OBJECTIVES : Radial head arthroplasty(RHA), is a recommended procedure for comminuted radial head fractures for which reliable reconstruction with stable internal fixation is not possible. The objective of this study was to evaluate radial head removal/revision rate, associated reimbursement, and cost.

METHODS : A retrospective cohort study for IBM and Medicare data, cross-sectional analysis for Premier between 2015Q4- 2020Q2(data used through 2019Q2 to allow for at least a 1-year follow-up) was conducted. Descriptive statistics were performed to describe the baseline demographics and clinical characteristics of the study cohort. Rate of removal/revision was calculated at 30, 60, 90 days and 1 and 2 years. Means, medians, and standard deviations are presented for all continuous outcome variables.

RESULTS : 846 patients with RHA were identified in the IBM commercial database. The average age was 45 years and 60% were female. RHA was predominantly performed in the hospital outpatient department (HOPD)(72%) with a mean reimbursement of $14,712(SD $11, 354). Removals ranged from 0.35% at 30 days to 8.06% at 2 years with a mean reimbursement of $3,135(SD $3,413) in the HOPD. 2,688 patients with RHA were identified in the Medicare database with an average age of 72 years and majority were female(83%).RHA and removals were predominantly performed in the HOPD (84% and 84%)with an average reimbursement of $7,955(SD $3,157) and an average RHA removal reimbursement of $8,545(SD $4,461). Removals ranged from 0% at 30 days to 5.08% at 2 years, respectively. Average RHA cost in the HOPD were $9,737(SD $5,773), while removal was $4,442(SD $4,025).

CONCLUSIONS : Radial head replacement is performed to treat to treat patients who have experienced destabilizing radial head fractures that cannot be repaired. Despite this study finding low revision rates, it is generally known that device survivorship will change over time and highlights the need to further investigate the causes of reoperation.