The load transfer effect of monopolar and bipolar radial head prosthesis designs on capitellar cartilage: A comparative biomechanical cadaver study

Objective: The aim of this study was to determine whether bipolar radial head arthroplasty may transfer less load to the capitellum than monopolar radial head arthroplasty and native radial heads. Methods: Six human elbow joints were obtained from six fresh frozen cadavers (3 males, 3 females; mean age = 78 years, age range = 66-80). None of the elbow joints had a previous osseous injury, a chondral defect, osteoarthritis, or instability. In group 1, load transfer of the native radial head was measured in each specimen under 100 N of compression force using a custom-made load cell at 0 degrees, 30 degrees, 60 degrees, 90 degrees, and 120 degrees flexion of the elbow in supination, neutral rotation, and pronation, respectively. After excision of the radial heads, the same testing protocol was first applied for monopolar radial head arthroplasty (Group 2) and then for bipolar radial head arthroplasty (Group 3). Results: The mean load transfer on the capitellum was significantly higher in each forearm rotation and all angles of the elbow flexion in the arthroplasty groups than the native radial head group. Mean load transfer values of bipolar prostheses were between the values of native radial heads and monopolar prostheses in all positions. Bipolar prostheses showed similar load transfer characteristics compared to those of the native radial head in supination at 60 degrees flexion; in neutral rotation at 0 degrees, 30 degrees, 60 degrees, and 120 degrees flexion; and in pronation at 90 degrees and 120 degrees flexion. Conclusion: The results of this study have revealed that bipolar radial head arthroplasty transfers similar loading as the native radial head on the capitellum in certain forearm positions and at elbow flexion angles. No significant differences could be found between load transfer values of bipolar head design and monopolar head design except in the pronation at full extension.