Anatomic Radial Head System | Acumed
The radial head is shaped like a round disc and is important in motion of the elbow.
Complications of radial head prostheses | SpringerLink
This study has several significant limitations. It is a retrospective, small case series without a control group. We recognize that the exact reasons for radial head replacement were not completely documented in all patients. This is important on account of the fact that the original injury could have in itself caused radio-capitellar cartilage trauma, which could adversely impact overall recovery and influence the development of pain during the short term as well as in the long term. The reasons for removal of the radial head rely on intraoperative notes and x-rays. The radiographic assessment is difficult, subjective, and we did not have radiographs of the contralateral (healthy) side to better judge parameters such as overlengthening and head size of the prosthesis (). Three surgeons were involved in the treatment and there was no standardization in the reporting of findings. In addition there was insufficient data to analyze pronation and supination, which are relevant to overall function. Our follow-up was short in a few cases to assess for long-term outcome of radial head prosthesis removal.
Right and left elbows were equally involved. In 9 patients, implantation of radial head prosthesis was done in an acute setting (less than one week after trauma), and in five patients arthroplasty was performed in a chronic setting (on average 13 months after trauma, range 7 weeks to 29 years) . The index surgery was performed in our institution in eight patients with a Wright Medical radial head implant (Wright Medical Technology, Arlington, TN). The size of the stem was 5.5 millimeters (mm) in three patients (one with a 20 mm and two with a 22 mm head), 6.5 mm in three patients (one with a 20mm and two with a 26 mm head) and 7.5mm in two cases (22 mm and 26 mm head). All implants were non-cemented. Regarding the prostheses implanted in other institutions, the make of the radial head was specified and recorded; however, the size of stems and heads were unknown . The mean age of the patients was 48 years (range 24 to 65 years) at the time of radial head prosthesis removal. The average time between implantation and removal surgery was 23 months (range 2 weeks to 12 years).
Radial Head Implant Arthroplasty - Journal of Hand …
If the radial head is non displaced (remains in position) then a more conservative approach such as immobilisation followed by physiotherapy may be recommended.
If the radial head fracture is displaced (out of position) following trauma then may be required to reposition and stabilise the joints using screws or pins.
Radial head arthroplasty has developed into a ..
Removal of radial head prosthesis improved function and lessened pain in our case series. The reoperation rate was yet nearly 30% due to ulnar neuritis. Selective ulnar nerve decompression at the time of removal must be evaluated, especially in patients with expected large gain in range of motion after removal.
The leading reported complaints before removal were restricted mobility of the elbow (active range of motion of less than 100 degrees) in 6, pain in 3, and pain together with restricted mobility in 4 patients. The objective findings before removal were restricted mobility of the elbow in 10 (71%), capitellar cartilage wear, loose implants, and heterotopic ossification each in 8 (57%), subluxation of the radio-capitellar joint or malpositioning of the stem in 5 (36%), and chronic infection in 2 (14%) patients. All patients with pain had wear of the capitellar cartilage on radiographs. The ulnar nerve was decompressed in four patients at the time of removal. Four patients underwent a subsequent operation for postoperative ulnar nerve symptoms 5 to 21 months after removal. Four patients were still complaining about persistent pain at the last follow-up visit. Except two patients, the total range of motion improved with a mean of 34 degrees (range 5 to 70) after a mean follow-up of 11 months.
Radial Head Technique Animation - YouTube
Radial Head Arthroplasty - Journal of Hand Surgery
Find all the manufacturers of radial head prosthesis and contact them directly on MedicalExpo.
OSKAR Radial Head Prosthesis - BIOTEK
14/08/2017 · Radial head replacement is frequently used in treatment of radial head fractures or sequela
Radial Head Fractures - Trauma - Orthobullets
14/08/2017 · The radial head is a commonly fractured bone of the elbow joint
Elbow radial head replacement - Things You Didn't Know
Radial head excision is a surgical procedure that involves the removal of the radial head after severe damage following trauma such as radial head fracture or as a result of degenerative changes associated with arthritis.
