Amir Reza Kachooei1, Femke M A P Claessen2, Samantha M Chase3, Kirsten K J Verheij4, C Niek van Dijk5, David Ring6. 1. Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: akachooei@mgh.harvard.edu. 2. Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: fclaessen@mgh.harvard.edu. 3. Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: smchase@partners.org. 4. Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, Massachusetts, USA. Electronic address: kverheij@mgh.harvard.edu. 5. Department of Orthopaedic Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands. Electronic address: c.n.vandijk@amc.uva.nl. 6. Dell Medical School - The University of Texas at Austin, 1400 Barbara Jordan Blvd. Suite 1.114AC. MC: R1800, Austin, TX 78723, USA. Electronic address: david.ring@austin.utexas.edu.
Abstract
PURPOSE: This study tests the hypothesis that there are no factors associated with removal or revision of a radial head prosthesis. A secondary analysis addressed the time to removal or revision. METHODS: We reviewed the database of two large hospitals from 2000 to 2014 and identified 278 patients that had radial head replacement after an acute fracture or fracture dislocation of the elbow: 19 had removal and 3 had revision of the radial head implant within the study period. Explanatory variables including demographics, the type of injury, prosthesis type, surgeon, medical centre, and associated injuries were evaluated. Survival analysis using Kaplan-Meier curves evaluated time to removal/revision. RESULTS: After adjustment for potential confounders using Cox regression multivariable analysis, hospital was the only factor independently associated with removal or revision (Hazard ratio=2.4, Confidence interval: 1.03-5.8, P value=0.043). The highest proportion of removal/revision was during the first year after implantation and decreased by half each year over the second to fourth years. The most common reason for removal of the prosthesis was to facilitate removal of heterotopic ossification (the majority with proximal radioulnar synostosis) rather than technical error or problems with the prostheses. CONCLUSION: These findings suggest that the decision to remove a radial head prosthesis may depend more on surgeon or hospital preferences than on objective problems with the prosthesis. Until clarified by additional study, removal of a prosthesis should not be considered an objective outcome in research. In addition, patients offered removal of a radial head prosthesis, might get the opinion of more than one surgeon at more than one hospital before deciding whether or not to proceed. LEVEL OF EVIDENCE: Level III Prognostic.
PURPOSE: This study tests the hypothesis that there are no factors associated with removal or revision of a radial head prosthesis. A secondary analysis addressed the time to removal or revision. METHODS: We reviewed the database of two large hospitals from 2000 to 2014 and identified 278 patients that had radial head replacement after an acute fracture or fracture dislocation of the elbow: 19 had removal and 3 had revision of the radial head implant within the study period. Explanatory variables including demographics, the type of injury, prosthesis type, surgeon, medical centre, and associated injuries were evaluated. Survival analysis using Kaplan-Meier curves evaluated time to removal/revision. RESULTS: After adjustment for potential confounders using Cox regression multivariable analysis, hospital was the only factor independently associated with removal or revision (Hazard ratio=2.4, Confidence interval: 1.03-5.8, P value=0.043). The highest proportion of removal/revision was during the first year after implantation and decreased by half each year over the second to fourth years. The most common reason for removal of the prosthesis was to facilitate removal of heterotopic ossification (the majority with proximal radioulnar synostosis) rather than technical error or problems with the prostheses. CONCLUSION: These findings suggest that the decision to remove a radial head prosthesis may depend more on surgeon or hospital preferences than on objective problems with the prosthesis. Until clarified by additional study, removal of a prosthesis should not be considered an objective outcome in research. In addition, patients offered removal of a radial head prosthesis, might get the opinion of more than one surgeon at more than one hospital before deciding whether or not to proceed. LEVEL OF EVIDENCE: Level III Prognostic.
Authors: Pierre Laumonerie; David Ancelin; Nicolas Reina; Meagan E Tibbo; Panagiotis Kerezoudis; Stephanie Delclaux; Nicolas Bonnevialle; Pierre Mansat Journal: Int Orthop Date: 2017-05-12 Impact factor: 3.075
Authors: Pierre Laumonerie; Meagan E Tibbo; Panagiotis Kerezoudis; Marc Olivier Gauci; Nicolas Reina; Nicolas Bonnevialle; Pierre Mansat Journal: Int Orthop Date: 2018-07-30 Impact factor: 3.075
Authors: Pierre Laumonerie; Nicolas Reina; Claudia Gutierrez; Stephanie Delclaux; Meagan E Tibbo; Nicolas Bonnevialle; Pierre Mansat Journal: Int Orthop Date: 2017-09-21 Impact factor: 3.075
Authors: Pierre Laumonerie; Maroun Raad; Meagan E Tibbo; Panagiotis Kerezoudis; Nicolas Bonnevialle; Pierre Mansat Journal: Shoulder Elbow Date: 2019-05-19
Authors: Jetske Viveen; Izaak F Kodde; Andras Heijink; Koen L M Koenraadt; Michel P J van den Bekerom; Denise Eygendaal Journal: EFORT Open Rev Date: 2020-01-28