Radial head replacement with a bipolar system: a minimum 2-year follow-up

doi:10.1016/j.jse.2011.05.012

Journal of Shoulder and Elbow Surgery

Volume 21, Issue 1, January 2012, Pages 98-104

https://doi.org/10.1016/j.jse.2011.05.012 Get rights and content

Background

We report the short-term results of a cohort of patients undergoing radial head replacement using a novel radial head prosthesis with a smooth, unfixed, telescoping stem and a bipolar design after a mean follow-up of 34 months (range, 24-48 months).

Materials and methods

Patients were assessed using clinical and radiographic examination as well as with standardized outcome measures. Thirty implants (29 patients) were available for review.

Results

At final follow-up, the average Mayo Elbow Performance Index Score was 92.1 and the Disabilities of the Arm, Shoulder, and Hand Score was 13.8. Clinical examination revealed significant differences between operative and nonoperative sides for flexion/extension and pronation/supination. Radiographic measurement of medial and lateral ulnohumeral spaces revealed re-establishment of a congruent elbow joint. No significant arthritic changes were identified at the radiocapitellar joint. Minimal angular migration of the implant in the proximal radial shaft was observed over time. Complications included 1 patient requiring temporary placement of a hinged external fixator for instability and 1 patient requiring revision surgery at 4 weeks.

Conclusion

This review demonstrates that a bipolar radial head prosthesis with a smooth stem and telescoping neck effectively restores stability to elbows with a comminuted radial head fracture and valgus instability. To date, this is the largest reported outcome analysis of bipolar radial head replacement in the literature.

Section snippets

Materials and methods

Between March 2004 and October 2006, 36 prostheses were placed in 34 patients (21 women, 13 men) at Allegheny General Hospital (AGH) or Rush University Medical Center (RUMC). The radial head was resected in all individuals, followed by replacement arthroplasty with the Katalyst bipolar implant. Replacement arthroplasty was required in 27 patients after acute fracture or fracture-dislocation where the radial head was deemed irreparable at the time of surgery and in 7 patients for post-traumatic

Results

Of the 36 implants, 30 were available for review and constitute the cohort evaluated in this study. Follow-up averaged 34 months (range, 24-48 months). Average scores for the entire cohort were MEPI, 92.1 (range, 65-100); VAS for pain, 1.4 (range, 0-5); and DASH, 13.8 (range 0-52.5). When broken down into the 23 procedures performed for acute injury vs the 7 performed for chronic conditions (ie, previous surgeries, elbow reconstruction, arthritis), the mean MEPI score showed the chronic group

Discussion

A variety of implants have been used to replace the radial head. These include those made of ferrule caps,²³ metal,⁵ acrylic,⁷ and silicone.²⁴ Silicone was initially popular, but fragmentation²⁶ and the limited load-bearing capacity of silicone¹³ led to the development of metallic implants. A variety of implant designs are currently available; however, little data exist on the superiority of one design over another. Most current implants function as “monoblock” or “unipolar” devices.

Conclusion

This report reviews the clinical experience with a bipolar implant for a variety of pathologic conditions, including high-energy trauma. The implant has a telescoping smooth stem design with a bipolar neck. Several head diameters are available, and implant length can be adjusted in 2-mm increments in situ. At a minimum 2-year follow-up, no major complications were identified specifically related to the implant.

Radiographic and clinical evaluations revealed re-establishment of a congruous elbow

Disclaimer

Support for this study was obtained from The Pittsburgh Foundation. Integra LifeSciences Corporation (Plainsboro, NJ) provided funding that assisted in data collection.

