Primary vs. secondary total elbow arthroplasty for distal humerus fractures

Abstract

The purpose of this study was to compare functional results and complication rates after primary total elbow arthroplasty (TEA) and TEA after failed reconstruction or nonoperative treatment (secondary TEA) for distal humerus fractures. We hypothesized that clinical and functional results are better for primary TEA with fewer complications. Data of 23 patients (primary TEA, n = 9; secondary TEA, n = 14; mean age, 66 years) were retrospectively reviewed with a mean follow-up of 28 months (range, 6–43 months). The clinical and functional results were evaluated using the arc of motion, Mayo Elbow Performance Score (MEPS), and Disabilities of the Arm, Shoulder and Hand Score (DASH). Complications and revision surgeries were also analyzed. The extension–flexion arc was 111° for primary and 96° for secondary TEA (p = 0.14). Both MEPS (94 vs. 79 points, p = 0.051) and DASH (24 vs. 48 points, p = 0.007) showed favorable results for primary TEA. Pain was described as moderate or severe by 11% of patients after primary TEA and 36% after secondary TEA. The duration of surgery was significantly longer for secondary TEA (91 vs. 150 min, p = 0.002). One patient in the primary group had septic loosening of the prosthesis. In the secondary TEA group, two cases of aseptic loosening were documented. Primary TEA showed favorable functional results over secondary TEA. Notably, subjective evaluation was better in the primary TEA group owing to less pain than in the secondary TEA group. Despite the extended duration of surgery for secondary TEA, the complication rates were comparable. III.