Radial head replacement with a bipolar system: a minimum 2-year follow-up

Background: We report the short-term results of a cohort of patients undergoing radial head replacement using a novel radial head prosthesis with a smooth, unfixed, telescoping stem and a bipolar design after a mean follow-up of 34 months (range, 24-48 months). Materials and methods: Patients were assessed using clinical and radiographic examination as well as with standardized outcome measures. Thirty implants (29 patients) were available for review. Results: At final follow-up, the average Mayo Elbow Performance Index Score was 92.1 and the Disabilities of the Arm, Shoulder, and Hand Score was 13.8. Clinical examination revealed significant differences between operative and nonoperative sides for flexion/extension and pronation/supination. Radiographic measurement of medial and lateral ulnohumeral spaces revealed re-establishment of a congruent elbow joint. No significant arthritic changes were identified at the radiocapitellar joint. Minimal angular migration of the implant in the proximal radial shaft was observed over time. Complications included 1 patient requiring temporary placement of a hinged external fixator for instability and 1 patient requiring revision surgery at 4 weeks. Conclusion: This review demonstrates that a bipolar radial head prosthesis with a smooth stem and telescoping neck effectively restores stability to elbows with a comminuted radial head fracture and valgus instability. To date, this is the largest reported outcome analysis of bipolar radial head replacement in the literature. Level of evidence: Level IV, Case Series, Treatment Study. (C) 2012 Journal of Shoulder and Elbow Surgery Board of Trustees.