Clinical outcomes of anconeus interposition arthroplasty after radial head resection in native and prosthetic radial heads

• Published in: Journal of shoulder and elbow surgery 2018-06, Vol.27 (6), p.S29-S34
• Main Authors: Rahmi, Hithem, Neumann, Julie A., Klein, Christopher, van Eck, Carola F., Lee, Brian K., Itamura, John
• Format: Article
• Language: English
• Subjects: Adult; Anconeus; Arthroplasty - adverse effects; Arthroplasty - methods; Device Removal; elbow; Elbow Joint - diagnostic imaging; Elbow Joint - injuries; Elbow Joint - physiopathology; Elbow Joint - surgery; Elbow Prosthesis; Epiphyses; Follow-Up Studies; Humans; Muscle, Skeletal - surgery; Musculoskeletal Pain - surgery; radial head arthroplasty; radial head resection; radiocapitellar pathology; Radius - diagnostic imaging; Radius - injuries; Radius - surgery; Range of Motion, Articular; Retrospective Studies; trauma
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2018.02.052

Radiocapitellar pathology after traumatic injury to the elbow can be challenging to treat. The anconeus interposition arthroplasty has been proposed to treat radiocapitellar or proximal radioulnar joint dysfunction and pain, or both. This study evaluated whether radial head excision (native or prosthetic), followed by an anconeus interposition arthroplasty, relieves pain and improves subjective and objective elbow function in patients with post-traumatic radiocapitellar pathology. A retrospective comparative case series was performed of 50 consecutive patients who underwent a native radial head excision or radial head implant excision, followed by an anconeus interposition arthroplasty. Clinical outcome scores, range of motion, and proximal radius migration were evaluated in patients with at least 2 years of follow-up. Included were 23 patients (11 native and 12 prosthetic radial heads) with a mean age of 41 years. Average follow-up was 38 months. Overall, significant improvement was obtained in the Disabilities of the Arm, Shoulder and Hand and visual analog scale scores. Range of motion significantly improved from preoperatively to postoperatively. Patients with a native radial head excision scored better on the Single Assessment Numeric Evaluation (76.8 vs. 56.3, P = .037) and obtained significantly more flexion postoperatively (141° vs. 123°, P = .016). Mild wrist pain developed in 3 patients, but no further intervention was required. The overall complication rate was 13%, and 5 patients required reoperation. Anconeus interposition arthroplasty performed after radial head resection in native and prosthetic groups is a viable adjunct in the operative treatment of patients with post-traumatic radiocapitellar pathology. However, whether anconeus interposition arthroplasty alone produced the favorable clinical results of this study was difficult to determine.