Page 23 - ISAKOS 2018 Winter Newsletter

An alternative surgical option for radiohumeral arthritis is ea shomrtening osbteotomyeof therprosximal paOrt of thenradius.l Biomechanical testing has shown reduction of the contact
pressure at the radiohumeral joint, without loss of valgus stability, following shortening of the proximal radius by 2.5
mm
unpublished series of 5 strictly selected patients with ongoing pain due to arthritis of the radiohumeral joint. However, these results need to be verified in a larger series.
As symptomatic radiohumeral arthritis is a demanding condition to treat, especially in young, active patients, other treatment alternatives that avoid the need for resection and arthroplasty need to be identified.
Conclusion
Radiohumeral arthritis is a common and challenging entity. The surgeon is confronted with high-demand patients and a limited armamentarium of treatment options. Long-term results of prosthetic replacement at the elbow are limited by the bone stock and the complex anatomy. Hence, preserving the joint should be the goal of treatment. Shortening osteotomy of the radius may be an option to gain time for the patient.
01 Arthroscopic views showing the introduction of a K-wire (KW) at a flat angle (left), leading to sliding and keying of the articular surface (right). RH = radial head, AL = annular ligament, C = capitellum
02 Photograph showing potential portals for microfracture of the dorsal segment of the radial head. Bringing the K-wire in through the low posterolateral portal (red line) creates a flatter angle, compared with a higher and more laterally placed portal (green line). R = radial head, C = capitellum, O = olecranon.
03 Arthroscopic view showing the correct entry of the K-wire into the radial head at the defect without sliding. KW = K-wire, RH = radial head, AL = annular ligament, C = capitellum.
04 Arthroscopic view showing extrusion of a large bubble of fat cells (FC) from the bone marrow. R = radial head, C = capitellum.
5
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For example, the bone-cement-implant interfaces can become loose during functional activities. Moreover, there is concern regarding the loading of the articular cartilage of the capitellum by the prosthetic components. Also, the fitting accuracy of radial head prostheses has not yet achieved a high level. These considerations render radial head replacement as a backup treatment option, especially in the scenario of arthritic changes. If erosion of the capitellum is present, implantation of a radial head replacement often leads to a painful joint. In such cases, radiocapitellar joint replacement has been advocated. Given the anatomical conditions at the capitellum, stable fixation of a prosthesis is difficult, and early loosening with unfavorable outcome has been reported.
ISAKOS NEWSLETTER 2018: VOLUME I 21
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