LATERAL ULNOHUMERAL JOINT SPACE WIDENING IS NOT DIAGNOSTIC OF RADIAL HEAD ARTHROPLASTY OVERSTUFFING

Abstract

Purpose: Radial head replacement with a prosthesis that is too thick has been reported to be associated with stiffness, pain and capitellar wear. Radiographic widening of the lateral ulnohumeral joint following radial head replacement has been used as a criterion to diagnose overstuffing of the radiocapitellar joint. The purpose of this study was to show that widening of the lateral ulnohumeral joint is a normal anatomic variant and therefore cannot be used conclusively to diagnose radiocapitellar joint overstuffing.

Methods: Fifty normal standardized anteroposterior elbow radiographs from 50 patients with a mean age of 48 years were reviewed to evaluate variations in the joint space between the medial and lateral facets of the ulnohumeral joint. Using computer software at 4x magnification (GE, Fairfield, CT), two lines were drawn perpendicular to the lateral ulnohumeral joint and two lines perpendicular to the medial ulnohumeral joint. The difference in length of these two lines was used to assess how parallel the lateral and medial joint spaces are. The lengths of the two lines were averaged to compare lateral joint space thickness to medial joint space thickness.

Results: The width of the lateral ulnohumeral joint space (3.6mm & #61617; 0.8mm) was greater than the medial ulnohumeral joint space (2.8mm & #61617; 0.5mm) (p< 0.001). The lengths of the two medial joint space perpendicular lines were similar (p> 0.05), indicating the medial joint space is normally parallel. The lengths of the lateral joint space perpendicular lines were greater laterally (p= 0.02), indicating the lateral joint is not normally parallel.

Conclusions: The lateral ulnohumeral joint space is often wider than the medial ulnohumeral joint space on an anteroposteror radiograph of the normal elbow. While the medial ulnohumeral joint space is usually parallel, the lateral ulnohumeral joint space may be non-parallel and wider laterally, therefore, lateral joint space widening is not a reliable indicator of radiocapitellar joint overstuffing. A non-parallel medial ulnohumeral joint space may be suggestive of possible overstuffing of a radial head arthroplasty, however, comparison radiographs of the uninjured elbow is likely the best investigation to consider when overstuffing is suspected.