Is a Silastic Radial Head Still a Reasonable Option?

Author(s): Maghen Y, Andrew Leo, Hsu J, Hausman M

Source: Clin Orthop 469 1061-70, 2011.

Summary:
​This is a retrospective review of 23 patients who sustained injuries resulting in an unreconstructable radial head that were treated with silastic radial head arthroplasty and medial and/or lateral collateral ligament repair, as indicated. The purpose was to revisit the long term success of silastic radial head implants, as these have generally fallen out of favor due to reports of silicone synovitis and inability to load bear, with preference given to metal prostheses. Given the recent concerns with metal implants, including capitellum cartilage wear, loss of motion, and overstuffing, a retrospective look at outcomes of silastic implants may be warranted.
 
At an average of 70 months follow-up on these 23 patients, there were 8 re-operations, but none due to implant failure. Mean motion at last follow up was 11 degrees of extension to 145 degrees of flexion. Supination and pronation measured 80 degrees and 83 degrees, respectively. At last follow up, all elbows were stable with no evidence of dislocation, or instability. No patients developed radiographic or clinical symptoms of silicone synovitis.
 
The study is limited by small sample size and being retrospective in nature. The lack of occurrence of silicone synovitis in this sample group does question the level of concern for this adverse affect.  Silicone has, however, fallen out of favor for the elbow and these implants are not currently manufactured by the original vendor.  With the more recent problems associated with metal radial head implants, perhaps more research into alternative designs or materials is warranted.