Results Of Total Elbow Arthroplasty Research Articles

Descriptive analysis of total elbow arthroplasty for distal humerus fractures: 30-day complications.

Although functional outcomes of total elbow arthroplasty (TEA) for distal humerus fractures are satisfactory, there is a high rate of complications. This study aims to characterize the 30-day complications, readmissions, and mortality of patients with TEA for distal humerus fractures in a large registry database. Patients who underwent TEA for a distal humerus fracture were identified from the 2015 to 2020 ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database. Baseline demographics, clinical characteristics, and complications including deep vein thrombosis/pulmonary embolus, infection, mortality, readmissions, and reoperations were recorded. Overall, 134 patients (mean age, 73.6 years; mean body mass index, 28.9 kg/m2 ; 88.8% females) were included. The total complication rate was 21.6% (n=29). The most common complications were unplanned readmission (6.0%), postoperative transfusion (5.2%), unplanned reoperation (3.0%), wound disruption (2.2%), and urinary tract infection (1.5%). The composite infection rate was 3.7%. There were no 30-day events of mortality, sepsis, or cerebral vascular accident. Patients 80 years or older had higher but not significant rates of unplanned readmission (10.2% vs. 3.5%, P=0.116) and reoperation (6.1% vs. 1.2%, P=0.105). TEA for distal humerus fracture analyzed over 5 years had high rates of 30-day postoperative complications (21.6%), with unplanned readmission, reoperation, and infection being the most common. Level of evidence: IV.

Systematic Review and Meta-Analysis of Total Elbow Arthroplasty in Outpatient Versus Inpatient Settings.

Total joint arthroplasties, including total elbow arthroplasty (TEA), are growing in number and shifting towarda younger age group. These procedures are also moving more towardthe outpatient setting compared to previous years. We are conducting this study to update and summarize the current knowledge about the outcomes of TEA in outpatient versus inpatient settings.We conducted a systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework to compare TEA outcomes in outpatient versus inpatient settings. Electronic database searches were performed using PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Google Scholar. Previous studies deemed eligible for this study focused on inpatient cohortsand outpatient cohortsor compared inpatient and outpatient cohorts receiving TEA. Alldata used was obtained from the studiesthat were included.Three studies were deemed eligible and included a total of 1,634 patients, with 1,048 being inpatient and 586 being outpatient. There was a significant increase in total (any) complication rate (log of odds ratio (lnOR): 1.02, 95% CI: 0.35 to 1.68), adverse discharge (lnOR: 1.07, 95% CI: 0.22 to 1.92), and surgical site infection (lnOR: 0.88, 95% CI: 0.05 to 1.71) in the inpatient setting compared to the outpatient setting. There was no significant difference between outpatient and inpatient settings in regard to readmissions (lnOR: 0.85, 95% CI: -0.95 to 2.66), urinary tract infections (UTI)/renal complications (lnOR: 0.04, 95% CI: -0.09 to 0.17), pneumonia/respiratory failure (lnOR: 0.61, 95% CI: -0.29 to 1.51), deep vein thrombosis (DVT)/pulmonary embolism (lnOR: 0.07, 95% CI: -1.31 to 1.44), sepsis (lnOR: 0.86, 95% CI: -0.50 to 2.21), and wound dehiscence (lnOR: 0.55, 95% CI: -0.58 to 1.68).Our results reveal that with careful patient selection, current surgical techniques, and pain control methods, TEA may be performed in the outpatient setting with less risk of complications and lower financial burden compared to inpatient TEA.

Total Elbow Arthroplasty Follow Up 10 Years in Rheumatoid Arthritis, A Systematic Review/Meta-Analysis

Abstract Background Rheumatoid arthritis is the most common form of chronic inflammatory arthritis and affects about 1% of adults. It is characterized by progressive, symmetrical arthritis involving many joints, most commonly the knee, wrist and interphalangeal joints. The elbow is affected in between 20% and 65% of patients, often causing severe painful disability. In patients with severe arthritis, many forms of treatment are available to relieve pain and improve function. Total elbow arthroplasty is commonly performed for end-stage arthritis. However, Total elbow arthroplasty has inferior implant survival and higher complication rates compared with arthroplasties of other major joints. This is usually thought to be due to the high risks associated with Rheumatoid arthritis and the complex anatomy of the elbow joint. Aim of the Work The aims of this study were to report on the long term outcome of total elbow arthroplasty in patients with rheumatoid arthritis, and to identify factors that affect the outcome patients satisfaction. Patients and Methods We searched PubMed, MEDLINE, Cochrane Reviews, and Embase from between January 2005 and March 2020. The primary aim was to determine the implant failure rate, the mode of failure, and risk factors predisposing to failure. A secondary aim is to identify the overall complication rate, associated risk factors and clinical performance. A meta- regression analysis completed to identify the association between each parameter with the outcome. The initial literature search resulted in 4776 studies, with 4665 duplicates subsequently removed. The remaining 111 studies were screened using our exclusion criteria. Following application of our exclusion criteria, the full texts of 111 studies were thereafter evaluated with our inclusion criteria to screen for eligibility. Overall, 13 clinical studies including 349 elbows were included in this study Results According to the movement degree, flexion was recorded in 5 studies with 229 elbows and it was found that there was a significant difference in pre and post-operative groups (p < 0.001, I2 = 90%). Extension was recorded in 5 articles with 229 elbows. It was found that there was no significant difference in pre and post-operative groups (p = 0.12, I2 = 53%). Supination was recorded in 5 articles with 229 elbows. It was found that there was a significant difference in pre and post-operative groups (p = 0.008, I2 = 79%). Pronation was recorded in 5 papers with 209 elbows. It was found that there was a significant difference in pre and post-operative groups (p = 0.003, I2 = 83%). Conclusion Although elbow replacement is performed far less frequently than hip, knee, or shoulder replacement, its use is increasing and information for patients and clinicians on the longevity of implants and impact on quality of life is vital. Patients experienced a sustained improvement in pain and function for the 10 years following surgery.

