Failed radial head arthroplasty treated by removal of the implant.

IF 4.9 1区 医学 Q1 ORTHOPEDICS
Juan Ameztoy Gallego, Blanca Diez Sanchez, Afonso Vaquero-Picado, Samuel Antuña, Raul Barco
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引用次数: 0

Abstract

Aims: In patients with a failed radial head arthroplasty (RHA), simple removal of the implant is an option. However, there is little information in the literature about the outcome of this procedure. The aim of this study was to review the mid-term clinical and radiological results, and the rate of complications and removal of the implant, in patients whose initial RHA was undertaken acutely for trauma involving the elbow.

Methods: A total of 11 patients in whom removal of a RHA without reimplantation was undertaken as a revision procedure were reviewed at a mean follow-up of 8.4 years (6 to 11). The range of motion (ROM) and stability of the elbow were recorded. Pain was assessed using a visual analogue scale (VAS). The functional outcome was assessed using the Mayo Elbow Performance Score (MEPS), the Oxford Elbow Score (OES), and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Radiological examination included the assessment of heterotopic ossification (HO), implant loosening, capitellar erosion, overlengthening, and osteoarthritis. Complications and the rate of further surgery were also recorded.

Results: The indications for removal of the implant were stiffness in five patients, aseptic loosening in five, and pain attributed to the RHA in three. The mean time interval between RHA for trauma to removal was ten months (7 to 21). Preoperatively, three patients had overlengthening of the implant, three had capitellar erosion, six had HO, and four had radiological evidence of loosening. At the final follow-up, the mean the flexion-extension arc improved significantly by 38.2° (95% CI 20 to 59; p = 0.002) and the mean arc of prono-supination improved significantly by 20° (95% CI 0 to 72.5; p = 0.035). The mean pain VAS score improved significantly by 3.5 (95% CI 2 to 5.5; p = 0.004). The mean MEPS improved significantly by 27.5 (95% CI 17.5 to 42.5; p = 0.002). The mean OES improved significantly by 9 (95% CI 2.5 to 14; p = 0.012), and the mean DASH score improved significantly by 23.5 (95% CI 7.5 to 31.6; p = 0.012). Ten patients (91%) had HO and osteoarthritis. Two patients underwent further surgery due to stiffness and pain, respectively.

Conclusion: Simple removal of the implant at revision surgery following a failed RHA introduced following trauma provides satisfactory mid-term results with an acceptable risk of complications. Osteoarthritis, instability, and radioulnar impingement were not problems in this series.

通过移除植入物治疗失败的桡骨头关节置换术。
目的:对于桡骨头关节置换术(RHA)失败的患者,可以选择简单的移除植入物。然而,有关这种手术效果的文献资料很少。本研究的目的是回顾因肘部外伤而急性进行初次桡骨头关节成形术的患者的中期临床和放射学结果、并发症发生率和假体移除率:方法:在平均8.4年(6至11年)的随访中,对11名作为翻修手术而拆除RHA但未重新植入假体的患者进行了复查。记录了肘关节的活动范围(ROM)和稳定性。疼痛采用视觉模拟量表(VAS)进行评估。功能结果采用梅奥肘关节表现评分(MEPS)、牛津肘关节评分(OES)和手臂、肩部和手部残疾问卷(DASH)进行评估。放射学检查包括异位骨化(HO)、假体松动、髌骨侵蚀、过度延长和骨关节炎的评估。此外,还记录了并发症和进一步手术的比例:结果:取出假体的指征是,5 名患者的假体僵硬,5 名患者的假体出现无菌性松动,3 名患者的疼痛归因于 RHA。从因外伤植入 RHA 到取出的平均时间间隔为 10 个月(7 到 21 个月)。术前,3 位患者的种植体出现过长,3 位出现帽状侵蚀,6 位出现 HO,4 位出现放射学证据显示的松动。在最后的随访中,患者的屈伸弧度平均值明显改善了38.2°(95% CI 20至59;P = 0.002),前屈上翻弧度平均值明显改善了20°(95% CI 0至72.5;P = 0.035)。平均疼痛 VAS 评分明显改善了 3.5(95% CI 2 至 5.5;p = 0.004)。平均 MEPS 显著改善了 27.5(95% CI 17.5 至 42.5;p = 0.002)。平均 OES 显著改善了 9 (95% CI 2.5 至 14; p = 0.012),平均 DASH 显著改善了 23.5 (95% CI 7.5 至 31.6; p = 0.012)。十名患者(91%)患有 HO 和骨关节炎。两名患者分别因僵硬和疼痛接受了进一步手术:结论:在外伤后引入的 RHA 术失败后,在翻修手术中简单移除植入物可获得满意的中期效果,并发症风险可接受。在这一系列手术中,骨关节炎、不稳定性和桡肘撞击都不是问题。
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
Bone & Joint Journal
Bone & Joint Journal ORTHOPEDICS-SURGERY
CiteScore
9.40
自引率
10.90%
发文量
318
期刊介绍: We welcome original articles from any part of the world. The papers are assessed by members of the Editorial Board and our international panel of expert reviewers, then either accepted for publication or rejected by the Editor. We receive over 2000 submissions each year and accept about 250 for publication, many after revisions recommended by the reviewers, editors or statistical advisers. A decision usually takes between six and eight weeks. Each paper is assessed by two reviewers with a special interest in the subject covered by the paper, and also by members of the editorial team. Controversial papers will be discussed at a full meeting of the Editorial Board. Publication is between four and six months after acceptance.
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