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Radial Head Replacement for Acute Radial Head Fractures: Outcome and Survival of Three Implant Designs With and Without Cement Fixation

OBJECTIVES: To determine outcomes of radial head replacement (RHR) for acute fractures using 3 different implant designs with or without cement fixation. DESIGN: Retrospective. SETTING: Tertiary referral hospital. PATIENTS/PARTICIPANTS: One hundred fourteen elbows underwent RHR for an acute radial h...

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Autores principales: Songy, Chad E., Kennon, Justin C., Barlow, Jonathan D., Sanchez-Sotelo, Joaquin, O'Driscoll, Shawn W., Morrey, Mark E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Journal of Orthopaedic Trauma 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8115875/
https://www.ncbi.nlm.nih.gov/pubmed/34006797
http://dx.doi.org/10.1097/BOT.0000000000001983
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author Songy, Chad E.
Kennon, Justin C.
Barlow, Jonathan D.
Sanchez-Sotelo, Joaquin
O'Driscoll, Shawn W.
Morrey, Mark E.
author_facet Songy, Chad E.
Kennon, Justin C.
Barlow, Jonathan D.
Sanchez-Sotelo, Joaquin
O'Driscoll, Shawn W.
Morrey, Mark E.
author_sort Songy, Chad E.
collection PubMed
description OBJECTIVES: To determine outcomes of radial head replacement (RHR) for acute fractures using 3 different implant designs with or without cement fixation. DESIGN: Retrospective. SETTING: Tertiary referral hospital. PATIENTS/PARTICIPANTS: One hundred fourteen elbows underwent RHR for an acute radial head fracture using either (1) a nonanatomic design and smooth stem (n = 60), (2) a nonanatomic design with a grit-blasted, ingrowth, curved stem (n = 21), or (3) an anatomic design with a grit-blasted ingrowth straight stem (n = 33). Cemented (25%) or uncemented (75%) fixation was used at the discretion of the treating surgeon. INTERVENTION: RHR. MAIN OUTCOME MEASUREMENTS: The primary outcome was implant survivorship free of revision or removal for any reason. All elbows were evaluated clinically (the Mayo Elbow Performance Score and reoperations/complications) and radiographically. RESULTS: Fourteen implants (12%) were revised. Of elbows with a minimum 2-year clinical follow-up, the average Mayo Elbow Performance Score was 88. The rate of survivorship free from revision was 92% [95% confidence interval (CI) = 87%–98%] at 2 years, 90% (CI = 84%–96%) at 5 years and 84% (CI = 75%–94%) at 10 years. The differences in survivorship between the 3 implants did not reach statistical significance, but the nonanatomic design with a grit-blasted ingrowth curved stem had a hazard ratio of 4.6 (95% CI = 0.9%–23%) for failure. There were no differences in survivorship between cemented versus uncemented stems. For those elbows with a minimum of 2 years of radiographic follow-up, implant tilt was observed in 10 (16%) elbows and loosening in 16 (26%) elbows. Stress shielding was present in 19 (42%) of well-fixed implants. CONCLUSIONS: RHR for acute trauma leads to survivorship greater than 80% at 10 years. Radiographic changes (loosening, stress shielding, and implant tilting) can be expected in a substantial portion of elbows at long-term follow-up. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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spelling pubmed-81158752021-05-20 Radial Head Replacement for Acute Radial Head Fractures: Outcome and Survival of Three Implant Designs With and Without Cement Fixation Songy, Chad E. Kennon, Justin C. Barlow, Jonathan D. Sanchez-Sotelo, Joaquin O'Driscoll, Shawn W. Morrey, Mark E. J Orthop Trauma Original Article OBJECTIVES: To determine outcomes of radial head replacement (RHR) for acute fractures using 3 different implant designs with or without cement fixation. DESIGN: Retrospective. SETTING: Tertiary referral hospital. PATIENTS/PARTICIPANTS: One hundred fourteen elbows underwent RHR for an acute radial head fracture using either (1) a nonanatomic design and smooth stem (n = 60), (2) a nonanatomic design with a grit-blasted, ingrowth, curved stem (n = 21), or (3) an anatomic design with a grit-blasted ingrowth straight stem (n = 33). Cemented (25%) or uncemented (75%) fixation was used at the discretion of the treating surgeon. INTERVENTION: RHR. MAIN OUTCOME MEASUREMENTS: The primary outcome was implant survivorship free of revision or removal for any reason. All elbows were evaluated clinically (the Mayo Elbow Performance Score and reoperations/complications) and radiographically. RESULTS: Fourteen implants (12%) were revised. Of elbows with a minimum 2-year clinical follow-up, the average Mayo Elbow Performance Score was 88. The rate of survivorship free from revision was 92% [95% confidence interval (CI) = 87%–98%] at 2 years, 90% (CI = 84%–96%) at 5 years and 84% (CI = 75%–94%) at 10 years. The differences in survivorship between the 3 implants did not reach statistical significance, but the nonanatomic design with a grit-blasted ingrowth curved stem had a hazard ratio of 4.6 (95% CI = 0.9%–23%) for failure. There were no differences in survivorship between cemented versus uncemented stems. For those elbows with a minimum of 2 years of radiographic follow-up, implant tilt was observed in 10 (16%) elbows and loosening in 16 (26%) elbows. Stress shielding was present in 19 (42%) of well-fixed implants. CONCLUSIONS: RHR for acute trauma leads to survivorship greater than 80% at 10 years. Radiographic changes (loosening, stress shielding, and implant tilting) can be expected in a substantial portion of elbows at long-term follow-up. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. Journal of Orthopaedic Trauma 2021-06 2021-05-06 /pmc/articles/PMC8115875/ /pubmed/34006797 http://dx.doi.org/10.1097/BOT.0000000000001983 Text en Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Original Article
Songy, Chad E.
Kennon, Justin C.
Barlow, Jonathan D.
Sanchez-Sotelo, Joaquin
O'Driscoll, Shawn W.
Morrey, Mark E.
Radial Head Replacement for Acute Radial Head Fractures: Outcome and Survival of Three Implant Designs With and Without Cement Fixation
title Radial Head Replacement for Acute Radial Head Fractures: Outcome and Survival of Three Implant Designs With and Without Cement Fixation
title_full Radial Head Replacement for Acute Radial Head Fractures: Outcome and Survival of Three Implant Designs With and Without Cement Fixation
title_fullStr Radial Head Replacement for Acute Radial Head Fractures: Outcome and Survival of Three Implant Designs With and Without Cement Fixation
title_full_unstemmed Radial Head Replacement for Acute Radial Head Fractures: Outcome and Survival of Three Implant Designs With and Without Cement Fixation
title_short Radial Head Replacement for Acute Radial Head Fractures: Outcome and Survival of Three Implant Designs With and Without Cement Fixation
title_sort radial head replacement for acute radial head fractures: outcome and survival of three implant designs with and without cement fixation
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8115875/
https://www.ncbi.nlm.nih.gov/pubmed/34006797
http://dx.doi.org/10.1097/BOT.0000000000001983
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