Drs Baratz and Cohen receive royalties and institutional research support for this project, and are consultants for Integra LifeSciences Corporation. The other authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any

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Treatment of sequelae of radial head fractures with a bipolar radial head prosthesis: good outcome after 1-4 years follow-up in 11 patients
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A bipolar radial head prosthesis after comminuted radial head fractures: indications, treatment, and outcome after 5 years

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Cited by (56)

Treatment of comminuted radial head fractures with personalized radial head prosthesis produced with 3-dimensional printing technology
2023, Journal of Shoulder and Elbow Surgery
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.
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.
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.
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.
A radial head prosthesis that aligns with the forearm axis of rotation: a retrospective multicenter study
2022, Seminars in Arthroplasty JSES
Advancements in technique and devices and a better understanding of forearm kinematics have contributed to the improvement in outcomes following radial head arthroplasty. The results of radial head arthroplasty depend on the inherent variability of the proximal radial anatomy and on the subsequent difficulties in attaining anatomic positioning of the prosthesis. A monobloc prosthesis with an anatomical head that is aligned with the patient’s axis of forearm rotation has been recently introduced. We report the clinical and radiographic outcomes for patients across multiple centers who received this radial head implant with a minimum of 2-year follow-up.
This was a multi-institution retrospective follow-up including 6 centers and multiple surgeons. A total of 114 cases were performed prior to July 20, 2019, of which 52 (46%) responded to request for follow-up. Data collected included Mayo Elbow Performance Score, Disabilities of the Arm, Shoulder and Hand scores, visual analog scale (VAS) for pain, major complications, and reoperations. Major complications were defined as any prosthesis-related event which may or may not have required reoperation.
The mean Mayo Elbow Performance Score was 87.0 (range, 55-100), with 46% (24/52) scoring a 100. The mean VAS for pain at rest was 0.9 (range, 0-10), and the mean VAS for pain while unscrewing a bottle cap was 1.9 (range, 0-10). The mean Disabilities of the Arm, Shoulder and Hand score was 19.6 (range, 0-88.6). We recorded a total of 4 major complications, 3 of which required reoperations, for a rate of 7.6% and 5.7%, respectively.
The current results, collected from 6 institutions and multiple surgeons, are comparable to those of other similar series for radial head prostheses. Our series had lower rates of complications and reoperations. There were no cases of stem loosening. The alignment of the radial head to the forearm axis of rotation may restore forearm kinematics. This design may lead to radiocapitellar contact pressures that are more physiologic in load transmission.
Post-traumatic elbow osteoarthritis after radial head arthroplasty: Prevalence and risk factors
2021, Revue de Chirurgie Orthopedique et Traumatologique
L’arthroplastie de tête radiale (ATR) est une option thérapeutique dans les fractures comminutives de la tête radiale, notamment en cas de luxation du coude associée. Alors que les résultats cliniques des ATR sont bien documentés, l’incidence de l’arthrose post-traumatique du coude après ATR et les facteurs favorisants sont peu connus.
Déterminer l’incidence de l’arthrose post-traumatique du coude (huméro-ulnaire et condylo-radiale) après ATR et identifier des facteurs prédictifs.
Tous les patients ayant bénéficié d’une ATR dans notre institution entre 2008 et 2016 ont été inclus rétrospectivement. Les critères d’inclusion étaient : ATR de première intention, fracture récente de la tête radiale, fracture isolée ou associée à une luxation du coude, recul minimum d’un an, examen clinique et radiographique au dernier recul. Les critères d’exclusion étaient : arthrose du coude préexistante, changement d’ATR, fractures multiples au membre supérieur homolatéral ou polytraumatisme. L’évaluation au dernier recul comportait un examen clinique (amplitudes articulaires et Mayo Elbow Performance Score–MEPS) et des radiographies standards. Des corrélations statistiques ont été recherchées entre l’incidence et la sévérité de l’arthrose et différents facteurs de risque potentiels.
Un total de 73 ont été inclus pour l’analyse, d’âge moyen 56 (21–85) ans. Les types de lésions étaient : 41 triades terribles, 15 fractures isolées de tête radiale, 11 fractures de Monteggia, 6 fractures-luxations transolécrâniennes. Le recul moyen était de 3,4 (1–10,9) ans. De l’arthrose sur les radiographies au dernier recul était retrouvée sur le compartiment huméro-ulnaire dans 55,7 % des cas et sur le compartiment condylo-radial dans 72,5 % des cas. Une corrélation statistique a été retrouvée entre la présence d’une arthrose huméro-ulnaire au dernier recul et : l’arc de mobilité en flexion-extension (p = 0,003), le MEPS (p < 0,001), la durée d’immobilisation (p = 0,03) et la présence d’une subluxation postérieure sur la radiographie post-opératoire immédiate (p = 0,012). Une corrélation statistique a été retrouvée entre la présence d’une arthrose condylo-radiale au dernier recul et : l’arc de mobilité en flexion-extension (p = 0,0054), le positionnement de la PTR (p < 0,01), le caractère monopolaire (p = 0,027).
L’incidence de l’arthrose du coude après ATR retrouvée dans notre série était respectivement de 55,7 % sur le versant huméro-ulnaire et 72,5 % sur le versant condylo-radial. Le positionnement de l’ATR, une subluxation postérieure en postopératoire et la durée d’immobilisation étaient significativement associés à la survenue d’une arthrose.
IV ; Série de cas sans groupe témoin.
Post-traumatic elbow osteoarthritis after radial head arthroplasty: Prevalence and risk factors
2021, Orthopaedics and Traumatology: Surgery and Research
Citation Excerpt :
Delclaux et al. [37] reported a 100% elbow OA incidence in their study of 26 RHA cases. When RHA is performed months to years after the initial trauma, the clinical outcomes are not as good [10,23,38] and elbow OA rates are high: 74% in the Shore et al study [39] after RHA done an average of 2.4 years after the initial injury. The treatment strategy for symptomatic elbow OA after RHA has not been standardized.
