Advertisement

Ulnohumeral joint static cartilage compression is affected by radial head implant size

      Highlights

      • Ulnohumeral joint cartilage relaxation contact force can be measured.
      • Ulnohumeral contact force increases with elbow supination and flexion.
      • Radial head arthroplasty overstuffing increases ulnohumeral contact force.
      • Ulnohumeral contact force can be measured without destroying static joint stabilizers.

      Abstract

      Introduction

      Radiocapitellar joint arthroplasty is a commonly performed procedure, which often leads to early failure or instability. Few studies assess the effect of radiocapitellar joint arthroplasty on the ulnohumeral joint. We hypothesized that static forces of contact (compressing cartilage, or cartilage relaxation contact force) would reveal the effect of varying radial head implant size and elbow position on the ulnohumeral joint.

      Methods

      A minimally–invasive method of measuring cartilage relaxation contact force was utilized in 10 fresh-frozen human cadaveric specimens that did not require significant dissection or intraarticular sensor placement. Specimens were rigidly fixed in various positions of elbow flexion and forearm pronosupination with increasing radial head implant lengths. Uniaxial distracting forces were applied and displacement was repeatedly measured with resultant best-fit polynomial curves to determine inflections corresponding to the force required to overcome static cartilage relaxation as in previous work.

      Findings

      Baseline mean (intra-cadaver) cartilage relaxation contact force was 11.8 N (standard error of the mean = 0.3) at 90° of elbow flexion and neutral rotation. There was little variation within specimens (Intraclass correlation coefficient > 0.94). Cartilage relaxation contact force increased at the ulnohumeral joint with radial head implant overstuffing (> 4 mm, P < 0.05) and elbow flexion (120°, P < 0.001). Pronosupination altered cartilage relaxation contact force in an implant-length independent manner (P < 0.05).

