ElbowRadial head replacement with a bipolar system: a minimum 2-year follow-up
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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2021, Revue de Chirurgie Orthopedique et TraumatologiquePost-traumatic elbow osteoarthritis after radial head arthroplasty: Prevalence and risk factors
2021, Orthopaedics and Traumatology: Surgery and ResearchCitation 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.
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 SurgeryCitation 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).
How to approach Monteggia-like lesions in adults: A review
2018, Annals of Medicine and SurgeryCitation 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].