Similar outcomes seen with acute vs delayed radial head arthroplasty
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TAMPA, Fla. — Acute and delayed radial head arthroplasties yield similar outcomes for radial head fractures, with 64% of patients who undergo either procedure receiving good or excellent Mayo Elbow Performance Scores, results showed.
“Radial head arthroplasty is an important tool for treating radial head and neck fractures. It can be used as an acute option for comminuted, displaced fractures, or it can used in a delayed fashion for nonunions, posttraumatic arthritis or failed open reduction internal fixation procedures,” Daniel C. Austin, MD, MS, said in his presentation at the American Shoulder and Elbow Surgeons Annual Meeting.
Austin and colleagues used the total joint registry database from the Mayo Clinic to identify 143 patients (143 elbows) who underwent radial head arthroplasty from 2000 to 2018. According to the abstract, 31.5% of patients had an isolated, radial head fracture, 65% had a terrible triad injury and 3.5% had an Essex-Lopresti injury. Patients who underwent surgery within 12 weeks of injury were identified as the acute cohort (n = 101), and patients who underwent surgery later than 12 weeks since injury were identified as the delayed cohort (n = 42). Outcome measures included Mayo Elbow Performance Scores (MEPS), implant revision, reoperation and Kaplan-Meier 2-year survivorship estimates.
After an average follow-up of 5.1 years, 41 of all patients required reoperation and 22 required implant removal or revision. Kaplan-Meier 2-year survivorship was 74.7% in the acute group and 72.4% in the delayed group. At 2 years, 38.1% of the acute group and 28.6% of the delayed group reported a pain-free elbow.
Average 2-year MEPS was also similar between the groups. In the acute group, 35.7% of patients had an excellent MEPS; 35.7% had good scores; 23.8% had fair scores and 4.8% had poor scores. In the delayed group, 21.4% of patients had an excellent MEPS; 35.7% had good scores; 35.7% had fair scores and 7.1% had poor scores. Austin also noted that terrible triad fractures were associated with a lower risk of implant revision in comparison to isolated fractures.
“All together, readmission and reoperation ranges were statistically similar between the groups, but it did trend higher in patients undergoing delayed radial head surgery,” Austin said. “Poor [Kaplan-Meier] survivor rates and MEPS scores highlight poor long-term outcomes for many of these patients following their procedures.”
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Austin DC, et al. Paper 18. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Dec. 15-17, 2021; Tampa, Fla.
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