      Interpretation

      Radiocapitellar joint arthroplasty implant length and elbow joint position independently contribute to increased cartilage relaxation contact force at the ulnohumeral joint. This further supports attempts at anatomic reconstruction of the radiocapitellar joint to prevent pathologic ulnohumeral joint loading.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Biomechanics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ahmad C.S.
        • Park M.C.
        • Elattrache N.S.
        Elbow medial ulnar collateral ligament insufficiency alters posteromedial olecranon contact.
        Am. J. Sports Med. 2004; 32: 1607-1612https://doi.org/10.1177/0363546503263149
        • Anand P.
        • Parks B.G.
        • Hassan S.E.
        • Osbahr D.C.
        Impact of ulnar collateral ligament tear on posteromedial elbow biomechanics.
        Orthopedics. 2015; 38: e547-e551https://doi.org/10.3928/01477447-20150701-50
        • Bachman D.R.
        • Thaveepunsan S.
        • Park S.
        • Fitzsimmons J.S.
        • An K.N.
        • O’Driscoll S.W.
        The effect of prosthetic radial head geometry on the distribution and magnitude of radiocapitellar joint contact pressures.
        J. Hand Surg. 2015; 40: 281-288https://doi.org/10.1016/j.jhsa.2014.11.005
        • Beingessner D.M.
        • Dunning C.E.
        • Gordon K.D.
        • Johnson J.A.
        • King G.J.
        The effect of radial head excision and arthroplasty on elbow kinematics and stability.
        J. Bone Joint Surg. Am. 2004; 86-A: 1730-1739https://doi.org/10.2106/00004623-200408000-00018
        • Canham C.D.
        • Schreck M.J.
        • Maqsoodi N.
        • Doolittle M.
        • Olles M.
        • Elfar J.C.
        A nondestructive, reproducible method of measuring joint reaction force at the distal radioulnar joint.
        J. Hand. Surg. [Am.]. 2015; 40 (1138 44)https://doi.org/10.1016/j.jhsa.2015.03.005
        • Canham C.D.
        • Schreck M.J.
        • Maqsoodi N.
        • Messing S.
        • Olles M.
        • Elfar J.C.
        Distal Radioulnar joint reaction force following ulnar shortening: diaphyseal osteotomy versus wafer resection.
        J. Hand. Surg. [Am.]. 2015; 40: 2206-2212https://doi.org/10.1016/j.jhsa.2015.07.036
        • Chen C.T.
        • Bhargava M.
        • Lin P.M.
        • Torzilli P.A.
        Time, stress, and location dependent chondrocyte death and collagen damage in cyclically loaded articular cartilage.
        J. Orthop. Res. 2003; 21: 888-898https://doi.org/10.1016/S0736-0266(03)00050-0
        • Fischer K.J.
        • Manson T.T.
        • Pfaeffle H.J.
        • Tomaino M.M.
        • Woo S.L.
        A method for measuring joint kinematics designed for accurate registration of kinematic data to models constructed from CT data.
        J. Biomech. 2001; 34: 377-383https://doi.org/10.1016/S0021-9290(00)00195-0
        • Frank S.G.
        • Grewal R.
        • Johnson J.
        • Faber K.J.
        • King G.J.
        • Athwal G.S.
        Determination of correct implant size in radial head arthroplasty to avoid overlengthening.
        J. Bone Joint Surg. Am. 2009; 91: 1738-1746https://doi.org/10.2106/JBJS.H.01161
        • Habermeyer P.
        • Schuller U.
        • Wiedemann E.
        The intra-articular pressure of the shoulder: an experimental study on the role of the glenoid labrum in stabilizing the joint.
        Arthrosc. 1992; 8: 166-172
        • Ito H.
        • Song Y.
        • Lindsey D.P.
        • Safran M.R.
        • Giori N.J.
        The proximal hip joint capsule and the zona orbicularis contribute to hip joint stability in distraction.
        J. Orthop. Res. 2009; 27: 989-995https://doi.org/10.1002/jor.20852
        • Kaplan E.B.
        Surgical approach to the proximal end of the radius and its use in fractures of the head and neck of the radius.
        J. Bone Joint Surg. Am. 1941; 23: 86-92
        • Kelly M.
        • Vasconcellos D.
        • Osman W.S.
        • Noorullah M.
        • Fowler X.
        • Elfar J.C.
        • Olles M.W.
        • Flemister A.S.
        • Ketz J.P.
        • Oh I.
        Alterations in tibiotalar joint reaction force following syndesmotic injury are restored with static syndesmotic fixation.
        Clin. Biomech. 2019;
        • Kelly M.
        • Vasconecellos D.
        • Osman W.S.
        • Masqoodi N.
        • Fowler X.
        • Elfar J.C.
        • Olles M.W.
        • Flemister A.S.
        • Ketz J.P.
        • Oh I.
        Alterations in tibiotalar joint reaction force following syndesmotic injury are restored with static syndesmotic fixation.
        Clin. Biomech. 2021; https://doi.org/10.1016/j.clinbiomech.2019.07.013
        • Lanting B.A.
        • Ferreira L.M.
        • Johnson J.A.
        • King G.J.
        • Athwal G.S.
        The effect of radial head implant length on radiocapitellar articular properties and load transfer within the forearm.
        J. Orthop. Trauma. 2014; 28: 348-353https://doi.org/10.1097/BOT.0000000000000009
        • Lu L.
        • Kaufman K.
        • Yaszemski
        M. Biomechanics.
        in: Einhorn T.A. O’Keefe R.J. Buckwalter J.A. Orthopaedic Basic Science: Foundations of Clinical Practice. American Academy of Orthopaedic Surgeons, Rosemont, IL2007
        • Moed B.R.
        • Ede D.E.
        • Brown T.D.
        Fractures of the olecranon: an in vitro study of elbow joint stresses after tension-band wire fixation versus proximal fracture fragment excision.
        J. Trauma. 2002; 53: 1088-1093https://doi.org/10.1097/01.TA.0000033766.65011.D5
        • Nepple J.J.
        • Philippon M.J.
        • Campbell K.J.
        • Dornan G.J.
        • Jansson K.S.
        • LaPrade R.F.
        • et al.
        The hip fluid seal--part II: the effect of an acetabular labral tear, repair, resection, and reconstruction on hip stability to distraction.
        Knee Surg. Sports Traumatol. Arthrosc. 2014; 22: 730-736https://doi.org/10.1007/s00167-014-2875-y
        • Osbahr D.C.
        • Dines J.S.
        • Breazeale N.M.
        • Deng X.H.
        • Altchek D.W.
        Ulnohumeral chondral and ligamentous overload: biomechanical correlation for posteromedial chondromalacia of the elbow in throwing athletes.
        Am. J. Sports Med. 2010; 38: 2535-2541https://doi.org/10.1177/0363546510376231
        • Pomianowski S.
        • O’Driscoll S.W.
        • Neale P.G.
        • Park M.J.
        • Morrey B.F.
        • An K.N.
        The effect of forearm rotation on laxity and stability of the elbow.
        Clin. Biomech. 2001; 16: 401-407https://doi.org/10.1016/S0268-0033(01)00021-3
      1. Pressure Measurement Film - Prescale. https://www.pressuremetrics.com/sites/default/files/Overview.pdf. In; 2016.

