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LUENAM S, TANTHAPRABHA N, KOSIYATRAKUL A. Anthropometric Study of Proximal Radius in Below-Average Height Thai Women and Its Correlation with Commercially Available Radial Head Prostheses. J Hand Surg Asian Pac Vol 2022; 27:864-873. [DOI: 10.1142/s2424835522500849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background: Most radial head prostheses were designed in Western countries based on the anatomical characteristics of Western populations. We hypothesised that these prostheses are too large for below-average height Thai women. The objective of this study is to evaluate the anthropometric parameters of the proximal radius in such a population and its correlation with commercially available prostheses. Methods: Dominant elbows of 124 Thai women whose height was <155 cm were studied. Using the standard anteroposterior and lateral radiographic images, the head diameter and thickness, the distance between the articular surface and radial tuberosity, the narrowest intra-medullary canal diameter and the narrowest outer diameter of the radial neck were measured. Correlations between body height and each radiographic parameter were assessed using the Pearson correlation coefficient (PCC). The specifications of the commercial metallic radial head implants were reviewed and used to evaluate the relevant radiographic parameters. Results: Mean of the minimum and maximum head diameter was 18.54 ± 1.11 mm and 19.13 ± 1.17 mm, respectively; the thickness was 7.43 ± 0.69 mm, the distance between the articular surface and tuberosity was 19.05 ± 1.45 mm, the intra-medullary canal diameter was 7.63 ± 1.2 mm and the outer diameter of the radial neck was 11.13 ± 1.26 mm. There is a poor correlation between the participant’s height and each parameter (PCC ≤ 0.50). In 24.2% of the participants, the smallest size of prosthetic designs with a head diameter of 20 mm is larger than +2 mm in reference to minor diameter. The minimum prosthetic head thickness is greater than the average value of the participants in 12 out of 15 designs. One participant has an outer neck diameter smaller than the smallest stem diameter of three designs. Conclusions: Surgeons must be aware that commercially available radial head replacement implants may be too large for below-average height Thai women. Level of Evidence: Level IV (Prognostic)
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Affiliation(s)
- Suriya LUENAM
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Natpawee TANTHAPRABHA
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Arkaphat KOSIYATRAKUL
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
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Bagley JJ, Della Rocca GJ, Smith MJ, Kim HM. Optimal Prosthesis Sizing for Radial Head Arthroplasty: A Review of Current Evidence and Guidelines. JBJS Rev 2021; 9:01874474-202104000-00012. [PMID: 33886524 DOI: 10.2106/jbjs.rvw.20.00178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Radial head arthroplasty is a viable surgical option when a radial head fracture cannot be reconstructed. Radial head arthroplasty provides a load-bearing articular structure against the capitellum in unstable fractured elbows. » Studies have emphasized the importance of choosing the correct implant size to replicate the native radial head anatomy, citing various consequences of improperly sized radial head prostheses. Overstuffing of the radiocapitellar joint, or lengthening of the radius, has been extensively studied because of its detrimental effects on elbow biomechanics, but other types of improper sizing also have negative consequences. » In the setting of severe fracture-dislocation or revision surgery, anatomic landmarks that are useful for prosthesis sizing often are missing. Various methods have been described to provide guidance for the accurate sizing of a prosthetic radial head; a retrieved radial head, the proximal edge of the lesser sigmoid notch, the radiocapitellar synovial fold, and the ulnohumeral joint space all represent useful references. » Intraoperative radiographic examination is an important step while assessing implant size, including the height of the prosthetic radial head. » Since no single method is perfect on its own, the surgeon should combine as many reference measures as possible, both before and during the procedure, for accurate prosthesis sizing in order to achieve successful outcomes.
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Affiliation(s)
- Joshua J Bagley
- Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Gregory J Della Rocca
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
| | - Matthew J Smith
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
| | - H Mike Kim
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
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Wegmann K, Hackl M, Leschinger T, Burkhart KJ, Müller LP. Overlengthening of the radial column in radial head replacement: a review of the literature and presentation of a classification system. Arch Orthop Trauma Surg 2021; 141:1525-1539. [PMID: 33057805 PMCID: PMC8354917 DOI: 10.1007/s00402-020-03619-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 09/30/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Radial head arthroplasty is a common procedure in elbow surgery. It has been shown to be of benefit for the patients, but there also are relevant complications that should be prevented if possible. One significant complication is overlengthening of the radial head prosthesis. In overlengthening, the head of the prosthesis overextends the physiological level of the native radial head and leads to overcompression in the radiohumeral joint. Rapid erosion and arthritic changes may then impede the clinical outcome. The incidence of overlengthening is not precisely known, but estimations range to up to 20% of all implanted prostheses. METHODS The present review discusses the available body of literature on overlengthening and lines out a classification system that may be used to guide treatment algorithms. The classification is based on the personal experiences of the author during their clinical practice. RESULTS In low-grade overlengthening (type I) conservative treatment can be an option. In Types II-IV usually revision surgery is needed. Depending on the state of the capitulum and joint stability, it is possible re-implant a prosthesis, or rely on implant removal alone. DISCUSSION The present review aimed at shedding light into overlengthening as a complication radial head replacement and to help identify and treat it.
