Skip to main content
Top
Published in: European Journal of Trauma and Emergency Surgery 1/2011

01-02-2011 | Original Article

Radial head arthroplasty with an uncemented modular metallic radial head prosthesis: short- and mid-term results

Authors: M. Muhm, R. de Castro, H. Winkler

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2011

Login to get access

Abstract

Background

In comminuted radial head fractures, arthroplasty is an alternative treatment to open reduction and internal fixation or radial head excision. The purpose of this study was to evaluate the short- and mid-term results after the implantation of the EVOLVE™ uncemented modular metallic radial head prosthesis.

Methods

Twenty-five patients with an unreconstructible comminuted radial head fracture were treated with the EVOLVE™ prosthesis. Two groups were formed in order to evaluate short-term (mean 1.6 years, range 1–2.3 years) and mid-term (mean 5.1 years, range 3–7.2 years) results. The short-term group consisted of 10 patients and the mid-term group of 15 patients. Objective physical outcome (ROM, grip strength) and outcome scores (Broberg/Morrey score, DASH) as well as radiological findings (periprosthetic lucency, prosthetic sizing, heterotopic ossification, posttraumatic osteoarthritis) were evaluated.

Results

Significant impairments in ROM and grip strength were observed in the affected arm. Differences in impairment of the affected arm between the two groups were not significant. There were no significant differences in the outcome scores between the two groups, with good results obtained overall. Understuffing was observed in 3 patients. Three patients had severe and 5 had no periprosthetic lucency. The groups barely differed in periprosthetic lucency.