        • Ring D.
        • Quintero J.
        • Jupiter J.B.
        Open reduction and internal fixation of fractures of the radial head.
        J. Bone Joint Surg. Am. 2002; 84-A: 1811-1815https://doi.org/10.2106/00004623-200210000-00011
        • Safran M.R.
        • McGarry M.H.
        • Shin S.
        • Han S.
        • Lee T.Q.
        Effects of elbow flexion and forearm rotation on valgus laxity of the elbow.
        J. Bone Joint Surg. Am. 2005; 87: 2065-2074https://doi.org/10.2106/JBJS.D.02045
        • Sahu D.
        • Holmes D.M.
        • Fitzsimmons J.S.
        • Thoreson A.R.
        • Berglund L.J.
        • An K.N.
        • et al.
        Influence of radial head prosthetic design on radiocapitellar joint contact mechanics.
        J. Shoulder Elb. Surg. 2014; 23: 456-462https://doi.org/10.1016/j.jse.2013.11.028
        • Schaffer J.C.
        • Vasconcellos D.
        • Kelly M.
        • Kaplan N.B.
        • Noorullah M.
        • Olles M.
        • Elfar J.C.
        • Giordano B.D.
        The effect of arthroscopic capsulotomy and repair on hip joint contact forces using a non-destructive extra-articular method.
        J. Hip Preserv. Surg. 2019; https://doi.org/10.1093/jhps/hnz032
        • Seiber K.
        • Gupta R.
        • McGarry M.H.
        • Safran M.R.
        • Lee T.Q.
        The role of the elbow musculature, forearm rotation, and elbow flexion in elbow stability: an in vitro study.
        J. Shoulder Elb. Surg. 2009; 18: 260-268https://doi.org/10.1016/j.jse.2008.08.004
        • Shore B.J.
        • Mozzon J.B.
        • MacDermid J.C.
        • Faber K.J.
        • King G.J.
        Chronic posttraumatic elbow disorders treated with metallic radial head arthroplasty.
        J. Bone Joint Surg. Am. 2008; 90: 271-280https://doi.org/10.2106/JBJS.F.01535
      2. Tekscan - Pressure Mapping, Force Measurement and Tactile Sensors. https://www.tekscan.com/products-solutions/pressure-mapping-sensors/4000. In; 2016.

        • Van Glabbeek F.
        • Van Riet R.P.
        • Baumfeld J.A.
        • Neale P.G.
        • O’Driscoll S.W.
        • Morrey B.F.
        • et al.
        Detrimental effects of overstuffing or understuffing with a radial head replacement in the medial collateral-ligament deficient elbow.
        J. Bone Joint Surg. Am. 2004; 86-A: 2629-2635
        • Van Glabbeek F.
        • van Riet R.P.
        • Baumfeld J.A.
        • Neale P.G.
        • O’Driscoll S.W.
        • Morrey B.F.
        • et al.
        The kinematic importance of radial neck length in radial head replacement.
        Méd. Eng. Phys. 2005; 27: 336-342https://doi.org/10.1016/j.medengphy.2004.04.011
        • Van Riet R.P.
        • Van Glabbeek F.
        • Baumfeld J.A.
        • Neale P.G.
        • Morrey B.F.
        • O’Driscoll S.W.
        • et al.
        The effect of the orientation of the radial head on the kinematics of the ulnohumeral joint and force transmission through the radiocapitellar joint.
        Clin. Biomech. 2006; 21: 554-559https://doi.org/10.1016/j.clinbiomech.2006.01.006
        • Yang L.
        • Cai G.
        • Coulton L.
        • Saleh M.
        Knee joint reaction force during tibial diaphyseal lengthening: a study on a rabbit model.
        J. Biomech. 2004; 37: 1053-1059https://doi.org/10.1016/j.jbiomech.2003.11.02