Prosthetic replacement of the radial head
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Original Contribution Obere Extremität https://doi.org/10.1007/s11678-020-00595-9 Received: 15 April 2020 Accepted: 6 August 2020 © The Author(s) 2020
Kilian Wegmann1,2 · Nadine Ott1,2 · Tim F. Leschinger1,2 · Andreas Harbrecht1,2 · Lars P. Müller1,2 · Michael Hackl1,2 1 2
Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany
Prosthetic replacement of the radial head Proximal osteolysis and correlation with patient characteristics and indication for index surgery Introduction Radial head replacement surgery is an established treatment option for elbow pathologies [1–4]. It is indicated for unreconstructable radial head fractures in elbow trauma and may be used for the replacement of arthritic degeneration of the radial head or trauma sequelae. It serves as a significant mechanical support at the forearm side against valgus forces, but also plays an important role in maintaining forearm longitudinal stability [5–7]. Different types of prostheses have been used. In general, the implants can be differentiated into monopolar and bipolar implants. While the bipolar implants allow movement of the head component, the monopolar ones rely on a simpler construct with rigid fixation of the head to the respective neck or shaft [8, 9]. Although the clinical outcomes after radial head arthroplasty are reliable, specific complications have been reported [9–12]. One of these is malpositioning of the implant, where the level of the articular surface is placed too high in relation to the native height of the radial head [13–17]. Further complications include infection, implant dissociation and stiffness [1, 3, 18]. As a common problem in musculoskeletal replacement surgery, loosening of radial head prostheses has also been described and usually occurs around the shaft component [19]. The precise pathomechanisms of loosening
are not fully understood; inflammatory, septic and mechanical factors are discussed. A less well-known form of bone loss around radial head implants has been observed in the clinical setting and is referred to as collar resorption. This describes bone loss at the proximal part of the radius, just distal to the neck of the prosthesis, which may arise during follow-up and is usually asymptomatic (. Fig. 1). Popovic et al. published their series on mid-term follow-ups of bipolar cemented radial head prostheses and reported a frequency of 31% of resorption just distal to the collar [20]. This entity is observed in various types of radial head prostheses. The present study aims to display the incidence of collar resorption in a monopolar press-fit implant and investigate whether it correlates with specific patient characteristics such as gender, age, indication for index surgery and the size of the implant used.
Methods This is a monocentric retrospective cohort study on patients having undergone prosthetic replacement of the radial head. Therefore, after obtaining approval from the loca
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