Long-term outcomes following radial head arthroplasty - a retrospective single-center cohort study

Radial head fractures are among the most common fractures in adults. In recent years, there has been an increasing trend in the use of radial head arthroplasty (RHA) for both traumatic and post-traumatic injuries. However, current literature on long-term outcomes after RHA remains scarce. The main objective of this study was to evaluate long-term implant survival and clinical outcomes following RHA. The secondary aim was to compare outcomes between press-fit and cemented implants. All patients who underwent primary RHA, using the Radial Head System (Tornier SAS, Montbonnot-Saint-Martin, France), between 2005 and 2022 at a single high-volume trauma center were retrospectively reviewed. A minimum follow-up of two years was required for inclusion. At final clinical follow-up, visual analogue scores (VAS) for pain, the Mayo elbow performance index (MEPI), and range of motion were assessed. Revision surgery was defined as any surgery in which the prosthesis was removed or replaced. Implant survival was calculated using the Kaplan-Meier method. A total of 68 patients were included in this study, with 48 (71%) being female. Press-fitted implants were used in the majority of patients (n=40, 59%). Median follow-up was 7.7 IQR: 3.3-12.1 years. Overall implant survival at 15-years follow-up was 79% 95% CI: 70-90. Cemented implants demonstrated superior 15-year implant survival compared to press-fitted implants 93% 95% CI: 84-100) vs 70% [95% CI: 57-86, p= 0.028). Revision rate was 17.6% with a median time to revision of 12.8 IQR: 7.4-20.5 months. At the final follow-up, the median VAS for pain at rest and after exercise was 0 (IQR: 0-15) and 10 IQR: 0-55, respectively. Median MEPI score was 85 (IQR: 85-100). Median flexion-extension and pronation-supination arcs were 130 (IQR: 120-135) and 150 (IQR: 140-160), respectively. Radial head arthroplasty demonstrates a 15-year survival rate of 79% 95% CI: 70-90, with cemented implants showing superior outcomes compared to press-fitted implants. Despite a relatively high early revision rate, long-term patient-reported outcomes measures and range of motion are positive after RHA.