Conclusions

Radial head arthroplasty with the EVOLVE™ prosthesis gave good results in terms of objective physical outcome and outcome scores at short- and mid-term follow-up. Periprosthetic lucency does not affect the outcome negatively. We assume that periprosthetic lucency does not necessarily imply prosthesis loosening in which revision is required. Radiological findings and the severity of the initial injury do not necessarily correlate with results.
Literature
1.
go back to reference Mason ML. Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg. 1954;42:123–32.CrossRefPubMed Mason ML. Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg. 1954;42:123–32.CrossRefPubMed
2.
go back to reference Ambacher T, Maurer F, Weise K. Treatment results after primary and secondary resection of the radial head. Unfallchirurg. 2000;103:437–43.CrossRefPubMed Ambacher T, Maurer F, Weise K. Treatment results after primary and secondary resection of the radial head. Unfallchirurg. 2000;103:437–43.CrossRefPubMed
4.
go back to reference Knight DJ, Rymaszewski LA, Amis AA, Miller JH. Primary replacement of the fractured radial head with a metal prosthesis. J Bone Joint Surg Br. 1993;75:572–6.PubMed Knight DJ, Rymaszewski LA, Amis AA, Miller JH. Primary replacement of the fractured radial head with a metal prosthesis. J Bone Joint Surg Br. 1993;75:572–6.PubMed
5.
go back to reference Morrey BF, An KN. Articular and ligamentous contribution to the stability of the elbow joint. Am J Sports Med. 1983;11:315–9.CrossRefPubMed Morrey BF, An KN. Articular and ligamentous contribution to the stability of the elbow joint. Am J Sports Med. 1983;11:315–9.CrossRefPubMed
6.
go back to reference Beingessner DM, Dunning CE, Gordon KD, Johnson JA, King GJ. The effect of radial head fracture size on elbow kinematics and stability. J Orthop Res. 2005;23:210–7.CrossRefPubMed Beingessner DM, Dunning CE, Gordon KD, Johnson JA, King GJ. The effect of radial head fracture size on elbow kinematics and stability. J Orthop Res. 2005;23:210–7.CrossRefPubMed
7.
go back to reference Charalambous CP, Stanley JK, Siddique I, Powell E, Ramamurthy C, Gagey O. Radial head fracture in the medial collateral ligament deficient elbow; biomechanical comparison of fixation, replacement and excision in human cadavers. Injury. 2006;37:849–53.CrossRefPubMed Charalambous CP, Stanley JK, Siddique I, Powell E, Ramamurthy C, Gagey O. Radial head fracture in the medial collateral ligament deficient elbow; biomechanical comparison of fixation, replacement and excision in human cadavers. Injury. 2006;37:849–53.CrossRefPubMed
8.
go back to reference Morrey BF. Current concepts in treatment of fractures of the radial head, the olecranon, and the coronoid. J Bone Joint Surg Am. 1995;77:316–27. Morrey BF. Current concepts in treatment of fractures of the radial head, the olecranon, and the coronoid. J Bone Joint Surg Am. 1995;77:316–27.
9.
go back to reference Lindenhovius AL, Felsch Q, Doornberg JN, Ring D, Kloen P. Open reduction and internal fixation compared with excision for unstable displaced fractures of the radial head. J Hand Surg Am. 2007;32:630–6.CrossRefPubMed Lindenhovius AL, Felsch Q, Doornberg JN, Ring D, Kloen P. Open reduction and internal fixation compared with excision for unstable displaced fractures of the radial head. J Hand Surg Am. 2007;32:630–6.CrossRefPubMed
10.
go back to reference Meyer-Marcotty MV, Lahoda LU, Hahn MP, Muhr G. Differential therapy of radial head fracture: a critical analysis based on outcome of 52 patients. Unfallchirurg. 2002;105:532–9.CrossRefPubMed Meyer-Marcotty MV, Lahoda LU, Hahn MP, Muhr G. Differential therapy of radial head fracture: a critical analysis based on outcome of 52 patients. Unfallchirurg. 2002;105:532–9.CrossRefPubMed
11.
go back to reference Coleman DA, Blair WF, Shurr D. Resection of the radial head for fracture of the radial head: long term follow up of seventeen cases. J Bone Joint Surg Am. 1987;69:385–92.PubMed Coleman DA, Blair WF, Shurr D. Resection of the radial head for fracture of the radial head: long term follow up of seventeen cases. J Bone Joint Surg Am. 1987;69:385–92.PubMed
