Short- to mid-term clinical outcomes and survivorship of the Nexel total elbow arthroplasty in Japanese patients: a single-center retrospective study.

We examined the relationship between the Japanese version of Patient-Rated Elbow Evaluation (PREE-J) and other established subjective and objective outcome measures in Japanese patients with rheumatoid arthritis (RA) who underwent total elbow arthroplasty (TEA). This study involved 46 elbows of 40 RA patients. We collected clinical data 1 year after surgery, including the PREE-J, the Mayo Elbow Performance Score (MEPS), Disability of the Arm, Shoulder, and Hand (DASH), and Hand20. The correlation and responsiveness to PREE-J were evaluated compared with other outcome measures preoperatively and postoperatively. Almost all outcome measures were improved significantly after surgery. Preoperative PREE-J was significantly correlated with preoperative DASH, Hand20, and MEPS. Interestingly, postoperative PREE-J did not correlate with postoperative MEPS. Multiple regression analyses revealed that preoperative grip strength [B = -0.09; 95% confidence interval (95% CI) -0.17 to -0.01, p = 0.03] and preoperative Hand20 (B = 0.31, 95% CI 0.03-0.58, p = 0.03) were significant factors that might influence the postoperative PREE-J. The PREE-J was shown to correlate well with other preoperative outcome measures among the RA patients included in the current study. The postoperative PREE-J after TEA was influenced by the preoperative grip strength and function of the hand.

Heterotopic ossification after total elbow arthroplasty: a systematic review

Modified triceps fascial tongue approach for primary total elbow arthroplasty

Hemiarthroplasty for the treatment of distal humerus fractures: long-term clinical results.

The aims of this study were to validate the outcome of total elbow arthroplasty (TEA) in patients with rheumatoid arthritis (RA), and to identify factors that affect the outcome. We searched PubMed, MEDLINE, Cochrane Reviews, and Embase from between January 2003 and March 2019. The primary aim was to determine the implant failure rate, the mode of failure, and risk factors predisposing to failure. A secondary aim was to identify the overall complication rate, associated risk factors, and clinical performance. A meta-regression analysis was completed to identify the association between each parameter with the outcome. A total of 38 studies including 2,118 TEAs were included in the study. The mean follow-up was 80.9 months (8.2 to 156). The implant failure and complication rates were 16.1% (95% confidence interval (CI) 0.128 to 0.200) and 24.5% (95% CI 0.203 to 0.293), respectively. Aseptic loosening was the most common mode of failure (9.5%; 95% CI 0.071 to 0.124). The mean postoperative ranges of motion (ROMs) were: flexion 131.5° (124.2° to 138.8°), extension 29.3° (26.8° to 31.9°), pronation 74.0° (67.8° to 80.2°), and supination 72.5° (69.5° to 75.5°), and the mean postoperative Mayo Elbow Performance Score (MEPS) was 89.3 (95% CI 86.9 to 91.6). The meta-regression analysis identified that younger patients and implants with an unlinked design correlated with higher failure rates. Younger patients were associated with increased complications, while female patients and an unlinked prosthesis were associated with aseptic loosening. TEA continues to provide satisfactory results for patients with RA. However, it is associated with a substantially higher implant failure and complication rates compared with hip and knee arthroplasties. The patient's age, sex, and whether cemented fixation and unlinked prosthesis were used can influence the outcome. Level of Evidence: Therapeutic Level IV. Cite this article: Bone Joint J 2020;102-B(8):967-980.

Outcome after total elbow arthroplasty: a retrospective study of 167 procedures performed from 1981 to 2008

Transposition of the local extensor fascia for elbow lateral collateral ligament reconstruction: Results in a group of competitive athletes.

