Radial Head Prosthesis Update
Stuffmann, Eric MD; Gannon, Amanda BS; Clemente, Jill MS; Baratz, Mark MD, Allegheny General Hospital, Pittsburgh, PA. Techniques in Shoulder & Elbow Surgery: March 2009 - Volume 10 - Issue 1 - pp 31-38
Radial head arthroplasty is an essential element in the management of an unstable elbow when there is a fracture of the radial head that cannot be repaired. Similarly, radial head arthroplasty must be considered when the radial head is not repairable and there is evidence of an injury to the interosseous membrane. If replacement of the radial head is necessary, the surgeon must make preoperative decisions regarding the implant and surgical approach; he or she must make intraoperative decisions regarding stem size and head size, as well as which structures are repaired. Most of the available implants will help restore lateral stability, however, the surgeon must decide if he or she wants a monopolar or a bipolar implant and whether the implant should have a smooth stem, a stem with the potential for ingrowth or a stem that will be cemented. Approach to the radial head may be facilitated by avulsion of the lateral complex. If the lateral complex is intact, the surgeon may choose to work around the intact complex or perform a release followed by repair. In most elbows, stability will be restored with placement of a radial head and repair of the lateral complex. However, the surgeon must have a contingency plan for dealing with residual instability. This article will discuss the developments in prosthetic treatment of radial head fractures, surgical technique, decision making, and the essential features of the varied radial head implant designs on the market today.