The effect of the orientation of the radial head on the kinematics of the ulnohumeral joint and force transmission through the radiocapitellar joint

Background. The treatment of radial head fractures that are not amenable to an open reduction and internal fixation, remains to be a difficult issue. A potential problem with prosthetic replacement of the radial head is the shape of current radial head prostheses. The purpose of this study was to determine the effect of the shape of the radial head on kinematics and load transfer of the elbow. Methods. Kinematics of the elbow and radiocapitellar force transmission were measured in 6 fresh frozen upper extremities. The effect of radial head shape was tested by rotating the head 90°, with a custom-made 'native' radial head prosthesis. 3-D spatial orientation of the ulna showed an average difference in ulnohumeral laxity, between the nominal and 90° conditions, of 0.1° throughout the arc of motion with neutral forearm rotation (maximum: 2°). Findings. We found an average difference in ulnar axial rotation, of 0.1° (maximum: 1.9°). No differences showed statistical significance. Radiohumeral joint force was measured and maximally showed a 32 times increase of force in the altered shape conditions. Interpretation. Our results show that the kinematics of the elbow was not affected by altering the shape of the radial head, but it did adversely affect the forces in the radiohumeral joint. This could possibly generate degenerative changes in the elbow.