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Factors Associated with Removal of a Radial Head Prosthesis Placed for Acute Trauma
Amir Reza Kachooei, MD1; Femke M.A.P. Claessen, MD1; Samantha M. Chase, MD1; Kirsten K.J Verheij, BSc1; C. Niek van Dijk, MD, PhD2; David C. Ring, MD1
1Massachusetts General Hospital, Harvard University, Boston, MA; 2Academic Medical Centre, Orthopedic Research Center Amsterdam, Amsterdam, Netherlands

Introduction: Because there are many types of prostheses and differences in opinion about the role a prosthesis might play over the long term, removal of a prosthesis might be highly variable. This study tests the hypothesis that there are no factors associated with removal or revision of a radial head prosthesis. A secondary analysis addressed the time to removal or revision.

Methods: We reviewed the database of two large hospitals from 2000 to 2014 and identified 278 patients that had radial head replacement after an acute fracture or fracture dislocation of the elbow: 19 had removal and 3 had revision of the radial head implant within the study period. Explanatory variables including demographics, the type of injury, prosthesis type, surgeon, medical center, and associated injuries were evaluated in a Cox regression model. Survival analysis using Kaplan-Meier curves evaluated time to revision.

Results: In the multivariable analysis, only the hospital was the independent factor influencing the rate of removal or revision (OR=2.4, Confidence interval: 1.0-5.7, P value=0.046). The rate of removal/revision was 8%. The highest rate of removal was during the first year after implantation (50%) and decreased each year by half over the following second to fourth years. The most common reason for removal of the prosthesis was to facilitate removal of heterotopic ossification (the majority with proximal radioulnar synostosis).

Conclusion: The most important finding is that there were differences by hospital, likely reflecting different opinions and preferences of the surgeons.

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