Complications after radial head arthroplasty: a comparison between short-stemmed bipolar and monopolar long-stemmed osteointegrative rigidly fixed prostheses
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To date, only a few studies have compared radial head prostheses (RHP) and their different anchoring principles. The aim of this study was to characterize concomitant injuries, necessary adjuvant procedures, complications, and radiological findings after implantation of two different types of RHP.
Sixty-six patients with radial head fractures were treated with MoPyC (Tornier/France, 50 mm stem, monopolar) or SBI rHead prostheses (Small Bone Innovations/USA, 22-mm stem, bipolar) and followed up over 42 months (16–64 months). Primary objective was the detection of different loosening and explantation rates. In addition to the revision rate and the reasons for revision, we also used radiological findings to assess the dynamics of lysis phenomena.
Thirty-five patients (mean age 48 years; 22–73 years) were treated with the MoPyC, and 31 patients (mean age 47 years, 19–69 years) with the rHead prosthesis. Of these, 98% had a Mason 3 or 4 type of radial head fracture, and 94% showed concomitant injuries, which were addressed in 89% of cases by adjuvant procedures. The surgical revision rate was 20% (rHead 23%; MoPyC 18%). Significantly more of the rHead prostheses had to be explanted compared to MoPyC prostheses because of painful loosening (16% vs. 3%; p = 0.029). Predictors of subsequent loosening were significant radiolucent lines in the RHP over the first six months and an increase in width by two and a half times within the first 50 days after implantation.
Complex radial head fractures are frequent and difficult to treat. The monopolar long-stemmed prosthesis showed significantly lower rates of painful loosening and explanation rates than the bipolar short-stemmed prosthesis.
KeywordsMoPyC rHead Radial head prostheses Bipolar RHP Monopolar RHP
Compliance with ethical standards
Study is based on institutional review board (IRB) approval. The study was approved by our institutional review board (IRB Approval LAEKH-FF-1316) and all patients provided informed consent.
Conflict of interest
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. On behalf of all authors, the corresponding author states that there is no conflict of interest.
- 9.Heijink A, Kodde IF, Mulder PGH, Veltman ES, Kaas L, van den Bekerom MPJ, Eygendaal D (2016) Radial head arthroplasty. Syst Rev 4(10). https://doi.org/10.2106/jbjs.rvw.15.00095
- 10.Morrey BF, Sanchez-Sotelo J (2009) The elbow and its disorders. Elsevier Health Sciences, AmsterdamGoogle Scholar
- 14.Laumonerie P, Reina N, Ancelin D, Delclaux S, Tibbo M, Bonnevialle N, Mansat P (2017) Mid-term outcomes of 77 modular radial head prostheses. Bone Joint J 99-B(9):1197–1203. https://doi.org/10.1302/0301-620X.99B9.BJJ-2016-1043.R2 CrossRefPubMedGoogle Scholar
- 24.Chen H, Wang Z, Shang Y (2017) Clinical and radiographic outcomes of unipolar and bipolar radial head prosthesis in patients with radial head fracture: a systemic review and meta-analysis. J Investig Surg 13:1–7Google Scholar
- 28.Doornberg JN, Van Duijn PJ, Linzel D, Ring DC, Zurakowski D, Marti RK, Kloen P (2007) Surgical treatment of intra-articular fractures of the distal part of the humerus. J Bone Joint Surg Am 89(7):1524–1532Google Scholar
- 32.Gruen TA, Mcneice GM, Amstutz HC (1979) “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res (141):17–27Google Scholar
- 36.Van Riet R, Sanchez-Sotelo J, Morrey B (2010) Failure of metal radial head replacement. Bone Joint J 92(5):661–667Google Scholar
- 41.Laumonerie P, Reina N, Gutierrez C, Delclaux S, Tibbo ME, Bonnevialle N, Mansat P (2017) Tight-fitting radial head prosthesis: does stem size help prevent painful loosening? Int Orthop. https://doi.org/10.1007/s00264-017-3644-6