Overlengthening of the radial column in radial head replacement: a review of the literature and presentation of a classi
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TRAUMA SURGERY
Overlengthening of the radial column in radial head replacement: a review of the literature and presentation of a classification system K. Wegmann1 · M. Hackl1 · T. Leschinger1 · K. J. Burkhart2 · L. P. Müller1 Received: 25 February 2020 / Accepted: 30 September 2020 © The Author(s) 2020
Abstract Background Radial head arthroplasty is a common procedure in elbow surgery. It has been shown to be of benefit for the patients, but there also are relevant complications that should be prevented if possible. One significant complication is overlengthening of the radial head prosthesis. In overlengthening, the head of the prosthesis overextends the physiological level of the native radial head and leads to overcompression in the radiohumeral joint. Rapid erosion and arthritic changes may then impede the clinical outcome. The incidence of overlengthening is not precisely known, but estimations range to up to 20% of all implanted prostheses. Methods The present review discusses the available body of literature on overlengthening and lines out a classification system that may be used to guide treatment algorithms. The classification is based on the personal experiences of the author during their clinical practice. Results In low-grade overlengthening (type I) conservative treatment can be an option. In Types II–IV usually revision surgery is needed. Depending on the state of the capitulum and joint stability, it is possible re-implant a prosthesis, or rely on implant removal alone. Discussion The present review aimed at shedding light into overlengthening as a complication radial head replacement and to help identify and treat it. Keywords Overlengthening · Radial head · Arthroplasty · Elbow · Erosion
Introduction Prosthetic implants are commonly in use for the treatment of pathologies of the proximal radius and have been investigated in several clinical studies [1–4]. The safety of the devices and the positive effects on pain, joint stability and load sharing across the joint and the forearm have been well documented. Despite the good impact the introduction and ongoing engineering of the implants had on patient treatment, specific complications related to radial head replacement are well known. Besides shaft-loosening and even uncoupling of prosthesis components, erosion of the * K. Wegmann Kilian.Wegmann@uk‑koeln.de 1
Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Kerpener Street 62, 50937 Cologne, Germany
Arcus Sportklinik, Pforzheim, Germany
2
capitulum is a common downside when the radial head is replaced. Erosion of the capitulum may lead to pain and stiffness with impaired functionality of the joint. One reason for the erosion of the capitulum, undoubtedly, is the difference in elasticity modules of the native capitulum and the prosthetic material. The amount of erosion can be greatly increased, however, when the pressure between prosthesis and capitulum exceeds physiological limits. This typically is the c
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