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Outcomes of press-fit radial head arthroplasty following complex radial head fractures

2020; Elsevier BV; Volume: 107; Issue: 2 Linguagem: Inglês

10.1016/j.otsr.2020.03.031

1877-0568

Luis Lobo Escolar, César Abellán-Miralles, Anna Escolà-Benet,

Shoulder Injury and Treatment

Press-fit radial head arthroplasty (RHA) is increasingly popular in treating complex radial head fractures. This study assessed the outcome of RHA, including the outcome following re-operation, and explored potentially influencing factors. Complex radial head fractures treated with press-fit radial head prosthesis would have a favourable outcome. Data on all consecutive patients treated with anatomic press-fit RHA from February 2002 to February 2015 were analysed. Post-surgery clinical and X-rays assessments included a post-discharge evaluation of function. Standardised methods implemented include the assessment of range of motion (ROM), the Mayo Elbow Performance Score (MEPS) and subjective satisfaction scales. Forty-five patients were recruited and 71% were classified in Mason IV and 62.2% had the “terrible triad”. Re-operation was performed in 26.7% and prosthesis removal in 15.6%. Mean follow-up was 140.8 months (95% CI 117.7–164) and prosthesis survival was 69.5% at 24 months. Mean MEPS before re-operations was 86.3 ± 15.9. Pain and/or instability were the most common reasons for re-operation, and re-operations were significantly more frequent in patients having one or more “associated injuries” ( p = 0.05), but not the terrible triad; and in patients with radiological “loosening” signs ( p < 0.01). Subjective scores were relatively good in most patients, although the functionality perceived in the re-operation with implant removal group was rather low. Several studies of complex radial head fractures treated with press-fit radial head prosthesis have also shown favourable results, but the patients in such studies generally had less severe lesions. Moreover, differently from previous reports, this study with a long follow-up has included a younger population with high functionality requirements. Pain and/or instability, as observed in several previous reports, were the most common reasons for re-operation, but contrary to the expectation, the terrible triad was not associated with unfavourable outcome. Treatment of complex fractures with press-fit radial head prosthesis, including re-operation with implant removal yields satisfactory results. Most scores of functional and subjective outcome improved following the re-intervention and most patients returned to their usual occupation. Level IV; case series; treatment study.