Abstract
Radial head arthroplasty design must consider that the implant needs to bear load, articulate correctly, and/or compensate for incorrect articulation. The radial head is elliptical, with a circular articular dish that is offset from the axis of rotation of the forearm, and angled in two planes. Design considerations can be grouped as to whether they relate to the head, the stem, or the head-stem connection. The head has an asymmetrical shape that bears load differently in different degrees of elbow flexion and forearm rotation. Importantly among these is the crescent-shaped rim posteromedially which has a variable radius of curvature that articulates with the lateral trochlear ridge of the humerus. This is the main load-bearing region in pronation/extension. A nonanatomic monoblock prosthesis is at risk of edge loading or failing to bear adequate load in this region. Stems are either fixed or loose-fitting. Fixed stems can be either cemented or press-fitted for bone ingrowth. Getting the height correct is one of the two most important technical variables. Getting the stem direct diameter correct is essential to prevent loosening of a porous ingrowth stem. Broaches and the final stem must be hammered into the canal to ensure reliable ingrowth. Current concerns include symptomatic loosening and osteolysis around ingrowth stems, cartilage and bone erosion due to nonanatomic radial head shapes on press-fitted stems, failure of head-stem coupling mechanisms, and the question of whether or not a loose-fitting stem in the canal truly functions as a load-bearing prosthetic replacement in the long term.
All text in this manuscript is used by permission of Shawn W. O’Driscoll. All rights reserved.
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References
Stormont TJ, An K-N, Morrey BF, Chao EY-S. Elbow joint contact study. Comparison of techniques. J Biomech. 1985;18:329–36.
Morrey BF, An K-N, Tanaka S. Valgus stability of the elbow. A definition of primary and secondary constraints. Clin Orthop. 1991;265:187–95.
Pomianowski S, Morrey BF, Neale PG, Park MJ, O’Driscoll SW, An KN. Contribution of monoblock and bipolar radial head prostheses to valgus stability of the elbow. J Bone Joint Surg Am. 2001;83-A(12):1829–34.
Hwang JT, Kim Y, Bachman DR, Shields MN, Berglund LJ, Fitzsimmons AT, et al. Axial load transmission through the elbow during forearm rotation. J Shoulder Elb Surg. 2018 Dec 28;27(3):530–7.
Hwang JT, Kim Y, Shields MN, Bachman DR, Berglund LJ, Fitzsimmons AT, et al. Effects of axial forearm instability on force transmission across the elbow. J Shoulder Elb Surg. 2019 Jan;28(1):170–7.
Jensen SL, Olsen BS, Sojbjerg JO. Elbow joint kinematics after excision of the radial head. J Shoulder Elb Surg. 1999;8(3):238–41.
Beingessner DM, Dunning CE, Gordon KD, Johnson JA, King GJ. The effect of radial head excision and arthroplasty on elbow kinematics and stability. J Bone Joint Surg Am. 2004 Aug;86-A(8):1730–9.
Antuna SA, Sanchez-Marquez JM, Barco R. Long-term results of radial head resection following isolated radial head fractures in patients younger than forty years old. J Bone Joint Surg Am. 2010 Mar;92(3):558–66.
Hall JA, McKee MD. Posterolateral rotatory instability of the elbow following radial head resection. J Bone Joint Surg Am. 2005 Jul;87(7):1571–9.
Schiffern A, Bettwieser SP, Porucznik CA, Crim JR, Tashjian RZ. Proximal radial drift following radial head resection. J Shoulder Elb Surg. 2011 Apr;20(3):426–33.
Morrey BF, Chao EY-S, Hui FC. Biomechanical study of the elbow following excision of the radial head. J Bone Joint Surg. 1979;61-A:63–8.
Ikeda M, Oka Y. Function after early radial head resection for fracture: a retrospective evaluation of 15 patients followed for 3-18 years. Acta Orthop Scand. 2000 Apr;71(2):191–4.
Herbertsson P, Josefsson PO, Hasserius R, Besjakov J, Nyqvist F, Karlsson MK. Fractures of the radial head and neck treated with radial head excision. J Bone Joint Surg Am. 2004 Sep;86-A(9):1925–30.