12.
go back to reference Frosch KH, Knopp W, Dresing K, Langer C, Stürmer KM. A bipolar radial head prosthesis after comminuted radial head fractures: indications, treatment and outcome after 5 years. Unfallchirurg. 2003;106:367–73.CrossRefPubMed Frosch KH, Knopp W, Dresing K, Langer C, Stürmer KM. A bipolar radial head prosthesis after comminuted radial head fractures: indications, treatment and outcome after 5 years. Unfallchirurg. 2003;106:367–73.CrossRefPubMed
13.
go back to reference Holmenschlager F, Halm JP, Piatek S, Schubert S, Winckler S. Comminuted radial head fractures. Initial experiences with a Judet radial head prosthesis. Unfallchirurg. 2002;105:344–52.CrossRefPubMed Holmenschlager F, Halm JP, Piatek S, Schubert S, Winckler S. Comminuted radial head fractures. Initial experiences with a Judet radial head prosthesis. Unfallchirurg. 2002;105:344–52.CrossRefPubMed
14.
go back to reference Broberg MA, Morrey BF. Results of delayed excision of the radial head after fracture. J Bone Joint Surg Am. 1986;68:669–74.PubMed Broberg MA, Morrey BF. Results of delayed excision of the radial head after fracture. J Bone Joint Surg Am. 1986;68:669–74.PubMed
15.
go back to reference Jannson RP, Vegter J. Resection of the radial head after Mason type-III fractures of the elbow: follow-up at 16 to 30 years. J Bone Joint Surg Br. 1998;80:231–3.CrossRef Jannson RP, Vegter J. Resection of the radial head after Mason type-III fractures of the elbow: follow-up at 16 to 30 years. J Bone Joint Surg Br. 1998;80:231–3.CrossRef
16.
go back to reference Wallenbock E, Potsch F. Resection of the radial head: an alternative to the use of a prosthesis? J Trauma. 1997;43:959–61.CrossRefPubMed Wallenbock E, Potsch F. Resection of the radial head: an alternative to the use of a prosthesis? J Trauma. 1997;43:959–61.CrossRefPubMed
17.
go back to reference Wening JV, Wobig B, Jungbluth KH. Resection of the radial head following multiple or comminuted fractures. Clinical results and critical evaluation compared with the literature. Unfallchirurg. 1993;19:175–82.CrossRef Wening JV, Wobig B, Jungbluth KH. Resection of the radial head following multiple or comminuted fractures. Clinical results and critical evaluation compared with the literature. Unfallchirurg. 1993;19:175–82.CrossRef
18.
go back to reference Schneeberger AG, Sadowski MM, Jakob HA. Coronoid process and radial head as posterolateral rotary stabilizers of the elbow. J Bone Joint Surg Am. 2004;86:975–82.PubMed Schneeberger AG, Sadowski MM, Jakob HA. Coronoid process and radial head as posterolateral rotary stabilizers of the elbow. J Bone Joint Surg Am. 2004;86:975–82.PubMed
19.
go back to reference Rosenblatt Y, Athwal GS, Faber KF. Current recommendations for the treatment of radial head fractures. Orthop Clin North Am. 2008;39:173–85.CrossRefPubMed Rosenblatt Y, Athwal GS, Faber KF. Current recommendations for the treatment of radial head fractures. Orthop Clin North Am. 2008;39:173–85.CrossRefPubMed
20.
go back to reference Grewal R, MacDermid JC, Faber KJ, Drosdowech DS, King GJ. Comminuted radial head fractures treated with a modular metallic radial head arthroplasty. J Bone Joint Surg Am. 2006;88:2192–200.CrossRefPubMed Grewal R, MacDermid JC, Faber KJ, Drosdowech DS, King GJ. Comminuted radial head fractures treated with a modular metallic radial head arthroplasty. J Bone Joint Surg Am. 2006;88:2192–200.CrossRefPubMed
21.
go back to reference Moghaddam A, Lennert A, Studier-Fischer A, Wentzensen A, Zimmermann G. Prosthesis after comminuted radial head fractures. Midterm results. Unfallchirurg. 2008;111:997–1004.CrossRefPubMed Moghaddam A, Lennert A, Studier-Fischer A, Wentzensen A, Zimmermann G. Prosthesis after comminuted radial head fractures. Midterm results. Unfallchirurg. 2008;111:997–1004.CrossRefPubMed
22.