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Affiliation(s)
- K Wegmann
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Kerpener Street 62, 50937, Cologne, Germany.
| | - M Hackl
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - T Leschinger
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | | | - L P Müller
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Kerpener Street 62, 50937, Cologne, Germany
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Hatta T, Shinagawa K, Kawakami J, Yamamoto N, Kitada M, Itoi E. Downsizing effect of a modular radial head prosthesis on the lateral collateral ligament of the elbow: A cadaveric study. Clin Biomech (Bristol, Avon) 2020; 80:105140. [PMID: 32745705 DOI: 10.1016/j.clinbiomech.2020.105140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 05/23/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND It remains unclear how the head and stem diameters for the radial head prosthesis could affect mechanical properties of the lateral collateral ligament measured by strain changes during elbow and forearm motions. METHODS Eight cadaveric specimens were secured to the device, which allows elbow flexion-extension and forearm pro-supination. Using six different implant combinations comprising 2 sizes for the head (long- and short-axis of the native head) and 3 sizes for the stem (press-fit, -1 mm, and -2 mm downsizing), prostheses were attached via the posterior approach. A differential variable reluctance transducer placed on the central portion of the radial collateral ligament were used for strain measurement with elbow flexion at 0°, 30°, 60°, and 90°. At each position, the strain patterns with the forearm in the neutral and 45° pro-supination positions were also assessed. FINDINGS Specimens implanted with long-axis head component showed greater increases in the ligament strain during elbow flexion than intact specimens or those implanted with short-axis head. Compared to press-fit stem, implants with downsizing to -1 mm approximated strain patterns during pro-supination with elbow extension to intact condition. INTERPRETATION Morphologic variation of the head and stem components in radial head prostheses led to altered strain patterns in the lateral collateral ligament during elbow and forearm motions. A short-axis head component can be used to prevent excessive strain changes after the prosthesis application. Downsizing of the stem component might be an option for approximating the biomechanics at the radiocapitellar joint during forearm rotation to the intact elbow.
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Affiliation(s)
- Taku Hatta
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.
| | - Kiyotsugu Shinagawa
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Jun Kawakami
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Masaaki Kitada
- Department of Stem Cell Biology and Histology, Tohoku University School of Medicine, Sendai, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
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Cucchi D, Luceri F, Celli A, Menon A, Barco R, Wegmann K, Randelli P, Eygendaal D, Arrigoni P. Fracture Pattern Influences Radial Head Replacement Size Determination Among Experienced Elbow Surgeons. Indian J Orthop 2020; 54:539-547. [PMID: 32843951 PMCID: PMC7429655 DOI: 10.1007/s43465-020-00039-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/06/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Correct sizing is challenging in radial head replacement and no consensus exists on the implant's optimal height and width to avoid elbow stiffness and instability. Studies exists, suggesting how to appropriately choose the implant size, but the manner by which the fracture pattern influences the surgeons' operative choices was not investigated. METHODS The radial heads of four fresh-frozen cadaveric specimens were excised, measured, and fractured to simulate four patterns: three fragments (A); four fragments (B); comminuted (C); comminuted with bone loss (D). Nine examiners were asked to indicate first the maximum diameter of the radial heads with the help of dedicated sizing dishes and then the appropriate implant size with trial implants. Accuracy and precision were determined. A coefficient of variation was calculated and agreement was evaluated with the Bland-Altman method. RESULTS Accuracy and precision of radial head diameter estimation with dedicated sizing dish were 96.73% and 93.64%, (best pattern, D; worst, C). Accuracy and precision of radial head diameter estimation with trial implants were 99.71% and 90.66% (best pattern, A; worst, D). Frequent modifications occurred between the initial radial head size proposal based on the sizing dish and the radial head size chosen after use of the trial implants (47.2%). CONCLUSIONS Diameter estimation of radial heads with dedicated sizing dishes may be underestimated in comminuted fractures; when bone loss is present, this may lead to an overestimation, especially when using trial implants. Care is essential to determine the optimal size of the implant and to avoid overlenghtening and oversizing, which can be responsible for implant failure. LEVEL OF EVIDENCE Basic Science Study. CLINICAL RELEVANCE Knowledge of the manner by which the fracture pattern influences radial head replacement size estimation can help preventing overlenghtening and oversizing during this procedure.
