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

Abstract

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. 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. 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. 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.