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01-07-2017 | Original Paper

Causes for early and late surgical re-intervention after radial head arthroplasty

Authors: Pierre Laumonerie, David Ancelin, Nicolas Reina, Meagan E. Tibbo, Panagiotis Kerezoudis, Stephanie Delclaux, Nicolas Bonnevialle, Pierre Mansat

Published in: International Orthopaedics | Issue 7/2017

Abstract

Purpose

The primary objective was to describe the reasons for surgical re-intervention after radial head arthroplasty. The secondary objective was to analyze the radiographic and clinical outcomes after surgical re-intervention at the elbow with implant conservation.

Methods

Among the 70 radial head arthroplasties with bipolar radial head implant performed between 2002 and 2014, 29 required surgical re-interventions. Reasons for surgical re-intervention were gathered from operative notes and follow-up documentation. Patients who underwent re-intervention with implant retention were reassessed via clinical and radiographic examinations by an independent reviewer.

Results

Twenty nine re-operations were performed at a mean follow-up of 16 ± 11.7 months (0.2–36 months). The prosthesis was removed in 18 cases and retained in 11. There was a significant difference in mean time to re-intervention between the implant removal and preservation groups, 23.1 ± 8.3 months (7–36 months) and 4.4 ± 4.7 months (0.2–13 months), respectively (p < 0.001). The primary reason for surgical re-intervention was painful loosening (13 cases). Radio-capitellar instability was the most frequent reason for re-intervention with implant retention (5 cases). Midterm quickDASH and MEPS after surgical re-intervention with implant retention were 15.4 ± 5.4 and 82.27 ± 7.3, respectively. At least one degenerative lesion was reported in nine cases (81.8%) (i.e. 5 periprosthetic osteolysis, 5 capitellar wear, 5 periarticular heterotopic ossification).

Conclusions

Painful loosening and capitellar instability are the primary reasons for surgical re-intervention with or without implant removal. Midterm clinical results are favourable despite an elevated rate of degenerative lesions after surgical re-intervention with implant retention.

Mason ML (1954) Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg 42(172):123–132CrossRefPubMed

Ring D (2008) Displaced, unstable fractures of the radial head: fixation vs. replacement—what is the evidence? Injury 39(12):1329–1337. doi:10.1016/j.injury.2008.04.011 CrossRefPubMed

Herbertsson P, Josefsson PO, Hasserius R, Besjakov J, Nyqvist F, Karlsson MK (2004) Fractures of the radial head and neck treated with radial head excision. J Bone Joint Surg Am 86-A(9):1925–1930CrossRefPubMed

Ikeda M, Oka Y (2000) Function after early radial head resection for fracture: a retrospective evaluation of 15 patients followed for 3-18 years. Acta Orthop Scand 71(2):191–194. doi:10.1080/000164700317413184 CrossRefPubMed

Ikeda M, Sugiyama K, Kang C, Takagaki T, Oka Y (2005) Comminuted fractures of the radial head. Comparison of resection and internal fixation. J Bone Joint Surg Am 87(1):76–84. doi:10.2106/JBJS.C.01323 PubMed

Morrey BF, Tanaka S, An KN (1991) Valgus stability of the elbow. A definition of primary and secondary constraints. Clin Orthop 265:187–195

Schiffern A, Bettwieser SP, Porucznik CA, Crim JR, Tashjian RZ (2011) Proximal radial drift following radial head resection. J Shoulder Elb Surg 20(3):426–433. doi:10.1016/j.jse.2010.11.008 CrossRef

Van Riet RP, Morrey BF (2010) Delayed valgus instability and proximal migration of the radius after radial head prosthesis failure. J Shoulder Elb Surg 19(7):e7–10. doi:10.1016/j.jse.2010.04.046 CrossRef

Moro JK, Werier J, MacDermid JC, Patterson SD, King GJ (2001) Arthroplasty with a metal radial head for unreconstructible fractures of the radial head. J Bone Joint Surg Am 83-A(8):1201–1211CrossRefPubMed

10.

Ring D, Jupiter JB, Zilberfarb J (2002) Posterior dislocation of the elbow with fractures of the radial head and coronoid. J Bone Joint Surg Am 84-A(4):547–551CrossRefPubMed

11.

Frank SG, Grewal R, Johnson J, Faber KJ, King GJW, Athwal GS (2009) Determination of correct implant size in radial head arthroplasty to avoid overlengthening. J Bone Joint Surg Am 91(7):1738–1746. doi:10.2106/JBJS.H.01161 CrossRefPubMed

12.

Luenam S, Chalongviriyalert P, Kosiyatrakul A, Thanawattano C (2012) Alteration of the end-plane angle in press-fit cylindrical stem radial head prosthesis: an in vitro study. Hand Surg 17(1):19–24. doi:10.1142/S0218810412500037 CrossRefPubMed

13.