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Affiliation(s)
- Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Francesco Luceri
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
- Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Andrea Celli
- Department of Orthopaedic surgery, Shoulder and Elbow Unit, Hesperia Hospital, Via Arquà, 80/A, 41125 Modena, Italy
| | - Alessandra Menon
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
- U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- REsearch Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Raul Barco
- Shoulder and Elbow Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, Madrid, 28046 Spain
| | - Kilian Wegmann
- Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Kerpenerstrasse 62, 50937 Cologne, Germany
| | - Pietro Randelli
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
- U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- REsearch Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Upper Limb Unit, Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Paolo Arrigoni
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
- U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- REsearch Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
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Luenam S, Vongvanichvathana A, Kosiyatrakul A, Kongphanich C, Chanpoo M, Koonchornboon T, Phakdeewisetkul K, Lohwongwatana B, Puncreobutr C. Matching precision of the reverse contralateral radial head in generating of the individualized prosthesis from the surface registration in tuberosity-neck and in tuberosity-diaphysis. J Orthop Surg (Hong Kong) 2020; 27:2309499018821774. [PMID: 30798711 DOI: 10.1177/2309499018821774] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Following the radial head replacement, the surface mismatches between the implants and the morphological characteristics of the original proximal radius decreased contact areas and increased contact forces which is potential for the long-term articulating cartilage wear. Several studies demonstrated that the individualized prosthesis, created from computed tomographic (CT) images of the contralateral side with the reverse engineering technology, may reduce the mismatch. The aim of this study is to demonstrate the matching precision of the reverse contralateral head between the surface registration in tuberosity-neck (TN) area and in tuberosity-diaphysis (TD) area. MATERIALS AND METHODS High-resolution CT scan of 11 pairs of the cadaveric arms was performed. Utilizing advanced image processing techniques, three-dimensional (3-D) models of each specimen was generated. The model of the left side was reversed and matched with the model of the right side in the same cadaver by registering in the area of radial neck along with tuberosity (TN) and in the area of radial tuberosity combined with 2 cm of proximal diaphysis (TD). The alteration of the head diameter, dish diameter, articular depth, head thickness, end-plane angle, offset, and head volume were evaluated and analyzed by paired t-test. RESULTS No statistically significant difference was found in all parameters from both TN and TD registrations ( p < 0.05). CONCLUSION The surface registration in either TN or TD area can generate the statistically symmetrical 3-D model with the original head. The registration in these areas may possibly be used in creating the individualized radial head prosthesis.
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Affiliation(s)
- Suriya Luenam
- 1 Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Adigun Vongvanichvathana
- 1 Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Arkaphat Kosiyatrakul
- 1 Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Chutcharn Kongphanich
- 2 Department of Radiology, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Malee Chanpoo
- 3 Department of Anatomy, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Tunyarut Koonchornboon
- 3 Department of Anatomy, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Kantapat Phakdeewisetkul
- 4 Department of Metallurgical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Boonrat Lohwongwatana
- 4 Department of Metallurgical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Chedtha Puncreobutr
- 4 Department of Metallurgical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
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Hemmingsen CK, Thillemann TM, Elmengaard B, de Raedt S, Nielsen ET, Mosegaard SB, Stentz-Olesen K, Stilling M. Elbow Biomechanics, Radiocapitellar Joint Pressure, and Interosseous Membrane Strain Before and After Radial Head Arthroplasty. J Orthop Res 2020; 38:510-522. [PMID: 31595550 DOI: 10.1002/jor.24488] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 09/17/2019] [Indexed: 02/04/2023]
Abstract
Complex radial head fracture and elbow instability can be treated with radial head arthroplasty. Good clinical results have been described after this surgical treatment. However, the revision and complication rate reported in the literature is concerning. This might be due to altered kinematics after radial head arthroplasty. Eight human native elbows were examined with dynamic radiostereometric analysis and compared with a radial head arthroplasty. Translations of the radial head in the x-, y-, and z-directions relative to the humerus and the ulna were measured. The radiocapitellar joint pressure was measured using a pressure sensor. The tension within the interosseous membrane was measured using a custom-made strain gauge. After radial head arthroplasty, the radial head was displaced approximately 1.8 mm medially and 1.4 mm distally at the starting point. During unloaded flexion motion the difference in all translations between the native radial head and the radial head arthroplasty was less than 1 mm (95% confidence interval [CI] ± 0.5 mm) (p = 0.001). With loading the difference was less than 1.5 mm (95% CI ± 1.5 mm) (p = 0.001). The mean difference in radiocapitellar joint contact pressure was less than 0.30 MPa (95% CI ± 0.40 MPa) (p = 0.001) during unloaded flexion motion. There were only submillimetre kinematic changes and small changes in joint pressure and interosseous membrane tension after the insertion of a radial head arthroplasty in an experimental setting. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:510-522, 2020.
