Causes for early and late surgical re-intervention after radial head arthroplasty

Purpose The primary objective was to describe the reasons for surgical re-intervention after radial head arthroplasty. The secondary objective was to analyze the radiographic and clinical outcomes after surgical re-intervention at the elbow with implant conservation. Methods Among the 70 radial head arthroplasties with bipolar radial head implant performed between 2002 and 2014, 29 required surgical re-interventions. Reasons for surgical re-intervention were gathered from operative notes and follow-up documentation. Patients who underwent re-intervention with implant retention were reassessed via clinical and radiographic examinations by an independent reviewer. Results Twenty nine re-operations were performed at a mean follow-up of 16 +/- 11.7 months (0.2-36 months). The prosthesis was removed in 18 cases and retained in 11. There was a significant difference in mean time to re-intervention between the implant removal and preservation groups, 23.1 +/- 8.3 months (7-36 months) and 4.4 +/- 4.7 months (0.2-13 months), respectively (p < 0.001). The primary reason for surgical re-intervention was painful loosening (13 cases). Radio-capitellar instability was the most frequent reason for re-intervention with implant retention (5 cases). Midterm quickDASH and MEPS after surgical re-intervention with implant retention were 15.4 +/- 5.4 and 82.27 +/- 7.3, respectively. At least one degenerative lesion was reported in nine cases 81.8%) ( i.e. 5 periprosthetic osteolysis, 5 capitellar wear, 5 periarticular heterotopic ossification). Conclusions Painful loosening and capitellar instability are the primary reasons for surgical re-intervention with or without implant removal. Midterm clinical results are favourable despite an elevated rate of degenerative lesions after surgical re-intervention with implant retention.