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Langzeitverlauf und Einflussfaktoren auf das Outcome nach endoprothetischem Ersatz des Radiuskopfes bei nichtrekonstruierbaren Frakturen

Radial head arthropolasty in unreconstructable comminuted fractures of the radial head: Long-term results and factors influencing the outcome

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Zusammenfassung

Hintergrund

Bei nichtrekonstruierbaren Frakturen des Radiuskopfes ist der endoprothetische Gelenkersatz als Standardversorgung anzusehen.

Ziel der Arbeit (Fragestellung)

Ziel dieser retrospektiven Studie war es, den Langzeitverlauf nach prothetischem Radiuskopfersatz zu untersuchen und in einer Subgruppenanalyse mögliche Einflussfaktoren auf das Ergebnis zu identifizieren.

Material und Methoden

Bei nichtrekonstruierbaren Frakturen des Radiuskopfes wurden zwischen Mai 2008 und Oktober 2018 48 Patienten mit einer zementfreien Radiuskopfprothese versorgt (30-mal bipolare Prothese Typ rHead Recon) 18-mal monopolare Prothese Typ MoPyc). 39 Patienten konnten nach einem Follow-up von durchschnittlich 4,6 Jahren nachuntersucht werden. Neben der klinischen Untersuchung wurden der MEPS erhoben und eine Röntgenuntersuchung durchgeführt.

Ergebnisse

Im MEPS wurden im Median 95 Punkte erreicht. Das Bewegungsausmaß für die Extension/Flexion und die Pro‑/Supination war im Vergleich zur Gegenseite im Median um 10° reduziert. 36 von 39 Prothesen waren knöchern fest integriert. Eine Prothese wurde bei einer symptomatischen Lockerung nach 23 Monaten entfernt. Ein „overlengthening“ wurde in 11 Fällen (28 %) nachgewiesen. Eine Resorptionszone am Prothesenkragen bei distal fest integrierter Prothese zeigte sich bei 25 der 39 Patienten (64 %). Periartikuläre Ossifikationen konnten in 15 Fällen (38 %) nachgewiesen. Posttraumatisch arthrotische Veränderungen zeigten 16 Patienten (41 %). Patienten mit erlittener Ellbogenluxation hatten eine signifikant schlechtere Funktion im MEPS und tendenziell vermehrt arthrotische Veränderungen. Ein Overlengthening der Prothese führte zu einer signifikant erhöhten Anzahl an arthrotischen Veränderungen.

Schlussfolgerung

Mittel- bis langfristig lassen sich durch den endoprothetischen Ersatz des Radiuskopfes gute bis sehr gute Ergebnisse erzielen. Negativen Einfluss auf das Ergebnis haben eine stattgehabte Ellenbogenluxation und ein Overlengthening der Prothese.

Abstract

Background

Radial head arthroplasty is recognized as the gold standard in the treatment of patients with unreconstructable radial head fractures.

Objective

The aim of this retrospective study was to investigate the long-term results after prosthetic replacement of the radial head and in a subgroup analysis to identify factors which influence the outcome.

Material and methods

A total of 48 patients with unreconstructable fractures of the radial head and neck were treated by cementless radial head arthroplasty between 05/2008 and 10/2018 (30 bipolar prosthesis type rHead Recon, 18 monopolar prosthesis type MoPyc). After a mean follow-up of 4.6 years 39 patients were assessed clinically and radiologically.

Results

The median MEP score was 95 points. Compared to the uninjured side the median range of motion was reduced by 10° for extension/flexion as well as for pronation/supination. In 36 of 39 cases an osseous integration of the prosthesis could be documented. One prosthesis had to be removed after 23 months because of painful loosening. Overlengthening was present in 11 cases (28%), 25 patients (64%) had subcollar bone resorption with a stable osteointegrated stem. Nonbridging heterotopic ossification was observed in 15 patients (38%), 16 patients (41%) showed posttraumatic arthrosis. Patients with sustained elbow dislocation had a significantly worse function in the MEP score and tended to develop an arthrosis more frequently. Ulnohumeral joint degeneration was significantly increased when overlengthening was present.

Conclusion

Radial head arthroplasty is an effective treatment option for unreconstructable fractures of the radial head and can provide good to excellent mid-term to long-term results. Sustained elbow dislocation as well as overlengthening of the prosthesis had a negative impact on the clinical outcome.

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Authors and Affiliations

  1. Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Marienhospital Stuttgart, Böheimstr. 37, 70199, Stuttgart, Deutschland

    Ulf-Wilhelm Bökeler, Felix Kraft, Verena Weisenberger, Anna Herlan & Ulrich C. Liener

  2. Klinik für Mund-, Kiefer- und Gesichtschirurgie, Marienhospital Stuttgart, Stuttgart, Deutschland

    Robert Schappacher

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  1. Ulf-Wilhelm Bökeler
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Correspondence to Ulf-Wilhelm Bökeler.

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Interessenkonflikt

U.-W. Bökeler, F. Kraft, R. Schappacher, V. Weisenberger, A. Herlan und U.C. Liener geben an, dass kein Interessenkonflikt besteht.

Diese retrospektive Studie erfolgte nach Konsultation der zuständigen Ethikkommission und im Einklang mit nationalem Recht.

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Bökeler, UW., Kraft, F., Schappacher, R. et al. Langzeitverlauf und Einflussfaktoren auf das Outcome nach endoprothetischem Ersatz des Radiuskopfes bei nichtrekonstruierbaren Frakturen. Unfallchirurgie 126, 218–226 (2023). https://doi.org/10.1007/s00113-021-01139-8

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