Hemiarthroplasty for the treatment of distal humeral fractures: midterm clinical results

This study aimed to evaluate the mid-term clinical outcomes, complications, and survival rates of the unlinked K-NOW (Teijin Nakashima Medical, Japan) total elbow arthroplasty (TEA), focusing on the use of cementless fixation. This retrospective study included 41 elbows in 37 patients who underwent primary TEA using unlinked K-NOW between April 2012 and March 2021, with a minimum follow-up of two years. Surgical approaches included the lateral paraolecranon (LPO) and triceps-off approaches. Clinical evaluations included range of motion (ROM) and Mayo Elbow Performance Score (MEPS). Complications were recorded, and Kaplan-Meier survival analysis was performed, with aseptic loosening and revision surgery as endpoints. The mean patient age was 68.4 years (SD 11.6), and the mean follow-up period was 4.7 years (2.1 to 10.1). The LPO approach was used in 35 elbows (85.4%), and cementless fixation was applied to 41 humeral components (100%) and 35 ulnar components (85.4%). Among patients with ≥ five years of follow-up (n = 16), significant improvements were observed in ROM (extension, from -38° to -19°; flexion, from 107° to 130°; pronation, from 55° to 72°; supination, from 62° to 73°; p < 0.001), and MEPS (from 48 to 93 points; p < 0.001) at five years postoperatively. Complications occurred in six elbows (14.6%): three elbows (7.3%) with aseptic loosening and three elbows (7.3%) with periprosthetic fractures; no postoperative dislocation was observed. Revision surgeries were required in two elbows (4.9%). Kaplan-Meier survival rates were 92.7% (95% CI 84.7 to 100) at five years for loosening, and 97.1% (95% CI 91.4 to 100) at five years for revision. All aseptic loosening occurred within three months postoperatively. The unlinked K-NOW with cementless fixation, mostly using the LPO approach, demonstrated favourable outcomes with improved ROM and MEPS, a low complication rate, and promising survival. In cases with severe osteoporosis or bone-implant instability, cemented fixation or a triceps-off approach may help reduce the risk of early complications.

AB0172 Usefulness of The Japanese Version of The Patient-Rated Elbow Evaluation in Patients with Rheumatoid Arthritis

Results of Total Elbow Arthroplasty in Patients Less Than 50 Years Old

We describe the allograft technique and present its final results of revision total elbow arthroplasty (TEA) using a strut allograft in two cases that revealed prosthetic loosening and severe bone resorption after TEA. Two patients complained of pain and motion limitation, and had difficulty in hair combing and with hygiene. The preoperative Mayo elbow performance scores of both cases were 50 points and 45 points. They were followed up for 24 months and 18 months. There was no pain after surgery and the postoperative Mayo elbow performance scores were all 90 points. Radiographic bone unions were achieved 3 months after the operations and patients were satisfied with the results. The revision of TEA with a supporting allograft is a demanding procedure but can be tried when the elbow joint has badly destructed or has a large cavitary defect.

ObjectiveTo evaluate and compare the outcomes of utilizing patient-specific instrumentation (PSI) technology, which incorporates personalized three-dimensional (3D) preoperative planning and customized 3D printing (3DP) osteotomy guides, against those achieved with traditional instruments in total elbow arthroplasty (TEA).MethodsA retrospective study was conducted to analyze the clinical data of 20 patients diagnosed with elbow arthritis who underwent TEA at the Center for Joint Surgery, The First Hospital Affiliated to Army Medical University, China, between January 2010 and July 2023. Patients were categorized into two groups according to the surgical techniques employed: 9 patients underwent personalized preoperative 3D planning and used customized 3DP osteotomy guides for TEA (3DP group); another 11 patients underwent TEA using traditional instruments and experience-based techniques (traditional group). The intraoperative fluoroscopy frequency, Mayo elbow performance score (MEPS), and Mayo elbow score before and after surgery in both groups were recorded. Additionally, in the 3DP group, changes in the imaging indicators such as the angle between the axis of humerus medullary cavity and the hinge axis of elbow (H-H angle), the angle between the axis of middle ulna medullary cavity and the hinge axis of elbow (MU-H angle), the angle between the axis of proximal ulna medullary cavity and the hinge axis of elbow (PU-H angle) were assessed before and after surgery.ResultsNo significant differences were observed in the baseline characteristics between the 3DP group and the traditional group (P > 0.05). We followed all patients for a period ranging from 12 to 36 months, with an average follow-up duration of 14.8 months. When comparing the two groups, the 3DP group required fewer intraoperative fluoroscopic view (P < 0.01). Postoperatively, the 3DP group showed notable improvements in the H-H angle, MU-H angle, and PU-H angle, all of which were significantly better than those in the traditional group (P < 0.01). Despite these advantages, the postoperative MEPS and Mayo elbow function scores did not differ significantly between the 3DP and traditional groups (P > 0.05).ConclusionCompared with traditional surgical methods, the use of PSI technology with preoperative 3D planning and customized 3DP osteotomy guides can significantly reduce the number of intraoperative fluoroscopies, which enhances both the efficiency and safety of TEA. PSI technology facilitates more accurate angle correction during elbow arthroplasty, ensuring precise osteotomies and effective correction of joint deformities.