Indications for Radial Head Replacement Following …
Your physiotherapy will include:
After radial head excision your elbow will be considerably unstable and weak which will significantly affect function in your elbow and hand.
Complications of radial head prostheses (PDF …
In selected cases, pain did appear to resolve completely after prosthesis removal surgery. There seems to be an association between pain persistence and duration of the interval between implantation and removal of the prosthesis in our patients. Patients that underwent implant removal earlier tended to have less persisting pain. We would speculate that patients with ongoing pain are likely to represent a more severe initial injury or a greater degree of capitellar wear or both, but are unable to substantiate this speculation. Our findings also raise the question of whether some of the currently available radial head prostheses which rely on a loose intramedullary fit may actually allow for excessive degrees of motion in several planes that may contribute to or accelerate capitellar wear. If so, this could support routine removal of radial head prostheses after an arbitrary period of 6 to 12 months when the soft tissues have healed and possibly before radio-capitellar symptoms manifest. According to Wretenberg et al, the removal of the radial head even several years after implantation led to further improvement in range of motion (). We shared similar results; the extension deficit and overall total ROM improved after removal nearly the same amount as noted by these authors. In contrast to our findings, Harrington et al. reported four patients requiring removal of the radial head prosthesis for pain, and could not correlate a better outcome following removal (). Ulnar nerve compression can be a complication seen in patients following complex elbow trauma. After removal of the radial head prosthesis, three of our first four patients underwent additional surgery to decompress the ulnar nerve. One reason for this could be the development of further heterotopic ossification and scarring as mentioned earlier. Another reason could be the additional gain in range of motion causing increased stretch and traction on the ulnar nerve as it traverses an injury scarred bed, which could potentially hamper its normal physiologic mobility with elbow motion. As a consequence, we therefore advocate the liberal use of ulnar nerve decompression in cases involving heterotopic ossification or when a significant increase in range of motion is anticipated or noted intraoperatively.
Radial Head Prosthesis System - Surgical Products
In our series, the two main complaints were painful elbow and stiffness. A chronically painful elbow after radial head prosthesis implantation was always associated with wear of the capitellar cartilage in our study. Progressive capitellar erosion following radial head prosthetic implantation presenting with increasing pain and stiffness has been described (). In our case series, the chronic wear process took more than a year to develop, although mechanical problems seem to accelerate the process. Burkhart and colleagues also reported three cases of capitellar erosion, mainly caused by overstuffing of the radio-humeral joint (). Although we agree that overlengthening can cause wear of the capitellar cartilage, more than half of our cases with wear did not appear to be affected by this technical problem. It appears that capitellar cartilage wear is a common sequel of the initial injury resulting in radial head implantation as well as a response to cartilage contact with metallic radial head prosthesis. An important unanswered question is whether the capitellar wear in these circumstances is the cause of pain, and can be ameliorated by radial head prosthesis removal. Besides the possible association of pain and wear, loosening of the radial head prosthesis was often in conjunction with pain in our study, especially after one year. Based on the implant, some radial head prostheses are designed to be loose, acting only as a spacer. Several studies have shown that radiolucency and pain are unrelated in the setting of radial head arthroplasty (, , ). However, O’Driscoll et al. noted that pain from a loose stem within the proximal radius may present as proximal radial forearmpain, and furthermore suggest that its presence be used as an indicator of symptomatic mechanical loosening (). Stiffness was mostly associated with heterotopic ossification, pain, or articular degenerative changes. In addition, there seems to be a correlation between HO and ulnar neuritis, which could be explained by the fact that most HO is found posteromedially as seen in our cohort as well as described recently by Park et al (). Mechanical or technical problems were found to typically result in early reoperation. This is in contrast to chronic process, which usually resulted in late explantation in our case series. Mechanical issues included oversized radial head implants, overlengthening or malpositioning of the prosthesis, and subluxation. Although rare, Burkhart et al. also described two cases of prosthetic dislocation in mid- to long-term follow-up (). We did not see any cases of frank implant dislocation in our series.
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