Loose-fit vs. press-fit stems and risk for surgical reintervention following radial head arthroplasty: a US-based cohort study of 1575 patients

IF 2.9 2区医学 Q1 ORTHOPEDICS

Journal of Shoulder and Elbow Surgery Pub Date : 2025-02-01 DOI:10.1016/j.jse.2024.07.050

David W. Zeltser MD , Kathryn E. Royse PhD , Heather A. Prentice PhD , Chelsea Reyes , Elizabeth W. Paxton PhD , Ronald A. Navarro MD , Abtin Foroohar MD

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引用次数: 0

Abstract

Background

Radial head arthroplasty (RHA) is performed with increasing frequency for reconstruction of comminuted radial head fractures. Implants can be categorized by stem design, either loose fit or press fit. Currently, the RHA literature does not suggest one implant type is superior to another based on revision and reoperation rates, although most RHA outcome studies have small numbers of patients with few events to detect a difference. This study evaluated the association between stem design and risk of revision and reoperation after RHA.

Methods

A total of 1575 patients aged ≥18 years who underwent primary RHA within a US-based health care system were identified (2009-2021). Revision following the index RHA was the primary outcome of interest; ipsilateral reoperation was a secondary outcome. Multivariable Cox proportional hazard regression was used to evaluate the risk of outcomes by loose vs. press fit with the adjustment for race and ethnicity, American Society of Anesthesiologists classification, region, surgeon RHA volume, and simultaneous ipsilateral extremity procedures.

Results

Of the 1575 RHAs, 681 (43.2%) received a loose-fit stem. The cumulative revision probability was 2.6% for loose fit and 3.5% for press fit. In adjusted analysis, we did not observe a difference in risk of revision (hazard ratio [HR] = 0.78, 95% confidence interval [CI] = 0.41-1.46) or reoperation (HR = 0.73, 95% CI = 0.43-1.25). Additionally, there were no observed differences in risk of revision (HR = 0.62, 95% CI = 0.28-1.38) or reoperation (HR = 0.90, 95% CI = 0.48-1.71) in the patient subgroup who underwent additional procedures in the same extremity at the time of RHA.

Conclusion

In this large multicenter cohort of 1575 primary RHAs, we did not observe a difference in risk of revision or reoperation following RHA based on stem design. The choice between using an implant with a loose- or press-fit stem may be based more on surgeon familiarity, implant availability, cost, and ease of use.

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桡骨头关节置换术后松配与压配骨柄与手术再介入风险：一项针对 1575 名患者的美国队列研究。

导言：桡骨头关节成形术（RHA）越来越多地用于粉碎性桡骨头骨折的重建。植入物可按柄设计分为松套式和压套式。目前，根据翻修率和再手术率，RHA文献并未表明一种植入物优于另一种植入物，尽管大多数RHA结果研究的患者人数较少，很少有事件能检测出差异。本研究评估了骨柄设计与RHA术后翻修和再次手术风险之间的关联。方法：在美国医疗保健系统中确定了1575名年龄≥18岁接受初级RHA的患者（2009-2021年）。指数 RHA 后的翻修是主要研究结果；同侧再手术是次要研究结果。多变量考克斯比例危险回归用于评估松散型与紧压型的结果风险，并对种族/人种、ASA分类、地区、外科医生RHA量和同侧肢体同时手术进行了调整：结果：在1575例RHA中，有681例（43.2%）接受了松套式骨干。松配和压配的累积翻修概率分别为2.6%和3.5%。在调整分析中，我们没有观察到翻修（HR=0.78，95% CI=0.41-1.46）或再次手术（HR=0.73，95% CI=0.43-1.25）风险的差异。此外，在RHA时在同一肢体接受其他手术的患者亚组中，翻修风险（HR=0.62，95% CI=0.28-1.38）或再次手术风险（HR=0.90，95% CI=0.48-1.71）没有观察到差异：在这一大型多中心队列的1575例初次RHA中，我们没有观察到RHA术后因骨柄设计不同而导致的翻修或再手术风险差异。选择使用松式或压入式植入物可能更多是基于外科医生的熟悉程度、植入物的可用性和成本以及易用性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Shoulder and Elbow Surgery 医学-外科

CiteScore

6.50

自引率

23.30%

发文量

604

审稿时长

11.2 weeks

期刊介绍： The official publication for eight leading specialty organizations, this authoritative journal is the only publication to focus exclusively on medical, surgical, and physical techniques for treating injury/disease of the upper extremity, including the shoulder girdle, arm, and elbow. Clinically oriented and peer-reviewed, the Journal provides an international forum for the exchange of information on new techniques, instruments, and materials. Journal of Shoulder and Elbow Surgery features vivid photos, professional illustrations, and explicit diagrams that demonstrate surgical approaches and depict implant devices. Topics covered include fractures, dislocations, diseases and injuries of the rotator cuff, imaging techniques, arthritis, arthroscopy, arthroplasty, and rehabilitation.