Long term results after bipolar radial head arthroplasty

Radial head fractures are common injuries, occurring mostly in active young people 85%. Treatment of the more complex radial head fractures (Mason type III and IV), appear to be challenging and remain a subject of controversy. Replacement of the radial head with a metal prosthesis imitates the stabilizing role of the radial head and has been considered as the treatment of choice. However, long-term results are scarce. We report our mid to long-term (mean 9.4 year) clinical and radiographic results after insertion of a Judet Bipolar Radial Head prosthesis. 34 patients were treated with the Judet Bipolar Head prosthesis between 2000 and 2008. In this study, 21 patients were re-examined after a mean period of 113 months (range, 174-84), ie, 9.4 years (range, 14.5-7). Follow-up examinations included both the Mayo Elbow Performance Index (MEPI) and Dis- abilities of the arm, shoulder and hand (DASH) score. Range of motion was measured with a hand goniometer. X-rays were evaluated for peri-articular ossifications, radiolucent lines and signs of proximal erosion, capitellar erosion. Mean Mayo Elbow Performance Index was 88.6 (Range 100-50). According to the MEPI score we had 14 excellent, 1 good, 5 fair results and one poor result. One patient reported severe pain, 3 patients reported moderate pain, one patient reported mild pain and 16 patients reported no pain at all. Difference between pronation-suppination range was noted between primary or secondary indication of the radial head, no other significant differences were found. Mean DASH score was 23.1 degrees (Range 0-63) without difference between primary and secondary indication. Mean flexion was 121.8 degrees (Range : 110-140), mean extension deficit was 24.8 degrees (Range 15-40), mean pronation was 62.4 degrees (Range : 50-80) and suppination 58.8 (Range : 45-80). Ten patients showed signs of ulnohumeral joint degenerative arthritis. One patient developed symptomatic ulna plus. One patient showed radiolucent lines surrounding the prosthesis with proximal bone erosion. There were no reports of dislocations of the prosthesis. One case of radiological signs of overlenghtening was noted. Mainly good clinical results are achieved with the Judet bipolar radial head implant. Functional results after long term follow-up are, however less optimistic then the excellent results achieved after short- to mid-term follow-up. No clear link between radiological signs and functional results can be found.