Zeltser David W, Royse Kathryn E, Prentice Heather A, Reyes Chelsea, Paxton Elizabeth W, Navarro Ronald A, Foroohar Abtin
Department of Orthopedic Surgery, Washington Permanente Medical Group, Bellevue, WA, USA.
Department of Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego, CA, USA.
J Shoulder Elbow Surg. 2025 Feb;34(2):516-524. doi: 10.1016/j.jse.2024.07.050. Epub 2024 Sep 25.
Radial head arthroplasty (RHA) is performed with increasing frequency for reconstruction of comminuted radial head fractures. Implants can be categorized by stem design, either loose fit or press fit. Currently, the RHA literature does not suggest one implant type is superior to another based on revision and reoperation rates, although most RHA outcome studies have small numbers of patients with few events to detect a difference. This study evaluated the association between stem design and risk of revision and reoperation after RHA.
A total of 1575 patients aged ≥18 years who underwent primary RHA within a US-based health care system were identified (2009-2021). Revision following the index RHA was the primary outcome of interest; ipsilateral reoperation was a secondary outcome. Multivariable Cox proportional hazard regression was used to evaluate the risk of outcomes by loose vs. press fit with the adjustment for race and ethnicity, American Society of Anesthesiologists classification, region, surgeon RHA volume, and simultaneous ipsilateral extremity procedures.
Of the 1575 RHAs, 681 (43.2%) received a loose-fit stem. The cumulative revision probability was 2.6% for loose fit and 3.5% for press fit. In adjusted analysis, we did not observe a difference in risk of revision (hazard ratio [HR] = 0.78, 95% confidence interval [CI] = 0.41-1.46) or reoperation (HR = 0.73, 95% CI = 0.43-1.25). Additionally, there were no observed differences in risk of revision (HR = 0.62, 95% CI = 0.28-1.38) or reoperation (HR = 0.90, 95% CI = 0.48-1.71) in the patient subgroup who underwent additional procedures in the same extremity at the time of RHA.
In this large multicenter cohort of 1575 primary RHAs, we did not observe a difference in risk of revision or reoperation following RHA based on stem design. The choice between using an implant with a loose- or press-fit stem may be based more on surgeon familiarity, implant availability, cost, and ease of use.
桡骨头置换术（RHA）用于粉碎性桡骨头骨折重建的频率日益增加。植入物可根据柄部设计分类，分为松质骨配合型或压配型。目前，RHA的文献并未表明基于翻修率和再次手术率，一种植入物类型优于另一种，尽管大多数RHA结局研究的患者数量较少，事件数量也很少，难以检测出差异。本研究评估了柄部设计与RHA后翻修和再次手术风险之间的关联。
在美国的一个医疗保健系统中，共确定了1575例年龄≥18岁且接受初次RHA的患者（2009年至2021年）。初次RHA后的翻修是主要关注的结局；同侧再次手术是次要结局。多变量Cox比例风险回归用于评估松质骨配合型与压配型的结局风险，并对种族和民族、美国麻醉医师协会分级、地区、外科医生的RHA手术量以及同侧肢体同期手术进行了调整。
在1575例RHA中，681例（43.2%）接受了松质骨配合型柄部。松质骨配合型的累积翻修概率为2.6%，压配型为3.5%。在调整分析中，我们未观察到翻修风险（风险比[HR]=0.78，95%置信区间[CI]=0.41-1.46）或再次手术风险（HR=0.73，95%CI=0.43-1.25）存在差异。此外，在RHA时同一肢体接受了额外手术的患者亚组中，翻修风险（HR=0.62，CI=）或再次手术风险（HR=0.90，95%CI=0.48-1.71）也未观察到差异。
在这个包含1575例初次RHA的大型多中心队列中，我们未观察到基于柄部设计的RHA后翻修或再次手术风险存在差异。选择使用松质骨配合型或压配型柄部的植入物可能更多地基于外科医生的熟悉程度、植入物的可获得性、成本和易用性。
