The effect of the radial head and prosthetic radial head replacement on resisting valgus stress at the elbow

Five fresh nonembalmed elbows were tested for resistance to valgus stress in their anatomic state, after radial head resection, and after insertion of Silastic and polymethylmethacrylate (PMMA) radial head replacements. The resistance to valgus stress was found to be reduced an average of 28% after radial head resection. The PMMA and Silastic implants restored valgus stiffness an average of 86% and 78% respectively, as compared to intact elbow values for corresponding flexion angles. Testing in pronation, supination and neutral forearm rotation demonstrated no difference in valgus stiffness. For each elbow, resistance to valgus stress was greatest at full extension and dropped approximately 30% at all other flexion angles as compared to corresponding full extension value. These data support the concept of the radial head as a stabilizer to valgus stress in the in vitro elbow. Further, this data demonstrated the ineffectiveness of current radial head replacement systems in restoring this biomechanical function and suggest that the use of a stiffer implant material may be beneficial in resisting valgus stress. Additional testing is indicated to determine the performance of a stiffer implant at the clinical and biological levels.