Anatomic Monopolar Press-fit Radial Head Arthroplasty; High Rate of Loosening at Mid-Term Follow Up.

Introduction: Radial head arthroplasty (RHA) is used for the management of unstable or unreconstructable injuries of the radial head. Our aim was to investigate clinical and radiographic outcomes in patients treated with the Acumed anatomic radial head press-fit system for trauma. Methods: Clinical and radiographic assessment of RHAs undertaken for trauma with minimum 2-year follow-up. Results: 16 consecutive patients, mean age 53 (21-82) and 66 month ± 27 (26-122) clinical follow-up were included. There were marked radiographic changes with 11/16 showing periprosthetic lucent lines and 13/16 showing subcollar osteolysis. Radiographic changes occurred early post-surgery. Stem loosening was associated with larger cantilever quotients (0.47 vs 0.38, p = 0.004). Overall survivability was 81.2%, with 3 RHAs removed. Clinical outcomes for the retained RHAs were acceptable with mean flexion 134°, extension deficit of 10°, pronation of 82°, and supination of 73°. Mean VAS scores were 8.5 ± 14.4, QuickDASH 13.8 ± 18.9, Mayo Elbow Performance Scores were 91.5 ± 12.5 with no poor scores. Conclusion: Mid-term clinical functional outcomes following the Acumed anatomic RHA are acceptable in most cases. However, in view of the extensive periprosthetic lucencies and surgical removal due to loosening, patients should be cautioned when consented for implantation of the prosthesis, especially if a large collar is anticipated.

Distal biceps tendon ruptures - the relation of radiological retraction and chronicity to the ability of tendon reattachment and long-term functional outcomes.

AIMS: To assess whether the degree of radiological retraction and chronicity of distal biceps tendon ruptures are related to the ability to reattach the tendon and long-term functional outcomes. METHODS: Analysis of consecutive patients undergoing surgery for distal biceps tendon ruptures by a single surgeon. Measurements regarding the site and degree of tendon retraction in relation to anatomical landmarks following rupture were correlated with intraoperative findings. Postoperative functional outcomes were assessed in cases with >12 months follow-up. RESULTS: 24 cases of distal biceps tendon ruptures treated surgically were identified. Mean tendon retraction was 6.0 cm (range 1.2-9.5) from the radial tuberosity. 22 cases were reattached successfully. 2 required ligament augmentation/bridging using a synthetic ligament. In 2 cases the tendon could not be reattached due to poor quality of the tendon stump. Ability to reattach the tendon was unrelated to degree of radiological retraction or chronicity of rupture. Degree of retraction was not related to rupture chronicity. All reattachments healed with no re-rupture at follow-up with no substantial motion loss. In 17 cases >12months follow-up the DASH and OES were not related to retraction or chronicity of rupture. CONCLUSIONS: Radiological retraction and chronicity are not related to the ability to reattach distal biceps tendon ruptures or their clinical outcomes, hence should not discourage surgical exploration and attempted reattachment. Substantial tendon retractions can occur acutely and reattachment in considerable flexion did not produce any significant motion loss. Some cases will need augmentation or gap bridging and augmentation devices need to be available at surgery. LEVEL OF EVIDENCE: Level IV Retrospective Study Defined.

A Dual Biomechanical Failure: Exeter Stem and Pubic Rami Insufficiency Fracture, following Hybrid Total Hip Arthroplasty.

Introduction. Incidence of Exeter stem fracture is extremely uncommon. Pubic rami insufficiency fractures following arthroplasty are also rare. To our knowledge no cases of spontaneous stem failure with previous insufficiency fractures have yet been reported. Case Presentation. This report describes a case of spontaneous fracture through a cemented Exeter stem in a 66-year-old patient who had previously undergone a hybrid total hip replacement and was found to have bifocal pubic rami insufficiency fractures. The patient presented 18-year postprimary surgery with spontaneous fracture of the middle third of the cemented femoral stem and adjacent proximal femur. Conclusion. This report demonstrates a unique case of Exeter stem fracture with previous pelvic insufficiency fractures. The case adds to the rare occurrences of Exeter stem failure in the literature and highlights the risk of potential insufficiency fractures in patients undergoing total hip replacement.