Bachman DR, Thaveepunsan S, Park S, Fitzsimmons JS, An KN, O’Driscoll SW. The effect of prosthetic radial head geometry on the distribution and magnitude of radiocapitellar joint contact pressures. J Hand Surg Am. 2015 Feb;40(2):281–8.
Johnson JA, Beingessner DM, Gordon KD, Dunning CE, Stacpoole RA, King GJ. Kinematics and stability of the fractured and implant-reconstructed radial head. J Shoulder Elbow Surg. 2005;14(1 Suppl S):195S–201S.
King GJ, Zarzour ZD, Patterson SD, Johnson JA. An anthropometric study of the radial head: implications in the design of a prosthesis. J Arthroplast. 2001;16(1):112–6.
van Riet RP, Van Glabbeek F, Neale PG, Bortier H, An KN, O’Driscoll SW. The noncircular shape of the radial head. J Hand Surg [Am]. 2003 Nov;28(6):972–8.
Swieszkowski W, Skalski K, Pomianowski S, Kedzior K. The anatomic features of the radial head and their implication for prosthesis design. Clin Biomech (Bristol, Avon). 2001;16(10):880–7.
Itamura J, Roidis N, Mirzayan R, Vaishnav S, Learch T, Shean C. Radial head fractures: MRI evaluation of associated injuries. J Shoulder Elb Surg. 2005 Jul-Aug;14(4):421–4.
Irish SE, Langohr GD, Willing R, King GJ, Johnson JA. Implications of radial head hemiarthroplasty dish depth on radiocapitellar contact mechanics. J Hand Surg Am. 2015 Apr;40(4):723–9.
Szmit J, King GJW, Johnson JA, Langohr GDG. The effect of stem fit on the radiocapitellar contact mechanics of a metallic axisymmetric radial head hemiarthroplasty: is loose fit better than rigidly fixed? J Shoulder Elb Surg. 2019 Dec;28(12):2394–9.
Moon JG, Berglund LJ, Domire Z, An KN, O’Driscoll SW. Stem diameter and micromotion of press fit radial head prosthesis: a biomechanical study. J Shoulder Elb Surg. 2009 Sep-Oct;18(5):785–90.
Chanlalit C, Shukla DR, Fitzsimmons JS, An KN, O’Driscoll SW. Effect of hoop-stress fracture on micromotion of textured ingrowth stems for radial head replacement. J Shoulder Elb Surg. 2011 Aug 9;21(7):949–54.
Chanlalit C, Shukla DR, Fitzsimmons JS, An KN, O’Driscoll SW. Stress shielding around radial head prostheses. J Hand Surg Am. 2012 Oct;37(10):2118–25.
Chanlalit C, Fitzsimmons JS, Moon JG, Berglund LJ, An KN, O’Driscoll SW. Radial head prosthesis micromotion characteristics: partial versus fully grit-blasted stems. J Shoulder Elb Surg. 2011 Oct 6;20(1):27–32.
Chanlalit C, Fitzsimmons JS, Shukla DR, An KN, O’Driscoll SW. Micromotion of plasma spray versus grit-blasted radial head prosthetic stem surfaces. J Shoulder Elb Surg. 2010 Feb 14;20(5):717–22.
Songy CE, Kennon JC, Barlow JD, Sanchez-Sotello J, O’Driscoll SW, Morrey ME. Radial head replacement for acute radial head fractures: outcome and survival of three implant designs with and without cement fixation. J Orthop Trauma. 2020;In Press.
Harrington IJ, Tountas AA. Replacement of the radial head in the treatment of unstable elbow fractures. Injury. 1981;12:405–12.
Knight DJ, Rymaszewski LA, Amis AA, Miller JH. Primary replacement of the fractured radial head with a metal prosthesis. J Bone Joint Surg. 1993;75-B:572–6.
