Contemporary Analysis of Revision and Resection Rates in Radial Head Arthroplasty Used in Elbow Trauma.

OBJECTIVE

To evaluate revision and removal rates of radial head arthroplasty (RHA) for elbow trauma using modern press-fit modular implants.

DESIGN

Retrospective cohort study.

SETTING

Urban academic medical center.

PATIENT SELECTION CRITERIA: Patients who underwent RHA (2012-2024) for isolated comminuted radial head fractures, combined head-neck fractures, terrible triad injuries, or Monteggia variants (OTA 2R1) were study eligible. Inclusion criteria consisted of treatment with press-fit modular implants and ≥1 year of clinical follow-up.

OUTCOME MEASURES AND COMPARISONS: Demographics, injury patterns, elbow range of motion, and postoperative complications-including fracture-related infection, nerve injury, periprosthetic fracture, implant resection, and nonresection procedures-were assessed. Implant survivorship was evaluated via Kaplan-Meier analysis.

RESULTS

Two hundred fifty patients were included (mean age 52.2 ± 17.8 years, range 18.1-88.3 years; mean length of follow-up 43.8 ± 35.2 months, range 12.0-128.0 months, body mass index 28.7 ± 6.3 kg/m 2 , 56.8% female). Common indications for RHA included Monteggia fractures (38.0%), isolated radial head fractures (23.6%), and terrible triad injuries (19.2%).Postindex surgery iatrogenic nerve injury occurred in 7.2%, most commonly involving the ulnar nerve. Fracture-related infection occurred in 2.8% postindex surgery, and 1 nonoperative periprosthetic fracture (0.4%) was observed.The resection rate was 7.2% (18/250), with 33.3% (6/18) of implant resection surgeries occurring within 1 year (mean length of follow-up 43.8 ± 35.2 months, range 12.0-128.0 months). Common resection indications included postoperative stiffness (n = 5), infection (n = 4), and neuropathy (n = 3). One-year implant survival was 97.6%, with mean survivorship of 8.5 ± 1.0 years (95% CI, 7.1-9.8).In total, 24 patients (9.6%) underwent additional nonresection procedures including nerve decompressions, elbow contracture releases with excision of heterotopic ossification, and manipulations under anesthesia.At final follow-up (mean 43.8 ± 35.2 months), mean range of motion was 125.4 degrees flexion, -14.9 degrees extension, 73.5 degrees pronation, and 79.3 degrees supination. No significant difference in length of follow-up was observed between patients with postoperative nerve injury (52.4 ± 38.2 months) and those without (42.5 ± 34.8 months, P = 0.16).

CONCLUSION

With a 7.2% resection rate and 1-year implant survival of 97.6%, contemporary press-fit modular RHA demonstrated durable elbow trauma outcomes.

LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.