In Radial Head Arthroplasty, Does Implant Fixation Type Affect Functional Outcomes? A Systematic Review and Meta-analysis
Kofi D Agyeman, MD; Ian Watkins, BA; Dhanur Damodar, MD; Seth D Dodds, MD
University of Miami, Miami, FL
Radial head arthroplasty is a popular method of managing radial head fractures that are unable to be repaired. While traditional implants were loosely placed, smooth stemmed implants that functioned more as spacers, modern designs have introduced press fit, tapered implants that articulate at the capitellum with true congruity. Cemented implants also employ strong fixation to ensure stability of the implant. Currently, there is debate as to which fixation method results in better functional outcomes.
Materials & Methods
63 articles were identified via 3 databases. 7 articles contained duplicate patient populations and were excluded, while 10 non-English or insufficient text articles were excluded. 3 others did not contain sufficient data. The remaining 43 articles were qualitatively reviewed in accordance with PRISMA guidelines. Preliminary quantitative analysis was then performed, while differential meta-analysis is currently underway.
46 populations were identified in 43 inclusive publications. 1331 unduplicated patients were identified: 751 fixed and 580 unfixed. Mean follow-up in months was 40.8 and 37.4 respectively.Average MEPS functional scores were 85.69 and 87.28 respectively. Average degrees of final ranges of motion were, respectively: flexion/extension arcs of 119.3 and 116.0; pronation of 73.2 and 73.5; and supination of 71.5 and 70.0. Complications rates were 28.98% for fixed patients and 17.80% for unfixed patients, while revision rates were 8.32% and 3.56% respectively.
In radial head arthroplasty, implant fixation type does not appear toaffect functional outcomes. However,rigidly fixing the implant may increase the risks of complications and revision surgery.
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