We believe that the complication in our patient was multifactorial and was principally caused by the axial forces acting on the metal prosthesis as it articulated with osteopenic bone. The metal prosthesis was probably one of the factors that caused early erosion of the capitellum in this patient. Because the stiffness of metal is greater than that of bone, the radiocapitellar contact area of the metal prosthesis is decreased in comparison with that of the native radial head15. Overstuffing of the radiohumeral joint is another factor that could have caused the erosion. Recent biomechanical studies have shown that lengthening of the radial neck results in an increased transmission of force through the radiocapitellar joint16,17. The radial head prosthesis in our patient was placed forty-four months after the initial resection of the radial head. Leaving a joint unloaded for that length of time has been shown to lead to disuse osteoporosis of the underlying subchondral bone18,19. Postoperatively, we noted progressive erosion of the capitellum. To our knowledge, this complication has not been reported previously.
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
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