The radial head prosthesis are useful for restoring the elbow and forearm stability when the radial head is unreparable in acute and chronic lesions. Little information with small series of patients have been reported in the literature on the bipolar radial head design used in acute and chronic elbow lesions. The propose of the current study is to report the results obtained in large series of the patients treated using the bipolar design for acute and chronic elbow lesions.
Materials and methods.: We performed in our Institution between 2000 to the end of 2009, 95. implants of bipolar radial head prosthesis . 70 consecutive patients were followed up with a minimum of 24 months ,39 implant were used in acute elbow lesions and 31 for chronic post-traumatic lesions. All the surgical procedures were performed using the same bipolar prosthesis. All the patients underwent clinical an radiographic evaluations. The clinical data were collected and analysed using the Mayo elbow performance score and the Dash score and the patient’s satisfactions, The radiographic evaluations were performed in static view (antero-posterior and lateral views) and in dynamic way using the fluoroscopy evaluations . The complications were divided in two groups, involving the prosthesis or the elbow joint to better understand the disadvantage of this prosthesis design.
70 patients (47 males and 23 females, mean age 44.5 years ) were followed up with mean time of 39.1 months According to MEPS , in the acute group we obtained 32 excellent results and 2 goods, one fair, four poor, in chronic group the excellent result were observed in 22 patients, four good, one fair and four poor. According to Dash in the acute lesions we observed at the last follow-up a mean value of 11.6 points (range from 0 to 62.5), in the chronic lesion the mean value was 8.5 points ( range from 0 to 35.3) The complications observed correlated to the implant design were found in 6 patients ( 31.6% of all the complications), 68.4 % of complications were correlated to the joint and not to the implant.
Discussion And Conclusion
From our experience , the bipolar design obtain significant advantage in the treatment chronic elbow lesion in particular if associated to the ulna fracture that involve the less sigmoid notch. The bipolar design can adapt itself to the anatomic variability of the elbow and can compensate the malreduction of the radial sigmoid notch, this consideration was confirmed by our results.