Chronic Posttraumatic Elbow Disorders Treated with Metallic Radial Head Arthroplasty

BACKGROUND: Metallic radial head arthroplasty is a proven technique for the treatment of complex radial head fractures. The purpose of this study was to evaluate the functional outcomes of a metallic radial head arthroplasty in patients with chronic posttraumatic elbow disorders. METHODS: The results of thirty-two metallic radial head arthroplasties in thirty-two consecutive patients were retrospectively reviewed. The indications for the radial head arthroplasty included posttraumatic nonunion and malunion of the radial head, elbow instability following previous excision of the radial head, and failure of a silicone radial head implant used to treat an acute radial head fracture. The study included thirteen male and nineteen female patients followed for a minimum of two years. The radial head arthroplasties were performed at an average of 2.4 years after the injury. Analysis included chart review, personal interview, physical examination, radiographic examination, and strength testing as well as the administration of general and region-specific questionnaires. RESULTS: The mean duration of follow-up was eight years. The average Mayo Elbow Performance Score was 83 of 100 points, with seventeen (53%) of the thirty-two results rated as excellent; four (13%), as good; seven (22%), as fair; and four (13%), as poor. The average score for subjective patient satisfaction was 8.5 points on a 10-point scale. Patients had significantly less motion and strength in the affected elbow than in the unaffected elbow. Seventy-four percent of the patients demonstrated some degree of posttraumatic arthritis. There were no significant differences in ulnar variance and the ulnohumeral joint space between the affected and unaffected arms. Over the course of the study, no metallic radial head arthroplasties required revision. CONCLUSIONS: Metallic radial head arthroplasty for the treatment of posttraumatic elbow disorders appears to be a safe and durable procedure that can provide a functional range of motion and pain relief for at least five to ten years. However, longer follow-up is needed to evaluate progression of lucencies adjacent to stems and osteoarthritis.