Summary

A review of 405 radial head arthroplasty found excellent survival and direct correlation of revision with increasing size of radial head diameter.

Abstract

Introduction

Radial head arthroplasty (RHA) is a commonly performed procedure for the treatment of comminuted radial head fractures. Indications as well as implant types continue to evolve. RHA has had good outcomes with respect to pain relief, range of motion, elbow stability, and mid-term longevity. The current literature is limited to small case series with varying implant types and short-term outcomes. We present a large series of patients from a single institution who underwent RHA and report on complications, revisions, and outcomes.

Methods

After IRB approval, a retrospective analysis of RHA cases performed by 75 surgeons at 14 medical centers in an integrated healthcare system between 2006 and 2017 was completed. Patient demographics, comorbidities, implant type, implant head size, and indications were recorded. Patients were contacted via telephone at a minimum of 2 years to obtain QuickDash and Oxford scores.

Results

Our study found that revision rate was positively correlated with increasing radial head size. A 26 mm head had 7.7 odds of revision compared to a size 18 mm head (95% CI 1.2 to 150.1). Over 95% of revision cases were performed within the first 36 months of the index procedure. There was a significantly higher overall re-operation rate for terrible triad (18.4%) versus isolated injuries (10.4%), p=0.04. There was no difference between Acumed Anatomic and Wright Medical Evolve radial head implants in overall re-operation, implant revision, post-operative range of motion, or patient-reported outcomes for either isolated or terrible triad injuries. There was no difference in QuickDash or Oxford scores between controls and smokers, diabetics, or those with a psychiatric diagnosis. Obese patients had a significantly lower mean post-operative Oxford score (35.5) compared to controls (38.3), p=0.02, but no significant difference in QuickDash (22.1 vs 19.1, p=0.067).

Conclusions

This is the first paper in the literature to demonstrate that the risk of revision is directly correlated with implanted radial head size. There were no differences in outcomes and complications between the two main implants used. Individuals who did not undergo a revision by 3 years’ time tend to retain the implant. Terrible triad injuries had a higher all-cause re-operation rate than isolated radial head fractures, but no difference in the rate of RHA revision. These data reinforce the practice of downsizing radial head implants when deciding on a radial head implant intra-operatively.