Functional outcomes of Radial head arthroplasty in people with complex radial head fractures and associated injuries

Abstract

<p>Radial head arthroplasty (RHAP) is proposed as the treatment of choice of complex radial head fractures not amenable to reconstruction. With advances in the understanding of elbow biomechanics and subsequently implant designs, low morbidity, few complications and good success has been reported with RHAP compared to internal fixation. Much of the success/complication post RHAP has been attributed to the fracture pattern and presence of associated injuries. While these are important parameters to reflect on, however, the outcome of surgery cannot be solely attributed to the methods of dealing with the radial head fracture. Importantly, the outcomes of RHAP are also influenced by patient factors. Hence, the purpose of this thesis was to assess the existing knowledge of functional outcomes post RHAP and explore the role of acute post surgical pain as a predictor of those outcomes.</p> <p>The first manuscript in the thesis systematically examines the current available English literature regarding the functional outcomes of metal RHAP. Studies reviewed revealed significant heterogeneity in the study and patient characteristics. Likewise, the method of reporting fracture classification, clinician and patient reported outcomes are inconsistent. Based on the level 4 evidence studies in the review, we concluded that RHAP provides good to excellent outcomes in short-midterm follow up, with no evidence regarding the superiority of one implant over another.</p> <p>The second manuscript explored the role of acute post surgical pain in development of chronic functional impairment post RHAP using the EVOLVE (Wright Medical Technology, Arlington, Tennessee) implant at 2 years post surgery. A total of 59 adults with complex radial head fractures treated with EVOLVE metal radial head implant were followed for a period of two years. Demographics, American Shoulder and Elbow Surgeon's-Elbow (ASES-e) pain subscale and Disability of Arm, Hand and Shoulder Questionnaire (DASH) data were collected at baseline and two years. Regression analyses revealed that acute post operative pain post RHAP is significantly related to the functional outcome at 2 years post RHAP. An ASES-e pain cut off score of 32/50 predicted the development of chronic functional impairment two years post RHAP.</p> <p>The results of this thesis highlight the need for prospective longitudinal studies, comparative analyses and standardized methods of reporting concerning effectiveness of RHAP. It also emphasizes the significance of quantifying pain levels in the immediate post operative period and classifying the patient in high/low risk groups for developing chronic functional impairment based on the pain level.</p>