or reconstructed primary elbow stabilizers permit use of silastic radial head implants without fragmentation, failure, and silicone synovitis. METHODS We retrospectively reviewed 23 patients with unreconstructable radial head fractures who were treated with silastic radial head arthroplasty and concomitant repair and/or reconstruction of the medial ulnar collateral ligament and/or lateral ulnar collateral ligament. Analysis included range of motion, pain, stability, and radiographic assessments; Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire; and Mayo Elbow Performance Score (MEPS). The minimum followup was 16 months (average, 69.6 months; range, 16-165 months). RESULTS At last followup, the mean elbow flexion was 145°, extension 11°, supination 80°, and pronation 83°. The mean MEPS score was 88.9. The mean DASH score was 11.8. There were eight reoperations, none resulting from failure of the radial head implants. CONCLUSIONS These results demonstrate silastic radial heads can be used with low complication rates and without evidence of synovitis when concomitant elbow ligament repair or reconstruction is performed. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Yariv Maghen
- Department of Orthopaedic Surgery, The Mount Sinai School of Medicine, 5 East 98th Street, Box 1188, New York, NY 10029 USA
| | - Andrew J. Leo
- Department of Orthopaedic Surgery, The Mount Sinai School of Medicine, 5 East 98th Street, Box 1188, New York, NY 10029 USA
| | - Jennifer W. Hsu
- Department of Orthopaedic Surgery, The Mount Sinai School of Medicine, 5 East 98th Street, Box 1188, New York, NY 10029 USA
| | - Michael R. Hausman
- Department of Orthopaedic Surgery, The Mount Sinai School of Medicine, 5 East 98th Street, Box 1188, New York, NY 10029 USA
| |
Collapse
|
42
|
Mid- to long-term results after bipolar radial head arthroplasty. J Shoulder Elbow Surg 2010; 19:965-72. [PMID: 20846619 DOI: 10.1016/j.jse.2010.05.022] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Revised: 05/20/2010] [Accepted: 05/25/2010] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radial head arthroplasty is considered the treatment of choice for unreconstructable radial head fractures in the acute fracture situation. Although short-term results in the current literature are promising, replacement of the radial head remains controversial as long-term results are still missing. We report our 8.8-year results after treatment with a bipolar radial head prosthesis by Judet. MATERIALS AND METHODS In our department, 19 patients were treated with bipolar radial head arthroplasty between 1997 and 2001. Seventeen of these patients-14 men and 3 women-were examined retrospectively after 106 months (range, 78-139). Of these, 9 patients were treated primarily, 7 patients secondarily, and 1 because of a tumor. RESULTS On the Mayo Elbow Performance Score, 6 patients achieved excellent results, 10 good, and one fair. The mean DASH score was 9.8 (range, 0-34). No differences were seen between primary and secondary implantation. Flexion averaged 124° (range, 110-150°), the extension deficit was 21° (range, 0-40°), pronation 64° (range, 30-90°), and supination 64° (range, 30-90°). The following complications were seen: 2 dislocations and 8 cases of degenerative changes of the capitellum, 1 with severe erosion. Signs of ulnohumeral arthrosis were found in 12 patients. No evidence of loosening, radiolucencies, or proximal bone resorption was detected. CONCLUSION Despite major primary complications and high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis.
Collapse
|
43
|
Moungondo F, El Kazzi W, van Riet R, Feipel V, Rooze M, Schuind F. Radiocapitellar joint contacts after bipolar radial head arthroplasty. J Shoulder Elbow Surg 2010; 19:230-5. [PMID: 20036580 DOI: 10.1016/j.jse.2009.09.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Revised: 05/28/2009] [Accepted: 09/23/2009] [Indexed: 02/01/2023]
Abstract
PURPOSE The purpose of this study was to determine radiocapitellar contacts before and after radial head replacement, using the bipolar design of Judet. METHODS Joint contacts were measured by moulding the joint surfaces of 6 fresh-frozen cadaveric specimens, in various positions of elbow flexion and forearm rotation. RESULTS Expressed as function of the radial cup, contact areas averaged 44% in the normal elbow, decreasing with flexion and increasing with supination (P < .05). After prosthetic implantation, contact areas averaged 33% and remained quite similar, irrespective of elbow position. Subluxation of the prosthetic head over the lateral margin of the trochlea was seen systematically with supination. CONCLUSIONS Because of intraprosthetic mobility, contact areas were not dependant on elbow position. This adaptability, however, also led to abnormal positioning of the prosthetic radial head with supination, subluxing over the trochlea lateral margin.
