Meyer Heinz-Lothar, Polan Christina, Bernstein Anke, Abel Benedikt, Burggraf Manuel, Dudda Marcel, Kauther Max Daniel
Department for Trauma, Hand and Reconstructive Surgery, University Hospital Essen Germany, Hufelandstraße 55, 45147 Essen, Germany.
G.E.R.N. Laboratory for Tissue Replacement, Regeneration and Neogenesis, University Hospital Freiburg, Engesserstraße 4, 79108 Freiburg, Germany.
Case Rep Orthop. 2020 Aug 10;2020:8840087. doi: 10.1155/2020/8840087. eCollection 2020.
The implantation of a radial head prosthesis can take place as a therapeutic option after radial head fracture. There are various implants for this purpose. Many studies and case reports about silastic radial head prosthesis implantation describe foreign body reactions with accompanying synovitis and poor functional results. A few studies have investigated the reason for the material failure and the accompanying synovitis. The case report presented shows an unusually long durability of an in situ 14-year silastic radial head prosthesis. 14 years after implantation, a previously full-time working and healthy patient presented himself with a dislocation of the silastic radial head prosthesis and atraumatic joint blockage of the right elbow triggered by a negligible movement. The prosthesis was removed surgically. We found a macroscopic foreign body reaction intraoperatively. In a histopathological examination, with hematoxylin and eosin staining (HE) in 40x and 100x magnification, we have seen an aseptic inflammatory response to foreign bodies with activated epithelial cells and multinucleated giant cells with intracytoplasmic foreign material. Due to these problems, the silastic radial head prosthesis is no longer used today. However, there are still patients with the implanted silastic radial head prosthesis, which should therefore be checked regularly. A metal prosthesis also does not seem to be an optimal alternative due to cartilage wear and loss of ROM. The choice of prosthesis material should be selected carefully and patient-specific in radial head prosthetics according of the results presented.
桡骨头假体植入可作为桡骨头骨折后的一种治疗选择。为此有多种植入物。许多关于硅橡胶桡骨头假体植入的研究和病例报告描述了伴有滑膜炎的异物反应及不佳的功能结果。一些研究调查了材料失效及伴随滑膜炎的原因。所呈现的病例报告显示一个原位硅橡胶桡骨头假体具有异常长的耐用性。植入14年后，一名此前全职工作且健康的患者因轻微活动引发了硅橡胶桡骨头假体脱位及右肘关节无创伤性关节阻滞前来就诊。假体通过手术取出。我们在术中发现了宏观的异物反应。在组织病理学检查中，用苏木精和伊红染色（HE）在40倍和100倍放大倍数下，我们看到了对异物的无菌性炎症反应，有活化的上皮细胞和含有胞质内异物的多核巨细胞。由于这些问题，如今不再使用硅橡胶桡骨头假体。然而，仍有患者植入了硅橡胶桡骨头假体，因此应定期进行检查。由于软骨磨损和活动度丧失，金属假体似乎也不是一个最佳选择。根据所呈现的结果，在桡骨头假体置换中，假体材料的选择应谨慎且针对患者个体情况。
