EVALUATION OF MODERN PRESS-FIT RADIAL HEAD REPLACEMENT: A TEN-YEAR OBSERVATIONAL COHORT STUDY

Long-term outcomes and reintervention rates of modern press-fit radial head replacement (RHR) remain poorly understood. We evaluated a consecutive 10-year cohort with the primary aim of determining implant survival and the secondary aim of identifying risk factors associated with revision. A retrospective review of a prospectively collected database for radial head and/or neck facture was undertaken from 2015 to 2024. Arthroplasty indications were complex radial head/neck fractures not amenable to fixation with a stable ulnohumeral joint (Cohort A); ‘terrible triad’ injuries (Cohort B); and Monteggia-variant injuries with concomitant olecranon fractures (Cohort C). Demographics, complications, and reoperations were recorded and cross-checked with the national PACS archive. Post-operative radiographs were reviewed for anatomic restoration, joint congruence, long-term osteolysis, and degenerative osteoarthritis at follow-up. Of 193 surgically managed radial head or neck fractures, 173 received RHR (Cohort A: 30 [17.3%]; B: 78 [45.1%]; C: 65 [37.6%]). Median follow-up was 6 months (IQR 3–15); 96.5% received follow-up to at least 6 weeks. Reoperation occurred in 35/173 (20.2%), with 10 (27.8%) requiring further reoperation. Implant-related revision occurred in 29 patients (16.2%): 5 to total elbow replacement, 4 RHR revisions, 21 RHR excisions (1 following revision) – distributed across Cohort A (4/30; 13.3%), B (14/78; 17.9%), and C (11/65; 16.9%). Median time to revision was 14 months (IQR 3.75–19). Other reoperations included washout for infection (2), cubital tunnel release (2), revision collateral ligament repair (1), and MUA (1). In this large consecutive cohort, the cumulative 10-year revision rate following RHR was 16.2%, in keeping with current literature. Revision rates were higher in ‘terrible triad’ and Monteggia cohorts than those with stable ulnohumeral joints. Reoperations followed a bimodal distribution: early for instability or infection, late for stiffness. Ongoing work will correlate radiographic parameters and patient-specific risk factors with complications and PROMs.