JSES - 2026-08-06 - Journal Article
Outcomes of Implant Removal After Failed Radial Head Arthroplasty:An Average 7-Year Follow-up Study.
Hart CM, Weir TB, O'Driscoll CM, Esper R, Barlow JD, Yuan BJ, Tangtiphaiboontana J, Sanchez-Sotelo J, Morrey ME, O'Driscoll SW
Topics
Key Takeaway
Radial head implant removal without re-implantation yielded subjective improvement in 84% (21/25) of patients at mean 7-year follow-up, with 76% of those with painful loosening reporting resolution of proximal radial-sided forearm pain.
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Summary
This study evaluated outcomes of radial head implant removal without re-implantation in 25 elbows from a single-institution joint registry, with mean follow-up of 7 years. The most common removal indication was painful loosening (68%), and 84% of patients rated their elbow as improved or better on the SOD score postoperatively. Flexion-extension and pronation-supination arcs did not significantly change, though proximal radioulnar impingement and progressive osteoarthritis remained clinically relevant complications.
Key Limitation
The small cohort (n=25) with heterogeneous implant types, failure modes, and index injury patterns precludes any meaningful subgroup analysis to identify which patients benefit most from removal versus revision arthroplasty.
Original Abstract
INTRODUCTION
Failure of radial head implants secondary to loosening, painful capitellar wear and other reasons is not uncommon. When radial head implants fail, the relative indications for implanting a new radial head implant versus implant removal with or without soft-tissue interposition remain unclear. Removal theoretically reduces the risk of radiocapitellar pain, however, little is known about the outcomes following removal of failed radial head replacements. The purpose of this study was to evaluate the outcomes, complications, and rates of proximal radioulnar impingement pain following removal of failed radial head implants.
METHODS
Our institution's Total Joint Registry database was queried to identify all elbows that had undergone removal of a failed radial head arthroplasty without implantation of a new prosthesis. Patients with radiocapitellar or total elbow arthroplasty at the index surgery were excluded. Thirty-seven elbows met inclusion criteria, but 12 were had less than 2 years of follow-up; the remaining 25 elbows form the basis for this study. Demographics, complications, reoperations, pre and postoperative range of motion, development of symptomatic proximal radioulnar impingement, and patient reported outcome measures were collected. The mean age at the time of resection was 50 years (range, 16-75 years). The mean follow-up was 7 years (range, 2-15 years).
RESULTS
The mean time to removal following implantation was 31 months (range, 2-135 months). Compared to how they felt prior to surgery, 21/25 patients gave their elbows an SOD score of "Improved" or better while 4/25 rated their elbows as "Worse". Implants removed included 21 press-fit, 3 loose-fit, and 1 cemented radial head implant. The most common indication for removal was painful loosening (17/25, 68%), followed by head/neck uncoupling (3/25, 12%), overstuffing (2/25, 8%), maltracking (2/25, 8%), and infection (1/25, 4%). All the patients with loose implants (n=17) reported radial-sided proximal forearm pain prior to resection, which was improved at final follow-up in 76% (13/17), unchanged in 6% (1/17), and not recorded in 3 patients. The mean flexion-extension and pronation-supination arcs following resection did not significantly change.
CONCLUSION
Implant removal is a viable treatment strategy for failed radial head arthroplasty with good outcomes at average 7-year follow-up. In our study, 76% of patients with loose painful implants reported improvement in proximal radial-sided forearm pain. However, patients should be counseled about the risk of developing symptomatic proximal radioulnar impingement following implant removal, as well as the occasional progression of osteoarthritis requiring further surgery.
LEVEL OF EVIDENCE
Level IV; Retrospective Case Series; Treatment Study.