title: Radial Head Prosthesis Removal: a Retrospective Case Series of 14 Patients.
abstract: BACKGROUND
  The purpose of this study was to report the preoperative complaints and postoperative outcome of patients after removal of the radial head prosthesis.
  
  
  METHODS
  This is a retrospective review of 14 adult patients (6 females and 8 males) from 2007 to 2011, who underwent radial head prosthesis removal by three surgeons. The average time between implantation and removal was 23 months (range from 2 weeks to 12 years, median 12 months).
  
  
  RESULTS
  The leading reported complaints before removal were restricted mobility of the elbow (active range of motion of less than 100 degrees) in 6, pain in 3, and pain together with restricted mobility in 4 patients. The objective findings before removal were restricted mobility of the elbow in 10 (71%), capitellar cartilage wear, loose implants, and heterotopic ossification each in 8 (57%), subluxation of the radio-capitellar joint or malpositioning of the stem in 5 (36%), and chronic infection in 2 (14%) patients. All patients with pain had wear of the capitellar cartilage on radiographs. The ulnar nerve was decompressed in four patients at the time of removal. Four patients underwent a subsequent operation for postoperative ulnar nerve symptoms 5 to 21 months after removal. Four patients were still complaining about persistent pain at the last follow-up visit. Except two patients, the total range of motion improved with a mean of 34 degrees (range 5 to 70) after a mean follow-up of 11 months.
  
  
  CONCLUSIONS
  Removal of radial head prosthesis improved function and lessened pain in our case series. The reoperation rate was yet nearly 30% due to ulnar neuritis. Selective ulnar nerve decompression at the time of removal must be evaluated, especially in patients with expected large gain in range of motion after removal.
authors.affiliation: Valentin Neuhaus MD Dimitrios C. Christoforou MD Jesse B. Jupiter MD David C. Ring MD, PhD Chaitanya S. Mudgal MD Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Suite 2100, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: Valentin
authors.initials: V
authors.lastname: Neuhaus
authors.affiliation: Valentin Neuhaus MD Dimitrios C. Christoforou MD Jesse B. Jupiter MD David C. Ring MD, PhD Chaitanya S. Mudgal MD Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Suite 2100, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: Dimitrios C
authors.initials: DC
authors.lastname: Christoforou
authors.affiliation: Valentin Neuhaus MD Dimitrios C. Christoforou MD Jesse B. Jupiter MD David C. Ring MD, PhD Chaitanya S. Mudgal MD Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Suite 2100, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: Amir Reza
authors.initials: AR
authors.lastname: Kachooei
authors.affiliation: Valentin Neuhaus MD Dimitrios C. Christoforou MD Jesse B. Jupiter MD David C. Ring MD, PhD Chaitanya S. Mudgal MD Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Suite 2100, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: Jesse B
authors.initials: JB
authors.lastname: Jupiter
authors.affiliation: Valentin Neuhaus MD Dimitrios C. Christoforou MD Jesse B. Jupiter MD David C. Ring MD, PhD Chaitanya S. Mudgal MD Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Suite 2100, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Ring
authors.affiliation: Valentin Neuhaus MD Dimitrios C. Christoforou MD Jesse B. Jupiter MD David C. Ring MD, PhD Chaitanya S. Mudgal MD Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Suite 2100, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: Chaitanya S
authors.initials: CS
authors.lastname: Mudgal
keywords: Prosthesis; Radial head; Radial head fracture; Removal