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Affiliation(s)
- Chalotte K Hemmingsen
- Department of Clinical Medicine, Aarhus University, Groennehaven 25, 8520 Lystrup, Aarhus, Denmark.,Orthopedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Theis M Thillemann
- Department of Orthopedic Surgery, Shoulder and Elbow Section, Aarhus University Hospital, Aarhus, Denmark
| | - Brian Elmengaard
- Department of Orthopedic Surgery, Shoulder and Elbow Section, Aarhus University Hospital, Aarhus, Denmark
| | | | - Emil T Nielsen
- Department of Clinical Medicine, Aarhus University, Groennehaven 25, 8520 Lystrup, Aarhus, Denmark.,Orthopedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopedic Surgery, Hand Section, Aarhus University Hospital, Aarhus, Denmark
| | - Sebastian B Mosegaard
- Department of Clinical Medicine, Aarhus University, Groennehaven 25, 8520 Lystrup, Aarhus, Denmark.,Department of Orthopedic Surgery, Hand Section, Aarhus University Hospital, Aarhus, Denmark
| | | | - Maiken Stilling
- Department of Clinical Medicine, Aarhus University, Groennehaven 25, 8520 Lystrup, Aarhus, Denmark.,Orthopedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopedic Surgery, Hand Section, Aarhus University Hospital, Aarhus, Denmark
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8
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The radial head size in relation to osseous landmarks of the forearm. Surg Radiol Anat 2018; 41:415-421. [DOI: 10.1007/s00276-018-2160-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
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Songy CE, Couch CG, Siegel ER, Kee JR, Ahmadi S. The effect of radial head prosthesis diameter on posterolateral rotatory instability of the elbow. Clin Biomech (Bristol, Avon) 2018; 60:89-94. [PMID: 30336370 DOI: 10.1016/j.clinbiomech.2018.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 09/26/2018] [Accepted: 10/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of this study is to investigate how different diameters of radial head replacement affect posterolateral translation with a valgus and supination force. We hypothesized that there would be less posterolateral rotatory translation with larger implant diameter. METHODS Eleven cadaveric arms were stressed at 30 and 60° of flexion with a consistent supination and valgus stress force under five conditions: native radial head, radial head excision, and with 3 sizes of radial head prosthesis. Displacement of the radial head posteriorly in relation to the capitellum on radiographs was measured. Displacement was expressed as a percentage relative to the average of the maximum and minimum native radial head diameters. FINDINGS The native radial heads had average minimum and maximum diameters of 23.3 mm and 25.2 mm, respectively. The angle of testing did not significantly change translation of the radial head. There was increased posterior translation relative to native head as the radial head sizes decreased from 24 mm to 20 mm and with excision of the radial head. Compared to the native head, the differences in displacement were statistically significant for the 20 mm radial head, but not for the 22 mm or 24 mm replacements. Radial head translation significantly increased after radial head excision. INTERPRETATIONS This cadaveric study illustrates that patients treated with radial head excision and radial head prosthesis with undersized diameters have increased posterior translation with a valgus and supination stress. The larger the radial head prosthesis (closer to native radial head), the more closely it approximated the amount of translation of the native radial head.
