Acute radial head replacement with bipolar prostheses: midterm results
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ORIGINAL ARTICLE
Acute radial head replacement with bipolar prostheses: midterm results Alessandro Nosenzo1 · Cristina Galavotti1 · Margherita Menozzi1 · Alice Garzia1 · Francesco Pogliacomi1 · Filippo Calderazzi1 Received: 30 April 2020 / Accepted: 22 August 2020 © The Author(s) 2020
Abstract In irreparable radial head fractures, especially if primary stabilizers of the elbow are damaged, the prosthetic replacement prevents instability and stiffness. Concerns have arisen over the use of bipolar press-fit prostheses due to the frequent finding of osteolysis and the risk of instability if compared to monopolar implants. Our aim was to assess midterm clinical and radiological outcomes of bipolar implants and the influence of osteolysis on proximal pain. Seventeen patients with irreparable fractures of the radial head, treated in acute with the same prosthetic model (rHEAD recon SBI/Stryker) between January 2015 and December 2018, were enrolled. Clinical assessment was performed using MEPS and DASH scores; a radiographic study was done to identify heterotopic ossifications and periprosthetic osteolysis. Outcomes at the last follow-up, according to MEPS, were excellent in 10 cases, good in 5 and fair in 2; none of the patients had severe pain or instability. In 3 cases, it was necessary to remove the implant, mainly because of early loosening. Radiological findings of osteolysis were detected in 9 cases, but no statistical correlation was found with MEPS and proximal pain. The use of bipolar implants is reliable if an accurate repair of ligament tears is performed and provides a good stability. Nevertheless, the risk of early aseptic loosening in uncemented implants is not negligible, and the follow-up of the patient must be strict. Late osteolysis does not seem to have clinical relevance, but further prospective studies are necessary to clarify this topic. Keywords Radial head · Elbow · Arthroplasty · Bipolar prostheses
Introduction Radial head influence on the elbow stability as secondary stabilizer by resisting to valgus stress and on the prevention of posterolateral rotatory instability is well understood [1, 2]. When primary stabilizers such as the coronoid, lateral (LCL) and medial collateral ligaments (MCL) are damaged, the integrity of the radial head takes on a predominant role and must be preserved [3]; consequently, in comminuted and displaced fracture (Mason type III and Mason type IV), if an anatomical reconstruction is not a viable solution, the prosthetic replacement should always be performed [4–6]. Radial head arthroplasty allows the injured soft tissues acting as major stabilizers to heal properly by the restoration of the native radial length, decreases the edge loading thus * Alessandro Nosenzo [email protected] 1
Department of Surgery, Orthopaedic Clinic, Parma University Hospital, via Gramsci 14, 43100 Parma, Italy
preventing cartilage wear and the onset of osteoarthritis and reproduces radiocapitellar kinematics [7]. Modern radial head prostheses (RHP) try to re-esta
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