Popovic N, Djekic J, Lemaire R, Gillet P (2005) A comparative study between proximal radial morphology and the floating radial head prosthesis. J Shoulder Elb Surg 14(4):433–440. doi:10.1016/j.jse.2004.10.012 CrossRef

14.

Sahu D, Holmes DM, Fitzsimmons JS et al (2014) Influence of radial head prosthetic design on radiocapitellar joint contact mechanics. J Shoulder Elb Surg 23(4):456–462. doi:10.1016/j.jse.2013.11.028 CrossRef

15.

Delclaux S, Lebon J, Faraud A et al (2015) Complications of radial head prostheses. Int Orthop 39(5):907–913. doi:10.1007/s00264-015-2689-7 CrossRefPubMed

16.

Duckworth AD, Wickramasinghe NR, Clement ND, Court-Brown CM, McQueen MM (2014) Radial head replacement for acute complex fractures: what are the rate and risks factors for revision or removal? Clin Orthop 472(7):2136–2143. doi:10.1007/s11999-014-3516-y CrossRefPubMedPubMedCentral

17.

Kachooei AR, Claessen FMAP, Chase SM, Verheij KKJ, van Dijk CN, Ring D (2016) Factors associated with removal of a radial head prosthesis placed for acute trauma. Injury 47(6):1253–1257. doi:10.1016/j.injury.2016.02.023 CrossRefPubMed

18.

Neuhaus V, Christoforou DC, Kachooei AR, Jupiter JB, Ring DC, Mudgal CS (2015) Radial head prosthesis removal: a retrospective case series of 14 patients. Arch Bone Jt Surg 3(2):88–93PubMedPubMedCentral

19.

O’Driscoll SW, Herald JA (2012) Forearm pain associated with loose radial head prostheses. J Shoulder Elb Surg 21(1):92–97. doi:10.1016/j.jse.2011.05.008 CrossRef

20.

Van Riet RP, Sanchez-Sotelo J, Morrey BF (2010) Failure of metal radial head replacement. J Bone Joint Surg Br 92(5):661–667. doi:10.1302/0301-620X.92B5.23067 CrossRefPubMed

21.

Cusick MC, Bonnaig NS, Azar FM, Mauck BM, Smith RA, Throckmorton TW (2014) Accuracy and reliability of the Mayo elbow performance score. J Hand Surg Am 39(6):1146–1150. doi:10.1016/j.jhsa.2014.01.041 CrossRefPubMed

22.

Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The upper extremity collaborative group (UECG). Am J Ind Med 29(6):602–608CrossRefPubMed

23.

Charalambous CP, Stanley JK, Mills SP et al (2011) Comminuted radial head fractures: aspects of current management. J Shoulder Elb Surg 20(6):996–1007. doi:10.1016/j.jse.2011.02.013 CrossRef

24.

Pike JM, Athwal GS, Faber KJ, King GJ (2009) Radial head fractures—an update. J Hand Surg Am 34(3):557–565. doi:10.1016/j.jhsa.2008.12.024 CrossRefPubMed

25.

Ruan H-J, Fan C-Y, Liu J-J, Zeng B-F (2009) A comparative study of internal fixation and prosthesis replacement for radial head fractures of Mason type III. Int Orthop 33(1):249–253. doi:10.1007/s00264-007-0453-3 CrossRefPubMed

26.

Shore BJ, Mozzon JB, MacDermid JC, Faber KJ, King GJ (2008) Chronic posttraumatic elbow disorders treated with metallic radial head arthroplasty. J Bone Joint Surg Am 90(2):271–280. doi:10.2106/JBJS.F.01535 CrossRefPubMed

27.

Watters TS, Garrigues GE, Ring D, Ruch DS (2014) Fixation versus replacement of radial head in terrible triad: is there a difference in elbow stability and prognosis? Clin Orthop 472(7):2128–2135. doi:10.1007/s11999-013-3331-x CrossRefPubMed

28.

Chanlalit C, Shukla DR, Fitzsimmons JS, An K-N, O’Driscoll SW (2012) The biomechanical effect of prosthetic design on radiocapitellar stability in a terrible triad model. J Orthop Traum 26(9):539–544. doi:10.1097/BOT.0b013e318238b3a2 CrossRef

29.

Moon J-G, Berglund LJ, Zachary D, An K-N, O’Driscoll SW (2009) Radiocapitellar joint stability with bipolar versus monopolar radial head prostheses. J Shoulder Elb Surg 18(5):779–784. doi:10.1016/j.jse.2009.02.011 CrossRef

30.