Collapse
Affiliation(s)
- Fabian Moungondo
- Department of Orthopaedics and Traumatology, Université libre de Bruxelles, Campus Hospitalo-Facultaire Erasme, Brussels, Belgium
| | | | | | | | | | | |
Collapse
|
44
|
Moon JG, Berglund LJ, Domire Z, An KN, O'Driscoll SW. Stem diameter and micromotion of press fit radial head prosthesis: a biomechanical study. J Shoulder Elbow Surg 2009; 18:785-90. [PMID: 19427236 DOI: 10.1016/j.jse.2009.02.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 02/13/2009] [Accepted: 02/16/2009] [Indexed: 02/01/2023]
Abstract
BACKGROUND Aseptic loosening of the stem, ranging from mild periprosthetic lucency to symptomatic loosening leading to implant removal, has been reported in press fit radial head prostheses. HYPOTHESIS The purpose of this study was to determine the effect of the stem diameter and insertion force on initial stability with a press fit radial head prosthesis designed for bone ingrowth. MATERIALS AND METHODS Cadaveric radii were implanted with radial head prostheses of increasing stem diameter. The insertion forces for each rasp and stem were measured. Micromotion of the stem at the isthmus of the canal and stem tip were measured under circumstances simulating eccentric loads. RESULTS Insertion forces for all submaximum-sized rasps were similar. However, the insertion force for the maximum-sized rasp was approximately twice as large, and the insertion force for the oversized rasp was twice as large again, potentially indicating that the insertion force may be useful as a guide for determining appropriate stem size. Micromotions of the maximum diameter stem (isthmus, 41 microm; tip, 64 microm) were near the threshold for bone ingrowth, whereas the micromotions of the submaximum stem (isthmus, 253 microm; tip, 394 microm) were above this threshold. DISCUSSION The maximum diameter stem achieved greater stability (minimum micromotion) compared with the submaximum diameter stem. CONCLUSION The best fixation strength in the press fit radial head prosthesis was achieved by maximum sizing in the neck canal.
Collapse
Affiliation(s)
- Jun-Gyu Moon
- Biomechanics Laboratory, Department of Orthopaedic Surgery, Mayo Clinics, Rochester, MN 55905, USA
| | | | | | | | | |
Collapse
|
45
|
Moon JG, Berglund LJ, Zachary D, An KN, O'Driscoll SW. Radiocapitellar joint stability with bipolar versus monopolar radial head prostheses. J Shoulder Elbow Surg 2009; 18:779-84. [PMID: 19427239 DOI: 10.1016/j.jse.2009.02.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 02/02/2009] [Accepted: 02/08/2009] [Indexed: 02/01/2023]
Abstract
BACKGROUND Bipolar and monopolar designs are both available for replacement of the radial head. Few data exist comparing the biomechanical characteristics of these 2 quite different prostheses. This study evaluated the relative contribution to radiocapitellar stability by concavity compression with these 2 types of radial head prostheses. METHODS The study used 12 fresh frozen elbow cadavers. The capitellum of the distal humerus and 3 different conditions of radial head (native, monopolar and bipolar) were tested for radiocapitellar joint stability. RESULTS The monopolar metallic head and the native radial head behaved similarly regarding resistance to subluxation. The bipolar head behaved in an entirely opposite manner than the native and monopolar head and actually acted to facilitate subluxation. CONCLUSIONS Mobility of radial head components, such as in the bipolar radial head, has a compromising effect on the concavity compression stability of the radiocapitellar joint. A monopolar implant is more effective in stabilizing the radiocapitellar joint than a bipolar radial head prosthesis.
