Outcomes of press-fit radial head arthroplasty in unconstructable radial head fractures with associated elbow injuries: An average 5-year follow up

Aims: Unstable and nonreconstructable radial head fractures require radial head arthroplasty (RHA) to restore stability. Multiple implant designs are available with varying survival rates (76 to 97%). There is concern that loosening of the press-fit stems leads to implant failure. We review our outcomes using the Acumed press-fit prosthesis for trauma.

Methods: Between February 2008 and November 2020, all primary RHA for trauma from a single-centre were reviewed. Primary outcome was implant survivorship. Secondary outcome were clinical, radiographic and patient related outcome measures.

Results: In total, 96 cases were included. Seven revisions were recorded, all within 24-months of implantation. Kaplan-Meier estimated 10-year survival was 92.1% (95% confidence interval (CI) 84.0-96.1%). Median follow-up time was 5.7 years (Interquartile range (IQR) 3.2-8.5 years). Median Oxford Elbow Score was 43 (IQR 29-46) for and median Mayo Elbow Performance Score was 90 (IQR 72-100). 72% were able to fully-return to pre-injury activities. Radiographic analysis identified osteolysis around radial neck (48%), loosening (32%), valgus stem position (20%), heterotopic ossification (16%) and capitellar erosion (15%). No radiological findings were associated with long-term poor clinical outcomes.

Conclusion: Our study demonstrates an excellent survival of press-fit RHA of 92.1% at 10-years. No radiographic features on follow-up were associated with poorer patient recorded outcome measures.