One of the treatment options for comminuted radial head fractures is radial head arthroplasty (RHA), especially when the elbow is also dislocated. While the clinical outcomes of RHA have been well documented, the incidence of post-traumatic osteoarthritis after RHA and its risk factors are not well known.
To determine the incidence of post-traumatic elbow osteoarthritis (humeroulnar and humeroradial joints) after RHA and identify its risk factors.
All patients who underwent RHA at our hospital between 2008 and 2016 were included retrospectively. The inclusion criteria were primary RHA, recent radial head fracture (isolated or associated with elbow dislocation), minimum 1 year of follow-up, clinical and radiographic examination at final assessment. The exclusion criteria were pre-existing elbow osteoarthritis, RHA revision, multiple fractures of the ipsilateral upper limb or polytrauma. The final assessment consisted of a clinical examination [joint range of motion (ROM) and Mayo Elbow Performance Score (MEPS)] and standard radiographs. The correlation between the incidence and severity of osteoarthritis and various risk factors was determined.
Seventy-three patients were included in the analysis with a mean age of 56 years (21–85). The injuries consisted of 41 terrible triad, 15 isolated radial head fractures, 11 Monteggia fractures and 6 transolecranon fracture-dislocations. The mean follow-up was 3.4 years (1–10.9). At the final assessment, osteoarthritis was visible in the humeroulnar compartment in 56% of cases and in the humeroradial compartment in 72% of cases. There was a statistical correlation between the presence of humeroulnar osteoarthritis at the final assessment and ROM in flexion-extension (p = 0.003), MEPS (p < 0.001), duration of immobilization (p = 0.03) and presence of posterior subluxation on immediate postoperative radiographs (p = 0.012). The correlation between humeroradial osteoarthritis at the final assessment and ROM in flexion-extension (p = 0.0054), RHA implant position (p < 0.01), and unipolar configuration (p = 0.027) was statistically significant.
In our study, elbow osteoarthritis incidence after RHA was 56% in the humeroulnar joint and 72% in the humeroradial joint. RHA implant placement, posterior subluxation immediately postoperative and the duration of immobilization were significantly corelated with osteoarthritis.
IV; case series without control group.
Preserving the radial head in comminuted Mason type III fractures without fixation to the radial shaft: a mid-term clinical and radiographic follow-up study
2019, Journal of Shoulder and Elbow Surgery
Citation Excerpt :
Our study shows similar excellent results following reconstruction of the radial head, with a MEPI of 94.8 in the radial head spacer group. With rates of 75% in patients treated with radial head implants and 62.5% in patients treated with mini-fragment plates, we observed higher rates of osteoarthritis than in other trials reported so far.2,23,29,41,59 This finding could be explained by the longer follow-up periods (mean follow-up time, 6.3 years).
The treatment of multifragment Mason type III fractures is challenging. Open reduction–internal fixation (ORIF), radial head arthroplasty, and in some cases, even radial head resection are the current options; however, each of these treatment methods is associated with characteristic benefits and complications. We present our experience with a radial head salvage procedure in comminuted radial head fractures irrespective of concomitant injuries, which are not accompanied by typical ORIF-related complications.
The first group comprised 29 patients with multifragment Mason type III fractures treated surgically with biological radial head spacers (group S). The fragments were reduced and fixated in an extracorporeal manner, and the reconstructed radial head was placed in its anatomic position without fixation to the shaft. The second group comprised 12 patients treated with conventional ORIF using mini-fragment plates (group P).
Thirty patients were enrolled to undergo clinical and radiographic follow-up at an average of 76 months (range, 12-152 months). In group S, nonunion at the head-neck junction developed in 70% of the cases; however, the overall Mayo Elbow Performance Index averaged 94.8, which was superior to the average Mayo Elbow Performance Index of 83.1 in group P. Radiographic evaluation showed development of osteoarthritic changes in 75% of patients in group S and 62.5% in group P. None of the patients had wrist-joint pain.
Preserving the native radial head in comminuted Mason type III fractures without fixation to the radial shaft is a reliable option. Excellent functional results can be expected; however, the development of osteoarthritis cannot be impeded.
How to approach Monteggia-like lesions in adults: A review
2018, Annals of Medicine and Surgery
Citation Excerpt :
Anyway, it is advisable to start this surgery with radial head prosthesis in the surgery room. There is no scientific evidence of superiority in terms of effectiveness or survival of bipolar or monoblock radial head prosthesis as well as the use of cemented or pressfit implants [37–42]. Radial head excision should be avoided, as the radial head is a primary stabilizer of the elbow and forearm, unless the patient is not very functionally demanding or the amount of fragmented radial head to be removed is small [34,43].
Monteggia-like lesions encompass a wide spectrum of fractures of the forearm and elbow associated with dislocations, subluxations and ligamentous lesions.
Many attempts have been made to classify these injuries, not only to understand their pathology but also to develop optimal treatments.
Unfortunately, although some of these classifications are complete, they are either complex, not immediately usable, or not exhaustive. An orthopedic surgeon who aims to rapidly treat this kind of injury needs a visual classification, and knowledge of the best surgical approach.
Monteggia like lesions do not allow for mistakes during surgery, as even a minor error could be prove detrimental to performing and completing all surgical steps.
In this paper, based on our extensive experience in treating these rare lesions, we suggest a practical guide to the best surgical approach for various types of Monteggia like lesions.
Some technical tips and pitfalls are also described.

