Short- and Medium-Term Results of Total Elbow Arthroplasty after Trauma

Abstract

Treatment of distal humerus fractures by open reduction and internal fixation, especially in elderly patients, does not always result in satisfactory outcomes. Previous studies show good outcomes in total joint replacement of these fractures. The objective of this study is to present our experience with primary and secondary implantation of a semiconstrained elbow prosthesis after trauma. In two study centers, between 2003 and 2009, a total of 44 patients (34 women and 10 men) with an average age of 65 years were treated primarily (n = 19) or secondarily (n = 25) by semiconstrained total elbow replacement after distal humerus fractures. Primary treatment referred exclusively to 13C2 and 13C3 fractures according to the AO/ASIF-classification, except for two cases. Indications for secondary elbow arthroplasty were post-traumatic arthrosis (n = 10), non-union of the bone (n = 6), failed osteosynthesis (n = 5), post-traumatic chronic luxation (n = 2) and severe bony defect situation after chronic osteitis (n = 2). In two cases a prostheses exchange for a periprosthetic fracture after fall was performed. Clinical outcome was radiologically controlled and measured by the use of the Mayo Elbow Performance Score (MEPS) and DASH score after a mean follow-up of 38 (13 to 96) months. 33 Patients (75 %) had a follow-up examination clinically and radiologically. Mayo Elbow Performance Score was excellent or good in 27 (82 %) cases with a mean of 87 points (primary group 87 vs. secondary group 86). The average DASH score was 28 points (primary group 24 vs. secondary group 32). The flexion was on average 131° (110 to 145°), the extension deficit 30° (0 to 80°) to neutral position and the range of motion was 100° (40 to 145°) (primary group 102° vs. secondary group 97°). The mean operation time was 141 (100 to 250) minutes (primary group 138 vs. secondary group 144 min.). The length of stay in hospital was on average 15 days. Complications occurred due to ulnar paresthesia (n = 4), deep infection (n = 6), periprosthetic ulna fracture (n = 1), heterotopic ossifications requiring intervention (n = 1), elbow stiffness (n = 1), triceps insufficiency (n = 5) and triceps avulsion (n = 2). Primary elbow joint replacement seems to be a promising alternative for distal humerus fractures without a sufficient reconstruction opportunity, showing encouraging short- and medium-term results in the elderly. Secondary replacement can achieve satisfying results in failed osteosynthesis, non-union of the bone or post-traumatic arthrosis as well. The rate of complications and revisions is high.