Purpose
Multifragmentary radial head and neck fractures not amenable to open reduction and
internal fixation are usually treated with radial head arthroplasty (RHA). Although
the optimal implant design is still subject to debate, anatomic designs are common.
We hypothesized that positioning of the implant leading to increased radial stem angle
(RSA) (angle of the RHA stem with respect to the proximal radius shaft, RSA) in anatomic
RHA designs will contribute to failures. The aim of this study was to characterize
the risk of RHA failure with respect to the stem angle in anatomic RHA design.
Methods
A retrospective review of patients who underwent anatomic RHA for acute fractures
between 2006 and 2019 at 2 academic centers was conducted. Initial postoperative elbow
radiographs were reviewed to measure RSA on the anterior-posterior and lateral views.
Radiolucency, stress shielding, and radiocapitellar arthritis were also evaluated.
Implant failure was defined as prosthesis removal or revision.
Results
Implant failure was associated with significantly larger lateral RSA than that in
intact implants. Increasing stem shaft angle on a lateral radiograph was associated
with decreased implant survival. Radiolucency, stress shielding, and radiocapitellar
arthritis were similar between the 2 groups.
Conclusions
Anatomic radial head implants are commonly used; however, the importance of prosthesis
positioning, specifically that of the stem within the proximal radius, remains understudied.
Higher RSA is associated with the risk of implant failure and need for revision.
Type of study/level of evidence
Prognostic IV.
Key words
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Article info
Publication history
Published online: April 06, 2022
Accepted:
February 2,
2022
Received:
March 24,
2021
Footnotes
Dr Lattanza is a consultant for Acumed LLC. No benefits in any form have been received or will be received by the other authors related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