View all citing articles on Scopus

: This study was approved by the Institutional Review Boards of Allegheny General Hospital, Allegheny-Singer Research Institute (RC #4511), and Rush University Medical Center (#07121902).

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ElbowRadial head replacement with a bipolar system: a minimum 2-year follow-up

Background

Materials and methods

Results

Conclusion

Section snippets

Materials and methods

Results

Discussion

Conclusion

Disclaimer

J Shoulder Elbow Surg

J Hand Surg Am

J Shoulder Elbow Surg

Injury

J Shoulder Elbow Surg

J Shoulder Elbow Surg

Management of Mason type-III radial head fractures with a titanium prosthesis, ligament repair, and early mobilization

J Bone Joint Surg Am

Treatment of sequelae of radial head fractures with a bipolar radial head prosthesis: good outcome after 1-4 years follow-up in 11 patients

Acta Orthop

Metallic cap replacement of the radial head following fracture

West J Surg

Use of acrylic prosthesis in the treatment of fracture of the head of the radius

J Bone Joint Surg Br

A bipolar radial head prosthesis after comminuted radial head fractures: indications, treatment, and outcome after 5 years

Unfallchirurg

Comminuted radial head fracture treated with a modular metallic radial head arthroplasty. Study of outcomes

J Bone Joint Surg Am

Comminuted radial head fractures. Initial experiences with a Judet radial head prosthesis

Unfallchirug

Elbow
Radial head replacement with a bipolar system: a minimum 2-year follow-up