To compare the mid-term outcomes in intra-articular distal humerus fracture (AO/OTA type C) treated with either open reduction-internal fixation (ORIF) or total elbow arthroplasty (TEA) in patients older than 75 years and with more than fiveyears of follow-up. Retrospective study including 24 patients (11 TEA vs. 13 ORIF) with a mean age of 82 years and being all females. Results assessed included (1) radiographic measures; (2) functional results: range of motion, Mayo Elbow Performance Score (MEPS), quick-DASH; and (3) complications. TEA group vs. ORIF group achieved a mean flexion of 117° ± 9.6° vs. 106° ± 14°, extension loss of 38° ± 17° vs. 30.8° ± 16°, pronation 75° ± 5° vs. 85° ± 7° and supination 75° ± 4° vs. 70° ± 5°. Mean MEPS score was 71.6 vs. 83.6 (p = .183) and mean quick-DASH was 44.8 vs. 42.6 (p = .789). All 13 patients in the ORIF group demonstrated radiographic signs of bone union and none underwent conversion to TEA. Sixty-three percent of the patients in the TEA group underwent re-operation at an average of 72 months (62.4-75.2 months), including three for periprosthetic fracture and four for implant loosening. Whereas in the ORIF group, 23% of the patients were re-operatedupon excluding olecranon osteotomy hardware, two for stiffness, and one for an olecranon tension band wire failure. Although there were no differences in mid-term functional outcomes between either treatment, our results suggest that the recent trend towards the use of TEA instead of ORIF in the elderly should be re-examined due to the high rate of complications beyond five years of follow-up with TEA.

To investigate the effectiveness of total elbow arthroplasty (TEA) with preservation of triceps brachii insertion approach. Between January 2012 and September 2017, 17 patients with elbow disease were treated with TEA with preservation of triceps brachii insertion approach. There were 3 males and 14 females, with an average age of 65.2 years (range, 48-85 years). The injuries located on left elbow in 5 cases and on right elbow in 12 cases. There were 11 cases of distal humerus fracture (AO type C1 in 2 cases and type C3 in 9 cases); the interval between fracture and operation was 3-10 days (mean, 4.1 days). There were 3 cases of osteoarthritis and 3 cases of rheumatoid arthritis, with the disease duration of 2-26 years (mean, 8.7 years). The postoperative elbow function and pain was assessed by Mayo elbow performance score (MEPS) and visual analogue scale (VAS) score, respectively. The prosthesis position, heterotopic ossification, and periprosthetic fracture were observed by X-ray films. All incisions healed by first intention. Sixteen patients were followed up 18-69 months (mean, 40.6 months). Intraoperative ulnar nerve injury occurred in 2 cases, and healed after symptomatic treatment. At last follow-up, the MEPS score was 55-100 (mean, 90.3). The results were excellent in 11 cases, good in 2 cases, fair in 2 cases, and poor in 1 case, with an excellent and good rate of 81.3%. The VAS score was 0-2 (mean, 0.4). X-ray reexamination showed that no polyethylene wear, prosthesis loosening and fracture, abnormal prosthesis position, periprosthetic fracture occurred during the follow-up period, and the prosthesis survival rate was 100%. Heterotopic ossification occurred in 2 and 3 months after operation in 2 cases, respectively. The triceps on approach for TEA are satisfactory for distal humerus fracture, osteoarthritis, and rheumatoid arthritis.