go back to reference Wretenberg P, Ericson A, Stark A. Radial head prosthesis after fracture of radial head with associated elbow instability. Arch Orthop Trauma Surg. 2006;126:145–9.CrossRefPubMed Wretenberg P, Ericson A, Stark A. Radial head prosthesis after fracture of radial head with associated elbow instability. Arch Orthop Trauma Surg. 2006;126:145–9.CrossRefPubMed
23.
go back to reference Speed K. Ferrule caps for the head of the radius. Surg Gynecol Obstet. 1941;73:845–50. Speed K. Ferrule caps for the head of the radius. Surg Gynecol Obstet. 1941;73:845–50.
24.
go back to reference Vanderwilde RS, Morrey BF, Melberg MW, Vinh TN. Inflammatory arthritis after failure of silicone rubber replacement of the radial head. J Bone Joint Surg Br. 1994;76:78–81.PubMed Vanderwilde RS, Morrey BF, Melberg MW, Vinh TN. Inflammatory arthritis after failure of silicone rubber replacement of the radial head. J Bone Joint Surg Br. 1994;76:78–81.PubMed
25.
go back to reference King GJ, Zarzour ZD, Rath DA, Dunning CE, Patterson SD, Johnson JA. Metallic radial head arthroplasty improves valgus stability of the elbow. Clinical Orthop Rel Res. 1999;368:114–25. King GJ, Zarzour ZD, Rath DA, Dunning CE, Patterson SD, Johnson JA. Metallic radial head arthroplasty improves valgus stability of the elbow. Clinical Orthop Rel Res. 1999;368:114–25.
26.
go back to reference Pribyl CR, Kester MA, Cook SD, Edmunds JO, Brunet ME. The effect of the radial head and prosthetic radial head replacement on resisting valgus stress at the elbow. Orthopedics. 1986;9:723–6.PubMed Pribyl CR, Kester MA, Cook SD, Edmunds JO, Brunet ME. The effect of the radial head and prosthetic radial head replacement on resisting valgus stress at the elbow. Orthopedics. 1986;9:723–6.PubMed
27.
go back to reference Ring D, King GJ. Radial head arthroplasty with a modular metal spacer to treat acute traumatic elbow instability. Surgical technique. J Bone Joint Surg Am. 2008;90:63–73.CrossRefPubMed Ring D, King GJ. Radial head arthroplasty with a modular metal spacer to treat acute traumatic elbow instability. Surgical technique. J Bone Joint Surg Am. 2008;90:63–73.CrossRefPubMed
28.
go back to reference Doornberg JN, Parisien R, van Duijn PJ, Ring D. Radial head arthroplasty with a modular metal spacer to treat acute traumatic elbow instability. J Bone Joint Surg Am. 2007;89:1075–80. Doornberg JN, Parisien R, van Duijn PJ, Ring D. Radial head arthroplasty with a modular metal spacer to treat acute traumatic elbow instability. J Bone Joint Surg Am. 2007;89:1075–80.
29.
go back to reference Madsen JE, Flugsrud G. Radial head fractures: indications and technique for primary arthroplasty. Eur J Trauma Emerg Surg. 2008;34:105–12.CrossRef Madsen JE, Flugsrud G. Radial head fractures: indications and technique for primary arthroplasty. Eur J Trauma Emerg Surg. 2008;34:105–12.CrossRef
30.
go back to reference Judet T, Garreau de Loubresse C, Piriou P, Charnley G. A floating prosthesis for radial-head fractures. J Bone Joint Surg Br. 1996;78:244–9.PubMed Judet T, Garreau de Loubresse C, Piriou P, Charnley G. A floating prosthesis for radial-head fractures. J Bone Joint Surg Br. 1996;78:244–9.PubMed
31.
go back to reference Harrington IJ, Sekyi-Out A, Barrington TW, Evans DC, Tuli V. The functional outcome with metallic radial head implants in the treatment with unstable elbow fractures: a long-term review. J Trauma. 2001;50:46–52.CrossRefPubMed Harrington IJ, Sekyi-Out A, Barrington TW, Evans DC, Tuli V. The functional outcome with metallic radial head implants in the treatment with unstable elbow fractures: a long-term review. J Trauma. 2001;50:46–52.CrossRefPubMed
32.
go back to reference Pomianowski S, Morrey BF, Neale PG, Park MJ, O’Driscoll SW, An KN. Contribution of monobloc and bipolar radial head prostheses to valgus stability of the elbow. J Bone Joint Surg Am. 2001;83:1829–34.PubMed Pomianowski S, Morrey BF, Neale PG, Park MJ, O’Driscoll SW, An KN. Contribution of monobloc and bipolar radial head prostheses to valgus stability of the elbow. J Bone Joint Surg Am. 2001;83:1829–34.PubMed
33.
