Clinical Relevance of Postoperative Radial Neck Osteolysis After Radial Head Arthroplasty: A Retrospective Radiographic–functional Correlation Study

Introduction: Radial head arthroplasty (RHA) is widely used in the treatment of unreconstructable radial head fractures, particularly in complex elbow injuries. While functional outcomes are generally favorable, postoperative radiographic anomalies—such as radial neck osteolysis, stress shielding, and heterotopic ossifications—are frequently observed. The clinical relevance of these so-called “silent” anomalies remains controversial. Methods: We conducted a retrospective monocentric study at the Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges (CHIV) between 2010 and 2023. Sixteen adult patients undergoing modular press-fit radial head arthroplasty were included. Clinical evaluation at final follow-up included the Mayo Elbow Performance Score (MEPS), QuickDASH, VAS for pain, and range of motion (ROM). Radiographic anomalies were assessed through standardized X-rays and postoperative CT scans, and their correlation with functional outcomes was analyzed. Results: Radial neck osteolysis ≥ 3 mm was the most common anomaly (62.5%) and was significantly associated with lower MEPS scores (ρ = − 0.88, p < 0.001) and higher pain (VAS) scores (ρ = +0.86, p < 0.001). Other anomalies, including stress shielding (31.2%), Delta sign (37.5%), and Brooker grade ≥ II heterotopic ossifications (43.7%), showed trends toward poorer outcomes but without statistical significance. Patients with complex injury patterns (terrible triad, olecranon fractures) had worse MEPS and higher osteolysis rates. These associations should be interpreted cautiously given the limited sample size. Conclusion: Radial neck osteolysis ≥ 3 mm may represent a clinically relevant radiographic finding and appears to be a key marker of reduced function and increased pain following RHA. The cumulative burden of radiographic anomalies may help identify high-risk patients who warrant closer follow-up. This study supports integrating structured radiographic assessment into postoperative surveillance protocols. Level of Evidence: Level IV; retrospective case series