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Specific patient, surgical characteristics increased radial head arthroplasty implant removal
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NEW YORK — Rates of implant removal or revision following radial head arthroplasty may be influenced by younger patient age, chronic indications and certain aspects of prosthesis design, according to results presented at the American Shoulder and Elbow Surgeons Annual Meeting.
“Surgeons should keep these factors in mind when deciding to perform radial head arthroplasty and council their patients accordingly,” Mark T. Dillon, MD, said in his presentation here.
Dillon and colleagues evaluated demographic factors, surgical indications, prosthesis fixation, implant polarity and additional procedures done at surgery among 312 patients who underwent primary radial head arthroplasty between 2009 and 2015.
At 2 years, Dillon noted patients had a prosthesis survival rate of 90%, with an 11.2% removal or revision rate.
“The only [patient-specific factor] that we found that was significant was age,” Dillon said. “Patients under 40 years of age had a higher proportion of implants undergoing revision or removal. We did not find associated comorbidities or sex to be predictive of revision or removal.”
A higher percentage of implants were removed or revised among patients with press-fit stems, according to Dillon. When researchers excluded implants that had been recalled, he noted press-fit stems still had higher implant removal or revision rate vs. polished stems. However, Dillon noted this did not reach statistical significance. He added patients undergoing surgery for a chronic condition or failed open reduction and internal fixation had a higher proportion of implants revised or removed.
“We then also performed a multivariate analysis and we saw that utilization of a recalled prosthesis was predictive of revision or removal,” Dillon said. “We also, again, saw that patient age of less than 40 years was predictive of revision or removal and there is a trend seen in chronic indications, although that did not quite reach statistical significance.” – by Casey Tingle
Reference:
Dillon MT, et al. Paper 47. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 17-19, 2019; New York.
Disclosure: Dillon reports no relevant financial disclosures.
Perspective
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Jonathan C. Levy, MD
In “Patient and procedure specific variables associated with revision or removal of radial head arthroplasty,” the authors at Kaiser present a multicenter retrospective analysis of 312 patients undergoing primary radial head arthroplasty during a 7-year period focused on identifying factors associated with revision or removal of the radial head arthroplasty. At an average follow-up of 4 years, there was a 11.2% revision rate. Factors associated with higher revision rates included age younger than 40 years, surgery for chronic conditions and use of a press-fit stem (many of which were later recalled), with multivariate analysis identifying only use of a recalled prosthesis and age younger than 40 years.
While these findings support prior work identifying young age and press-fit implants as being associated with higher rates of revision, it is the first to focus on the impact of prosthetic recalls on the revision rate following radial head arthroplasty. With prosthetic innovations continuing to expand, this study highlights the potential risks associated with innovations in ingrowth radial head arthroplasty.
References:
Duckworth AD, et al. Clin Orthop Relat Res. 2014;doi:10.1007/s11999-014-3516-y.
Dunn JC, et al. J Hand Surg Am. 2017;doi:10.1016/j.jhsa.2017.04.005.
Kachooei AR, et al. J Hand Surg Am. 2018;doi:10.1016/j.jhsa.2017.08.031.
Kusnezov N, et al. Hand (NY). 2018;doi:10.1177/1558944717715136.
Levy JC, et al. J Shoulder Elbow Surg. 2016;doi:10.1016/j.jse.2015.11.014.
Chief of orthopedics
Medical director, Holy Cross Orthopedic Research Institute
Fort Lauderdale, Florida
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