Department of Anatomical, Histological, Forensic Medicine, and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy.
Department of Orthopaedics and Traumatology, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy.
Bone Joint J. 2023 Aug 1;105-B(8):905-911. doi: 10.1302/0301-620X.105B8.BJJ-2022-0817.R2.
The aim of this study was to analyze how proximal radial neck resorption (PRNR) starts and progresses radiologically in two types of press-fit radial head arthroplasties (RHAs), and to investigate its clinical relevance.
A total of 97 patients with RHA were analyzed: 56 received a bipolar RHA (Group 1) while 41 received an anatomical implant (Group 2). Radiographs were performed postoperatively and after three, six, nine, and 12 weeks, six, nine, 12, 18, and 24 months, and annually thereafter. PRNR was measured in all radiographs in the four radial neck quadrants. The Mayo Elbow Performance Score (MEPS), the abbreviated version of the Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), and the patient-assessed American Shoulder and Elbow Surgeons score - Elbow (pASES-E) were used for the clinical assessment. Radiological signs of implant loosening were investigated.
The mean follow-up was six years (2 to 14). PRNR started after a mean of 7.5 weeks (SD 2.1) and progressed significantly during the first two years, by the end of which the bone resorption stabilized. PRNR was detected in 81% (n = 45) of patients in Group 1 and 88% (n = 36) in Group 2. The final mean PRNR was 3.0 mm (SD 2.3) in Group 1 and 3.7 mm (SD 2.5) in Group 2. The mean MEPS, QuickDASH, and pASES-E were 95.9 (SD 11.5), 4.4 (SD 9.2), and 94.8 (SD 10.9) in Group 1 and 92.2 (SD 16.2), 9.9 (SD 21.5), and 90.8 (SD 15) in Group 2, respectively. No significant differences were observed between groups in the clinical and radiological outcomes. No correlations were found between PRNR and the clinical results.
PRNR after press-fit RHA is a common radiological finding that develops in the first 24 months before stabilizing definitively. PRNR does not affect the clinical results or implant survival in the mid term.
本研究旨在分析两种压配合式桡骨小头置换（RHA）中近端桡骨颈吸收（PRNR）的起始和进展情况，并探讨其临床相关性。
共分析了 97 例接受 RHA 的患者：56 例接受双极 RHA（组 1），41 例接受解剖型植入物（组 2）。术后及术后 3、6、9、12 周，6、9、12、18 和 24 个月，以及此后每年进行 X 线检查。在四个桡骨颈象限的所有 X 线片中测量 PRNR。采用 Mayo 肘功能评分（MEPS）、上肢功能障碍问卷（QuickDASH）简表和患者评估的美国肩肘外科医生评分 - 肘（pASES-E）进行临床评估。研究了假体松动的放射学征象。
平均随访时间为 6 年（2 至 14 年）。PRNR 平均在 7.5 周（2.1 标准差）后开始出现，并在最初两年内显著进展，此时骨吸收稳定。组 1 中 81%（n=45）的患者和组 2 中 88%（n=36）的患者发现 PRNR。组 1 的最终平均 PRNR 为 3.0 毫米（2.3 标准差），组 2 为 3.7 毫米（2.5 标准差）。组 1 的平均 MEPS、QuickDASH 和 pASES-E 分别为 95.9（11.5 标准差）、4.4（9.2 标准差）和 94.8（10.9 标准差），组 2 分别为 92.2（16.2 标准差）、9.9（21.5 标准差）和 90.8（15 标准差）。两组在临床和影像学结果方面无显著差异。未发现 PRNR 与临床结果之间存在相关性。
压配合式 RHA 后出现的 PRNR 是一种常见的放射学发现，它在稳定前的前 24 个月内发展。PRNR 不会影响中期的临床结果或假体存活率。
