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Correlation between radiographic findings and clinical failure in monopolar radial head replacement

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The purpose of this study is to analyze the mid-term outcomes of a modular monopolar type of radial head arthroplasty in the treatment of complex fractures associated with acute elbow joint instability. We postulated that radiographic changes are related to the development of clinical complications.

Materials and methods

We evaluated at last follow-up 26 radial head arthroplasties in 26 consecutive patients who were followed for at least one and a half year. All patients had suffered radial head fractures (Mason III) in the context of unstable elbow injuries. Definitive treatment of the radial fracture was performed with modular and monopolar prosthesis which was inserted as a press fit. All patients were evaluated preoperatively and postoperatively. The evaluation included a clinical examination and a protocolized imaging study (standard X-Rays and CT) of the elbow. We analyzed the incidence of: heterotopic ossifications, secondary radiocapitellar joint osteoarthritis, hardware loosening, hardware disengagement, and joint infection. Diagnosis of clinical failure of the implant was defined as the time to the second surgery due to major complications related to the prosthesis, such as persistent lateral side pain or elbow stiffness and any kind of implant instability or dislocation.

Results

The implant-specific reoperation rate was 15% (four reoperations). The need for the second surgery was statistically associated with heterotopic ossifications, radiocapitellar osteoarthritis and cortical resorption around radial neck (p = 0.054, p = 0.033, and p = 0.019, respectively), being periprosthetic osteolysis the most likely factor related to failure, and radial pain the main symptom leading to surgical revision.

Conclusions

Our study shows a positive association between radiographic findings and patient symptoms for postoperative complications after radial head arthroplasty. Failed radial head replacements may lead to reoperation mainly due to pain, and this can be distinguished from other causes of pain in elbow region based on its radial location. Radiological loosening was prevalent in this group of failed replacement.

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Acknowledgements

The authors whose names are listed immediately below certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, University Hospital “Doce de Octubre”, Avda. De Córdoba s/n, 28041, Madrid, Spain

    Ana María Martín Fuentes, Luis Rafael Ramos Pascua & David Cecilia López

  2. UCM Department of Surgery, Complutense University of Madrid, Madrid, Spain

    Ana María Martín Fuentes, Luis Rafael Ramos Pascua & David Cecilia López

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  1. Ana María Martín Fuentes
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  2. Luis Rafael Ramos Pascua
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Correspondence to Ana María Martín Fuentes.

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Martín Fuentes, A.M., Ramos Pascua, L.R. & Cecilia López, D. Correlation between radiographic findings and clinical failure in monopolar radial head replacement. Arch Orthop Trauma Surg 140, 51–58 (2020). https://doi.org/10.1007/s00402-019-03273-w

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