go back to reference McKee MD, Bowden SH, King GJ, Patterson SD, Jupiter JB, Bamberger HB, Paksima N. Management of recurrent, complex instability of the elbow with a hinged external fixator. J Bone Joint Surg Br. 1998;80:1031–6.CrossRefPubMed McKee MD, Bowden SH, King GJ, Patterson SD, Jupiter JB, Bamberger HB, Paksima N. Management of recurrent, complex instability of the elbow with a hinged external fixator. J Bone Joint Surg Br. 1998;80:1031–6.CrossRefPubMed
34.
go back to reference Tan V, Daluiski A, Capo J, Hotchkiss E. Hinged elbow external fixators: indication and uses. J Am Acad Orthop Surg. 2005;13:503–14.PubMed Tan V, Daluiski A, Capo J, Hotchkiss E. Hinged elbow external fixators: indication and uses. J Am Acad Orthop Surg. 2005;13:503–14.PubMed
35.
go back to reference Greenspan A, Norman A. Elbow injury: a new imaging approach. Bull Hosp Jt Dis Orthop Inst. 1986;46:52–9.PubMed Greenspan A, Norman A. Elbow injury: a new imaging approach. Bull Hosp Jt Dis Orthop Inst. 1986;46:52–9.PubMed
36.
go back to reference Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stemtype femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979;141:17–27.PubMed Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stemtype femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979;141:17–27.PubMed
37.
go back to reference Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 1973;55:1629–32.PubMed Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 1973;55:1629–32.PubMed
38.
go back to reference Morrey BF. Radial head fracture. In: Morrey BF, editor. The elbow and its disorders. 3rd ed. Philadelphia: WB Saunders; 2000. p. 341–64. Morrey BF. Radial head fracture. In: Morrey BF, editor. The elbow and its disorders. 3rd ed. Philadelphia: WB Saunders; 2000. p. 341–64.
39.
go back to reference Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C. Measuring the whole or the parts? Validity, reliability, and responsiveness of the disabilities of the arm, shoulder and hand outcome measure in different regions of the upper extremity. J Hand Ther. 2001;14:128–46.PubMed Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C. Measuring the whole or the parts? Validity, reliability, and responsiveness of the disabilities of the arm, shoulder and hand outcome measure in different regions of the upper extremity. J Hand Ther. 2001;14:128–46.PubMed
40.
go back to reference Solway S, Beaton DE, McConnell S, Bombardier C. The DASH outcome measure user’s manual. 2nd ed. Toronto: Institute for Work and Health; 2002. Solway S, Beaton DE, McConnell S, Bombardier C. The DASH outcome measure user’s manual. 2nd ed. Toronto: Institute for Work and Health; 2002.
41.
go back to reference Müller MC, Burger C, Striepens N, Wirtz CD, Weber O. Clinical results after replacement of comminuted radial head fractures (Mason III and IV) by the radial head prosthesis of Judet. Z Orthop Unfall. 2008;146:218–26.CrossRefPubMed Müller MC, Burger C, Striepens N, Wirtz CD, Weber O. Clinical results after replacement of comminuted radial head fractures (Mason III and IV) by the radial head prosthesis of Judet. Z Orthop Unfall. 2008;146:218–26.CrossRefPubMed
42.
go back to reference Popovic N, Lemaire R, Georis P, Gillet P. Midterm results with a bipolar radial head prosthesis: radiographic evidence of loosening at the bone-cement interface. J Bone Joint Surg Am. 2007;89:2469–76.CrossRefPubMed Popovic N, Lemaire R, Georis P, Gillet P. Midterm results with a bipolar radial head prosthesis: radiographic evidence of loosening at the bone-cement interface. J Bone Joint Surg Am. 2007;89:2469–76.CrossRefPubMed
Metadata
Title
Radial head arthroplasty with an uncemented modular metallic radial head prosthesis: short- and mid-term results
Authors
M. Muhm
R. de Castro
H. Winkler
Publication date
01-02-2011
Publisher
Springer-Verlag
Published in
European Journal of Trauma and Emergency Surgery / Issue 1/2011
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-010-0051-8

Other articles of this Issue 1/2011

European Journal of Trauma and Emergency Surgery 1/2011 Go to the issue