Rotini R, Marinelli A, Guerra E, Bettelli G, Cavaciocchi M (2012) Radial head replacement with unipolar and bipolar SBi system: a clinical and radiographic analysis after a 2-year mean follow-up. Musculoskelet Surg 96(Suppl 1):S69–S79. doi:10.1007/s12306-012-0198-z CrossRefPubMed

31.

Berschback JC, Lynch TS, Kalainov DM, Wysocki RW, Merk BR, Cohen MS (2013) Clinical and radiographic comparisons of two different radial head implant designs. J Shoulder Elb Surg 22(8):1108–1120. doi:10.1016/j.jse.2013.02.011 CrossRef

32.

Giannicola G, Sacchetti FM, Antonietti G, Piccioli A, Postacchini R, Cinotti G (2014) Radial head, radiocapitellar and total elbow arthroplasties: a review of recent literature. Injury 45(2):428–436. doi:10.1016/j.injury.2013.09.019 CrossRefPubMed

33.

Zwingmann J, Welzel M, Dovi-Akue D, Schmal H, Südkamp NP, Strohm PC (2013) Clinical results after different operative treatment methods of radial head and neck fractures: a systematic review and meta-analysis of clinical outcome. Injury 44(11):1540–1550. doi:10.1016/j.injury.2013.04.003 CrossRefPubMed

34.

Heijink A, Kodde IF, Mulder PG et al (2016) Radial head arthroplasty: a systematic review. JBJS Rev 18:4(10). doi:10.2106/JBJS.RVW.15.00095

35.

Dou Q, Yin Z, Sun L, Feng X (2015) Prosthesis replacement in Mason III radial head fractures: a meta-analysis. Orthop Traumatol Surg Res OTSR 101(6):729–734. doi:10.1016/j.otsr.2015.06.015 CrossRefPubMed

36.

Shukla DR, Fitzsimmons JS, An K-N, O’Driscoll SW (2012) Effect of stem length on prosthetic radial head micromotion. J Shoulder Elb Surg 21(11):1559–1564. doi:10.1016/j.jse.2011.11.025 CrossRef

37.

Moon J-G, Berglund LJ, Domire Z, An K-N, O’Driscoll SW (2009) Stem diameter and micromotion of press fit radial head prosthesis: a biomechanical study. J Shoulder Elb Surg 18(5):785–790. doi:10.1016/j.jse.2009.02.014 CrossRef

38.

Chanlalit C, Shukla DR, Fitzsimmons JS, Thoreson AR, An K-N, O’Driscoll SW (2011) Radiocapitellar stability: the effect of soft tissue integrity on bipolar versus monopolar radial head prostheses. J Shoulder Elb Surg 20(2):219–225. doi:10.1016/j.jse.2010.10.033 CrossRef

39.

Schneeberger AG, Sadowski MM, Jacob HA (2004) Coronoid process and radial head as posterolateral rotatory stabilizers of the elbow. J Bone Joint Surg Am 86-A(5):975–982CrossRefPubMed

40.

Flinkkilä T, Kaisto T, Sirniö K, Hyvönen P, Leppilahti J (2012) Short- to mid-term results of metallic press-fit radial head arthroplasty in unstable injuries of the elbow. J Bone Joint Surg Br 94(6):805–810. doi:10.1302/0301-620X.94B6.28176 CrossRefPubMed

41.

Gauci M-O, Winter M, Dumontier C, Bronsard N, Allieu Y (2016) Clinical and radiologic outcomes of pyrocarbon radial head prosthesis: midterm results. J Shoulder Elb Surg 25(1):98–104. doi:10.1016/j.jse.2015.08.033 CrossRef

42.

Burkhart KJ, Mattyasovszky SG, Runkel M et al (2010) Mid- to long-term results after bipolar radial head arthroplasty. J Shoulder Elb Surg 19(7):965–972. doi:10.1016/j.jse.2010.05.022 CrossRef

43.

Harrington IJ, Sekyi-Otu A, Barrington TW, Evans DC, Tuli V (2001) The functional outcome with metallic radial head implants in the treatment of unstable elbow fractures: a long-term review. J Trauma 50(1):46–52CrossRefPubMed

44.

Marsh JP, Grewal R, Faber KJ, Drosdowech DS, Athwal GS, King GJ (2016) Radial head fractures treated with modular metallic radial head replacement: outcomes at a mean follow-up of eight years. J Bone Joint Surg Am 98(7):527–535. doi:10.2106/JBJS.15.00128 CrossRefPubMed

Title: Causes for early and late surgical re-intervention after radial head arthroplasty
Authors: Pierre Laumonerie
David Ancelin
Nicolas Reina
Meagan E. Tibbo
Panagiotis Kerezoudis
Stephanie Delclaux
Nicolas Bonnevialle
Pierre Mansat
Publication date: 01-07-2017
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 7/2017
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-017-3496-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Causes for early and late surgical re-intervention after radial head arthroplasty

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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