Comparison of short-term outcomes in patients undergoing elective total elbow arthroplasty versus total elbow arthroplasty for fracture

Abstract

BackgroundTotal Elbow Arthroplasty (TEA) has demonstrated promising functional outcomes for the treatment of complex distal humerus fractures. In many other joints, arthroplasty for trauma is associated with increased risks for acute postoperative complications. The purpose of this investigation is to identify the in-hospital and 30-day postoperative complications for TEA performed because of distal humerus fracture vs. arthritis, and to determine whether acute fracture is associated with differences in complications after TEA. MethodsThe American College of Surgeons National Surgical Quality Improvement Program was used to identify patients who underwent TEA from 2006 to 2018. Patients who were diagnosed with distal humerus fractures were identified and compared with patients without acute fracture. Patients without fracture were further divided into those undergoing TEA for Rheumatoid Arthritis (RA) vs. osteoarthritis (OA). Demographic data, length of hospital stay, readmission rate, reoperation rate, and postoperative complications within 30 days were analyzed by univariate analysis. Multivariable logistic regression was used to isolate the effect of acute fracture on postoperative complications and readmission. ResultsSix hundred fourty-six patients underwent TEA, and 149 (23.1%) had undergone TEA for distal humerus fracture. Patients undergoing TEA for fracture had an overall adverse event rate of 13.42% compared to a complication rate of 12.47% in patients undergoing primary elective TEA (P = .76). On univariate analysis, patients who underwent TEA for fracture were not significantly more likely to require reoperation within 30 days (1.34% vs. 4.63% for RA and 4.11% for OA, P = .24) or require readmission within 30 days (5.37% vs. 4.63% for RA and 4.88% for OA, P = .52). Multivariable logistic analysis found that TEA for fracture was not independently associated with readmission, reoperation, major complications, or minor complications. Increasing age is associated with increased risk of minor complications. Female gender is associated with decreased risk of major complication, and higher ASA classification was associated with increased odds of readmission. ConclusionsAcute fracture is not an independent risk factors for major complications, reoperation, or readmissions in patients undergoing TEA.Level of Evidence Level III; Retrospective Case-Control Study.