Radial head arthroplasty: a historical perspective.

There has been lively debate regarding the rationale behind the use of radial head arthroplasty (RHA) for more than 80 years. Currently, its primary indication is for treatment of non-reconstructible RH fractures. The first RH implant, released in 1941, was a ferrul cap used to prevent heterotopic ossification. Biomechanical studies in the 1980s stimulated a revolution in RHA design by promoting modular implants that replicated the native bony anatomy of the elbow. Subsequent data-driven evolution in design led to the creation of a variety of devices that also accommodated for common ligamentous injuries occurring at the time of RH fracture. Despite significant advances in our understanding of complex elbow instability, improvements in implant design have to make RHA the gold standard for treatment of non-reconstructible RH fractures. The challenge in the coming years will be to perform high-level clinical studies in order to obtain consensus regarding the most appropriate treatment for comminuted RH fractures.