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Affiliation(s)
- Chad E Songy
- University of Arkansas of for Medical Sciences, Department of Orthopaedic Surgery, Little Rock, AR, United States
| | - Cory G Couch
- University of Arkansas of for Medical Sciences, Department of Orthopaedic Surgery, Little Rock, AR, United States
| | - Eric R Siegel
- University of Arkansas of for Medical Sciences, Department of Biostatistics, Little Rock, AR, United States
| | - James R Kee
- University of Arkansas of for Medical Sciences, Department of Orthopaedic Surgery, Little Rock, AR, United States.
| | - Shahryar Ahmadi
- University of Arkansas of for Medical Sciences, Department of Orthopaedic Surgery, Little Rock, AR, United States
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10
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Abstract
OBJECTIVE To evaluate the effect of intentional undersizing of prosthetic radial head implant diameters on joint contact pressures. METHODS Eight fresh-frozen cadaveric elbows were aligned in neutral extension and loaded with 100 N using a custom testing apparatus. Radiocapitellar contact pressures were recorded using a Tekscan thin-film pressure sensor. Prosthetic radial head replacement was performed with 2 prostheses: the Anatomic Radial Head and the Evolve Proline Radial Head prostheses. Each design was sized according to the manufacturer's recommendations and then again using 2-mm smaller radial heads. RESULTS Average and peak pressures were significantly higher with the Evolve than the Anatomic prostheses (P < 0.03 and 0.02, respectively). Peak pressures decreased from 4.2 ± 0.5 MPa to 2.9 ± 0.3 MPa for the Anatomic Radial Heads and from 5.6 ± 0.5 MPa to 3.9 ± 0.6 MPa when the Evolve Radial Heads were undersized by 2 mm. The mean pressures of the Anatomic Radial Heads (1.4 ± 0.1 MPa) did not change significantly with undersizing (1.3 ± 0.1 MPa, P = 0.12), whereas the mean pressures of the Evolve Radial Heads (1.6 ± 0.1 MPa) were significantly reduced with undersizing (1.4 ± 0.1 MPa, P < 0.02). CONCLUSION Both mean and peak pressures were initially high for the Evolve Radial Head sized based on the short axis diameter and were improved with further undersizing by 2 mm. Peak, but not mean, contact pressures were improved by undersizing the Anatomic prosthesis based on the long axis diameter. CLINICAL RELEVANCE These findings support the clinical recommendation of some surgeons to undersize the Evolve prosthesis by 2-mm smaller diameter than the current manufacturer's suggestion and give reason to consider doing the same for the Anatomic prosthesis.
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11
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Hwang JT, Kim Y, Bachman DR, Shields MN, Berglund LJ, Fitzsimmons AT, Fitzsimmons JS, O'Driscoll SW. Axial load transmission through the elbow during forearm rotation. J Shoulder Elbow Surg 2018; 27:530-537. [PMID: 29290603 DOI: 10.1016/j.jse.2017.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 10/09/2017] [Accepted: 10/18/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Forearm rotation is closely associated with the axiorotational force transmission through the elbow joint. A technique has been developed to study the transmission of force across the radiocapitellar and ulnotrochlear joints during forearm rotation. METHODS Ten human cadaveric upper limbs were prepared on a custom-designed apparatus that permits the application of extrinsic axial loads across an intact cadaveric elbow joint. A force-sensitive transducer was inserted into the elbow joint of each cadaver. A 160 N axial force was applied to the specimen during cyclic forearm rotation while the force, contact pressure, and contact area through the elbow joint were measured. RESULTS The mean force across the radiocapitellar joint showed no significant difference between pronation and supination (P = .3547). The radiocapitellar joint showed significantly higher contact area (P = .0001) and lower contact pressure (P = .0001) in pronation than in supination. The mean values for contact pressure, area, and force across the ulnotrochlear joint were not significantly different between supination and pronation. CONCLUSION The contact pressure and contact area of the radiocapitellar joint in the cadaveric model changed according to forearm rotation while the force remained constant. The mean contact pressure of the radiocapitellar joint in pronation was significantly lower than that in supination because the force across it did not change significantly and its contact area decreased significantly. These findings may suggest that the pronated elbow can play an important role in protecting the radiocapitellar joint in high-impact activities like delivering punch in martial arts or falling on an outstretched arm.
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Affiliation(s)
- Jung-Taek Hwang
- Department of Orthopedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon, Republic of Korea
| | - Youngbok Kim
- Department of Orthopedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Daniel R Bachman
- Department of Orthopedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Maegan N Shields
- Department of Orthopedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Lawrence J Berglund
- Department of Orthopedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | | | - James S Fitzsimmons
- Department of Orthopedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Shawn W O'Driscoll
- Department of Orthopedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA.
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