Radial head arthroplasty effective as treatment for chronic, post-traumatic elbow disorders

At 8 years mean follow-up, Mayo Elbow Performance Scores averaged 83 points, with most cases having excellent or fair results.

Metallic radial head arthroplasty appears to be a safe and reliable option for reconstructing elbows with chronic, post-traumatic disorders at a mean follow-up of 8 years, according to a study by researchers in Canada.

"There was a 100% rate of survival of the radial head implants in our study up to a maximum of 14 years," the study authors noted in the American edition of The Journal of Bone and Joint Surgery.

Benjamin J. Shore, MD, and colleagues at the University of Western Ontario evaluated the functional outcomes for 32 elbows of 32 patients treated with metallic radial head arthroplasty between 1993 and 2004. All patients had chronic, post-traumatic elbow disorders, which were treated at least 4 weeks after sustaining the injury.

The study involved two radial head implants. Between 1993 and 1999, surgeons implanted a monoblock uncemented titanium radial head (Smith and Nephew Richards) in 22 cases. In 2000, surgeons switched to using an uncemented, modular cobalt-chromium implant (Evolve, Wright Medical Technology) in 10 cases "because of the improved sizing options and ease of implantation of a modular system," according to the study. Patients averaged 54 years of age and underwent surgery an average of 2.4 years after the initial injury.

At final follow-up, patients' Mayo Elbow Performance Score averaged 83 points, with results rated as excellent for 17 patients (53%), good for four patients (13%), fair for seven patients (22%) and poor for four patients (13%), according to the study.

The score for subjective patient satisfaction averaged 8.5 points, based on a 10-point scale.

Compared to the non-affected elbow, patients demonstrated significantly less motion and strength in the affected elbow. Also, 74% of patients had some degree of post-traumatic arthritis, the authors noted.

"At the time of follow-up, range-of-motion measurements demonstrated a significant mean loss of 10° of extension of the treated elbow as compared with the contralateral, normal elbow (P < .05)," the authors wrote. They also saw no significant difference in elbow flexion or forearm rotation between the affected and unaffected limbs.

"Grip strength was significantly decreased (P < .01) on the side of the injury, as was isometric flexion, extension, supination and pronation strength (P < .03)," they wrote.

"There were no significant differences in ulnar variance and the ulnohumeral joint space between the affected and unaffected arms. Over the course of the study, no metallic radial head arthroplasties required revision," the researchers added.

For more information:
Shore BJ, Mozzon JB, MacDermid JC, et al. Chronic posttraumatic elbow disorders treated with metallic radial head arthroplasty. J Bone Joint Surg Am. 2008;90-A:271-280.