Interposition elbow arthroplasty clinical and functional outcomes: A Systematic review

Abstract

Objective: Painful and stiff elbow, especially in young patients, results in severe impairment in daily activities. Persistent pain and stiffness despite conservative treatment indicate surgical arthroplasty. Total elbow arthroplasty (TEA) is relatively contraindicated in young patients with high activity due to the risk of early prosthetic loosening. Furthermore, TEA is relatively expensive and inaccessible, especially in developing countries. Interposition elbow arthroplasty has been an alternative to TEA with the possibility of further reconstruction and lower cost. This study aimed to conduct a systematic review of literature evaluating clinical and functional outcomes of various interposition elbow arthroplasty. Methods: We conducted a systematic review to obtain outcomes of interposition elbow arthroplasty. Literature searching was conducted in PubMed, Cochrane Library, and ScienceDirect. We included clinical studies, case series, or case reports related to interposition elbow arthroplasty. Relevant studies were critically appraised by Oxford Central for Evidence-Based Medicine (CEBM) critical appraisal tool. Relevant data including functional outcome, pain, and range of motion (ROM) was then pooled and analyzed. Results: We selected 15 relevant studies including nine retrospective clinical studies, three case series, and three case reports. All studies showed significant improvement of range of motion (ROM) and Mayo Elbow Performance Score (MEPS). The pain score of MEPS also showed improvement in several studies. Pooled study analysis showed an overall Z score of 20.4 (p<0,001) for ROM with a mean difference of 55.5°, Z score of 16.28 (p<0,001) for MEPS, and 9.30 (p<0,001) for MEPS pain score. Conclusion: Interposition elbow arthroplasty significantly improved clinical and functional outcomes postoperatively in patients with stiff and painful elbows.