Arthroplasty of radial head using cementless modular bipolar endoprosthesis with metal-on-metal bearings

I.V. Boiko, V.B. Makarov, D.E. Shcherbakov, I.І. Zherdev, А.N. Domanskii, G.O. Lazarenko

Abstract


Background. The authors of the article show the features of the surgical technique of implantation of the developed modular cementless bipolar endoprosthesis of radial head with metal-on-metal bearings, which was applied in the period from 2014 to 2017. Materials and me-thods. The developed cementless modular bipolar endoprosthesis of radial head with metal-on-metal bearings (material — medical stainless steel) was used in 14 patients, the mean age of them was 56 years (from 43 to 72 years). The average observation period was 18 months (from 6 to 24 months). Indications for radial head arthroplasty in all patients were multifragmental fractures and dislocation fractures type III–IV by Mason-Hotchkiss. The treatment outcome was evaluated by the Mayo Elbow Performance Score. Results. In case of Mason-Hotchkiss fractures type III, three basic methods of surgical treatment are used — resection of radial head, open reposition and internal osteosynthesis, radial head replacement. The resection of radial bone in case of stable elbow joint, as a rule, can always produce positive results in most patients without any additional violations in the function of the elbow joint. If other structures stabilizing elbow joint are damaged, the isolated resection of radial head always leads to complications such as progressive valgus instability of the elbow joint, radial bone shortening with an increase in the severity of the pain syndrome, both in the area of the hand and elbow joint; the risk of repeated forearm subluxation posteriorly is not excluded as well. The use of the developed modular endoprosthesis of radial head has allowed achieving the recovery of the elbow joint stability, the restoration of the rotational movements of the forearm with the preservation of the functional capacity of flexion-extention movement, as well as the restoration of radial bone length in all patients. According to the assessment system, the Mayo Elbow Performance Score was 88.5 points. Conclusions. Developed modular bipolar endoprosthesis of radial head made it possible to obtain positive results in all patients within 2 years after the surgery. A differentiated approach to the choice of surgical access with various da-mages to radial head, early mobilization of movements in the elbow joint and the restoration of the capsular-ligament apparatus of the elbow joint are determining factors for the achievement of positive clinical and functional results of radial head arthroplasty using developed modular bipolar endoprosthesis of radial head.


Keywords


surgical technique of radial head arthroplasty; bipolar cementless endoprosthesis of radial head; radial head fracture

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DOI: https://doi.org/10.22141/1608-1706.1.19.2018.126669

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