Fehringer EV, Burns EM, Knierim A, Sun J, Apker KA, Berg RE. Radiolucencies surrounding a smooth-stemmed radial head component may not correlate with forearm pain or poor elbow function. J Shoulder Elb Surg. 2009 Mar-Apr;18(2):275–8.
Doornberg JN, Parisien R, van Duijn PJ, Ring D. Radial head arthroplasty with a modular metal spacer to treat acute traumatic elbow instability. J Bone Joint Surg Am. 2007 May;89(5):1075–80.
Shore BJ, Mozzon JB, MacDermid JC, Faber KJ, King GJ. Chronic posttraumatic elbow disorders treated with metallic radial head arthroplasty. J Bone Joint Surg Am. 2008 Feb;90(2):271–80.
Moon JG, Shukla DR, Fitzsimmons JS, An KN, O’Driscoll SW. Stem Length and Neck Resection on Fixation Strength of Press-Fit Radial Head Prosthesis: An In Vitro Model. J Hand Surg Am. 2019 Dec;44(12):1098 e1–8.
Shukla DR, Fitzsimmons JS, An KN, O’Driscoll SW. Effect of stem length on prosthetic radial head micromotion. J Shoulder Elb Surg. 2012;21(11):1559–64.
Judet T. Garreau de Loubresse C, Piriou P, Charnley G. a floating prosthesis for radial-head fractures. J Bone Joint Surg Br. 1996 Mar;78(2):244–9.
Moon JG, Berglund LJ, Zachary D, An KN, O’Driscoll SW. Radiocapitellar joint stability with bipolar versus monopolar radial head prostheses. J Shoulder Elb Surg. 2009 Sep-Oct;18(5):779–84.
Athwal GS, Rouleau DM, MacDermid JC, King GJ. Contralateral elbow radiographs can reliably diagnose radial head implant overlengthening. J Bone Joint Surg Am. 2011 Jul 20;93(14):1339–46.
Moon JG, Southgate RD, Fitzsimmons JS, O’Driscoll SW. Simple overlay device for determining radial head and neck height. Skelet Radiol. 2010 Mar 1;39(9):915–20.
Shukla DR, Vanhees MKD, Fitzsimmons JS, An KN, O’Driscoll SW. Validation of a Simple Overlay Device to Assess Radial Head Implant Length. J Hand Surg Am. 2018 Dec;43(12):1135 e1–8.
Ramazanian T, MĂ¼ller-Lebschi JA, Yao Chuang M, Vaichinger AM, Fitzsimmons JS, O’Driscoll SW. Effect of incremental increase in radial neck height on coronoid and capitellar contact pressures. Shoulder & Elbow. 2019; In Press.
Berkmortel CJ, Gladwell MS, Ng J, Ferreira LM, Athwal GS, Johnson JA, et al. Effect of radial neck length on joint loading. J Shoulder Elb Arthroplasty. 2019;3
Bachman DR, Park SE, Thaveepunsan S, Fitzsimmons JS, An KN, O’Driscoll SW. Joint contact changes with under-sized prosthetic radial heads. J Orthop Trauma. 2018 Jul 30;32(11):e440–e4.
Lanting BA, Ferreira LM, Johnson JA, King GJ, Athwal GS. Radial head implant diameter: A biomechanical assessment of the forgotten dimension. Clin Biomech (Bristol, Avon). 2015;30(5):444–7.
Liew VS, Cooper IC, Ferreira LM, Johnson JA, King GJ. The effect of metallic radial head arthroplasty on radiocapitellar joint contact area. Clin Biomech (Bristol, Avon). 2003;18(2):115–8.
O’Driscoll SW, Herald JA. Forearm pain associated with loose radial head prostheses. J Shoulder Elbow Surg. 2011;21:92–7.
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Pierre O’Driscoll created the anatomic illustration.
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O’Driscoll, S.W. (2021). Design Considerations in Radial Head Arthroplasty. In: King, G.J.W., Rizzo, M. (eds) Arthroplasty of the Upper Extremity. Springer, Cham. https://doi.org/10.1007/978-3-030-68880-6_4
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DOI: https://doi.org/10.1007/978-3-030-68880-6_4
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