Long-term outcomes of modular metal prosthesis replacement in patients with irreparable radial head fractures.
BACKGROUND
The purposes of this study were to investigate the long-term outcomes of radial head replacement and to analyze the relationship between functional outcomes and periprosthetic radiolucency.


METHODS
We retrospectively reviewed 32 patients who underwent unilateral radial head replacement between 2004 and 2011. Data on patient characteristics including age, gender, injury complexity, associated trauma, injury chronicity, and number of surgeries were collected and analyzed. Of these patients, 14 had terrible triad injury, 14 valgus-type injuries, 3 Monteggia fracture, and 1 concomitant distal humerus fracture. Clinical survey was performed at 7 to 15 years after replacement surgery. The Mayo Elbow Performance Score (MEPS) and shortened Disabilities of the Arm, Shoulder, and Hand (quickDASH) score were used for functional evaluation. Residual elbow or forearm pain was evaluated using visual analog scale (VAS). Radiographs were reviewed by orthopedic and radiologic specialists, and periprosthetic radiolucency was measured based on the diameter of radial head prosthesis.


RESULTS
The 32 patients returned for follow-up at an average of 8.94 years. None underwent prosthesis revision or removal. MEPS averaged 83.4; good or excellent results were achieved in 26 patients. QuickDASH scores averaged 11.7. Significantly better MEPS (p = 0.023) and quickDASH scores (p = 0.026) were noted when replacement surgery served as the primary surgery instead of late salvage. VAS scores averaged 1.25, with residual pain noted in 24 elbows (75%). Periprosthetic radiolucency was noted in 21 patients (66%) with a mean thickness of 3.53 mm. The difference in functional outcomes was not significant between patients with and without radiolucency, with p values of 0.127 for MEPS and 0.135 for quickDASH scores. Spearman correlation analysis showed low correlation between the measured width of radiolucency and VAS scores (r = 0.143).


CONCLUSION
Sustained, encouraging clinical outcomes were reported in the present study. Although periprosthetic radiolucency did not correlate with functional or pain scores, surgical optimization and meticulous survey were warranted.
['Chen|Alvin Chao-Yu|AC|http://orcid.org/0000-0003-0111-490X', 'Chou|Ying-Chao|YC|', 'Weng|Chun-Jui|CJ|', 'Cheng|Chun-Ying|CY|']
D004551:Elbow Joint D005260:Female D006801:Humans D008297:Male D008670:Metals D019736:Prostheses and Implants D011859:Radiography D011885:Radius Fractures D016059:Range of Motion, Articular D012189:Retrospective Studies D016896:Treatment Outcome
Prosthesis Radial head fracture Radial head replacement Radiolucency