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Radial Head Prosthesis Removal: a Retrospective Case Series of 14 Patients
Valentin Neuhaus, MD; Dimitrios Christoforou, MD; Jesse B. Jupiter; David C. Ring;
Chaitanya Mudgal Massachusetts General Hospital, Boston, MA

Background: The purpose of this study was to analyze patients that had removal of radial head prosthesis and their outcome.
Methods: This is a retrospective review of 14 adult (6 female and 8 male) patients from 2007 to 2011, who underwent radial head prosthesis removal by three surgeons. Nine prostheses had been implanted acutely and five for the treatment of injury-related sequelae. The average time between implantation and removal was 23 months (range 2 weeks to 12 years, median 12 months). The mean age was 48 years (range 28 to 65) at the time of radial head prosthesis removal.
Results: Restricted mobility of the elbow (active range of motion of less than 100 degrees) in 6, pain in 4, and pain as well as restricted mobility also in 4 patients were the leading reported complaints. Chronic processes such as capitellar cartilage wear and loose implants were each present in 57% (8/14) based on radiographs. All patients with pain had wear of the capitellar cartilage on radiographs (p = 0.005). Radiographic loosening and pain had no statistically significant association (p = 0.59). Heterotopic ossification was seen in 57% (8/14) and seven of these were defined as having stiffness Mild arthritic changes were seen in 50% (7/14) of patients, and moderate changes were noted in 14% (2/14) based on the Broberg and Morrey classification. Concomitant factors leading to implant removal were subluxation of the radio-capitellar joint as well as malpositioning of the stem in five cases and chronic infection in two cases. The three surgeons reported reactive synovitis intraoperatively in five patients. The ulnar nerve was decompressed in four patients. Four patients underwent a subsequent operation for postoperative ulnar nerve symptoms 5 to 21 months after removal. Four patients complained about persistent pain at last follow-up. All except two patients improved their total range of motion 34 degrees (range 5 to 70) after prosthesis removal after a mean follow-up of 11 months.
Conclusion: 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.


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