Collapse
Affiliation(s)
- Jun-Gyu Moon
- Biomechanics Laboratory, Department of Orthopaedic Surgery, Mayo Clinics, Rochester, MN 55905, USA
| | | | | | | | | |
Collapse
|
46
|
Torres-Torres M, Ortiz-Espada A, Corella-Montoya F, Vaquero-Martín J. Estudio de 15 prótesis de cabeza radial bipolares. Rev Esp Cir Ortop Traumatol (Engl Ed) 2008. [DOI: 10.1016/s1888-4415(08)74839-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
47
|
Torres-Torres M, Ortiz-Espada A, Corella-Montoya F, Vaquero-Martín J. Bipolar radial head prosthesis implantation: a review of 15 cases. Rev Esp Cir Ortop Traumatol (Engl Ed) 2008. [DOI: 10.1016/s1988-8856(08)70114-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
48
|
Yian E, Steens W, Lingenfelter E, Schneeberger AG. Malpositioning of radial head prostheses: an in vitro study. J Shoulder Elbow Surg 2008; 17:663-70. [PMID: 18424091 DOI: 10.1016/j.jse.2007.12.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Revised: 11/15/2007] [Accepted: 12/12/2007] [Indexed: 02/01/2023]
Abstract
Nonanatomic insertion of radial head prostheses may result in maltracking and capitellar erosion. The purpose of this study was to analyze the ability to perform anatomic radial head replacement and to study radiocapitellar prosthetic subluxation under unstable conditions. In vitro measurements were performed in 10 intact elbows and after insertion of radial head prostheses (rigid uncemented, rigid cemented, bipolar). The diameter and length of the proximal radius were approximately restored. However, prosthesis-shaft malalignment, up to 21 degrees , was observed frequently. A posterolateral rotatory stress after resection of 50% of the coronoid caused a mean radiocapitellar subluxation of more than 30% for the rigid prostheses, whereas bipolar devices self-aligned with a mean subluxation similar to intact elbows. In conclusion, it was not possible to consistently insert radial head prostheses anatomically. Marked radiocapitellar subluxation occurred for the rigid but not for the bipolar implants. Clinical trials are needed to analyze these findings.
Collapse
Affiliation(s)
- Edward Yian
- Balgrist, Department of Orthopaedic Surgery, University of Zurich, Zurich, Switzerland
| | | | | | | |
Collapse
|
49
|
Heijink A, Morrey BF, Cooney WP. Radiocapitellar hemiarthroplasty for radiocapitellar arthritis: a report of three cases. J Shoulder Elbow Surg 2007; 17:e12-5. [PMID: 17967550 DOI: 10.1016/j.jse.2007.04.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Revised: 02/01/2007] [Accepted: 04/08/2007] [Indexed: 02/01/2023]
Affiliation(s)
- Andras Heijink
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | | | | |
Collapse
|
50
|
Rowland AS, Athwal GS, MacDermid JC, King GJW. Lateral ulnohumeral joint space widening is not diagnostic of radial head arthroplasty overstuffing. J Hand Surg Am 2007; 32:637-41. [PMID: 17482001 DOI: 10.1016/j.jhsa.2007.02.024] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Revised: 02/27/2007] [Accepted: 02/28/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE Metallic radial head replacement with a prosthesis that is too thick has been reported to be associated with stiffness, pain, and capitellar wear. Radiographic widening of the lateral ulnohumeral joint after radial head replacement has been used as a criterion to diagnose overstuffing. The purpose of this study was to show that widening of the lateral ulnohumeral joint is a normal anatomic variant and therefore cannot be used conclusively to diagnose joint overstuffing. METHODS Fifty normal standardized anteroposterior radiographs from 50 patients were reviewed to evaluate variations in the joint space between the medial and lateral ulnohumeral joints. Measurements were taken on 3 occasions by one surgeon and on a single occasion by a second surgeon. At 4-times magnification, 2 lines were drawn perpendicular to the lateral ulnohumeral joint and 2 lines perpendicular to the medial ulnohumeral joint. Measurements were then compared to evaluate joint space width and parallelism. RESULTS Intraclass correlation coefficients indicated excellent intrarater and interrater reliability. The width of the lateral ulnohumeral joint space was greater than that of the medial ulnohumeral joint space. The medial joint space was parallel, and the lateral joint space was nonparallel. CONCLUSIONS The lateral ulnohumeral joint space is often wider than the medial ulnohumeral joint space on anteroposteror radiographs of the normal elbow. Although the medial joint space is usually parallel, the lateral joint space may be nonparallel and wider laterally; therefore, lateral joint space widening is not a reliable indicator of radiocapitellar joint overstuffing. A nonparallel medial ulnohumeral joint space may suggest possible overstuffing of a radial head arthroplasty; however, comparing radiographs of the uninjured elbow is likely the best investigation to consider when overstuffing is suspected.
Collapse
|