Outcomes of total elbow arthroplasty in the treatment of distal humeral fractures in the elderly: a retrospective cohort comparison between primary arthroplasty and arthroplasty secondary to failed internal fixation

BackgroundThe primary objective of this study was to compare the clinical outcomes of total elbow arthroplasty as the index procedure in the treatment of traumatic distal humerus fractures, with secondary total elbow arthroplasty following failed internal fixation. The secondary objectives were to compare the complication rates and the radiographic results in the two groups. Our hypothesis was that the clinical results of total elbow arthroplasty performed secondarily to failed internal fixation were comparable to primary total elbow arthroplasty in the treatment of distal humerus fractures in the elderly population. MethodsWe conducted a retrospective cohort comparison study, including 60 patients with a median age of 80 years (71-85), who either underwent a primary total elbow arthroplasty (group 1; 45 patients), or secondary total elbow arthroplasty following failed internal fixation (group 2; 15 patients), in the treatment of a post-traumatic supra and intercondylar fracture of the distal humerus, between January 2004 and January 2021. The clinical examination, including MEPS score and triceps proficiency test, complication rates and the need for re-operation were noted. The average clinical and radiographic follow-up was 40.8 months (24-120). ResultsThe clinical results of the two groups were comparable when looking at the MEPS score (90.00 [85.00, 100.00] p= 0.486). With regards to complications, there were 2 surgical site infections in group 1 and 3 in group 2 (p=0.099), 1 case of mechanical loosening of the humeral component in group 1 and 1 in group 2 (p= 0.448), and 1 patient with triceps insufficiency in group 1. ConclusionSecondary total elbow arthroplasty following failed internal fixation has shown good functional results, and a complication rate comparable to that of index total elbow arthroplasty in the treatment of articular fractures of the distal humerus in the elderly.

Demographic heterogeneity in valgus angulation of the proximal ulnar canal in relation to the flexion-extension axis.

The long-term outcome of total elbow arthroplasty remains unsatisfactory because of loosening and polyethylene wear, which could be caused by malpositioning of the ulnar component. When introducing an ulnar component, 2 different angles should be considered in the coronal plane: the valgus angulation of the proximal ulna in relation to the flexion-extension axis (FE-axis) and the intramedullary varus angulation in relation to the FE-axis. Currently, available TEA designs may not always be able to reconstruct the FE-axis because of the morphologic variability of the ulna. This study aimed to determine the demographic variability of the ulna and the relation between the 2 angulations in the frontal plane based on 3-dimentional computed tomography (CT) reconstructions of the elbow joint of healthy volunteers. Computed tomography scans of 36 left elbows of healthy volunteers were obtained (20 men and 16 women). The scans were segmented and analyzed using the Mimics Research 20.0 software. A local coordinate system was created based on the FE-axis of the elbow and the ulna's longitudinal axis. The measurements were conducted using the 3-Matic Research 12.0 software. The valgus angulation of the proximal medullary canal was on average 16° in men but 12° in women and ranged between 5° and 21°. The varus angulation of the medullary cavity could be determined at 57 mm in men and 64 mm in women from the FE-axis. This angulation was on average 10° in men and 7° in women. There was no significant correlation between this angle and the length of the ulna or the point of varus angulation. This study found a wide range of valgus angulation of the proximal ulnar canal in relation to the FE-axis. The available elbow implant designs are discordant with the mean valgus angulation of the proximal ulna found in this study, and the valgus laxity of the implants does not cover the variability in the population.

Clinical results of total elbow arthroplasty after treatment failure for Monteggia-like injuries

Monteggia-like fractures (MLF) are complex injuries with high complication rates and frequently unsatisfying clinical results. Total elbow arthroplasty (TEA) represents the only option to salvage the functional requirements in some patients with pronounced posttraumatic arthropathy. This case series provides clinical results of TEA following failed treatment of MLF. All patients who underwent TEA from 2017 to 2022 for failed treatment of MLF were retrospectively included in this study. Complications and revisions before and after TEA and functional results, measured by the Broberg/Morrey score, were evaluated. In this study 9 patients with amean age of 68 (±7; 54-79) years were included. The mean follow-up was 12 (±9; 2-27) months. The main reasons leading to posttraumatic arthropathy were chronic infections (44.4%), bony instability due to coronoid deficiency (33.3%) or acombined coronoid and radial head deficiency (22.2%) and non-union of the proximal ulna with radial head necrosis (11.1%). The mean number of surgical revisions between primary fixation and TEA was 2.7 (±1.8; 0-6). The revision rate following TEA was 44%. The mean Broberg/Morrey score at the time of the latest follow-up was 83 (±10; 71-97) points. Chronic infection and coronoid deficiency are the main reasons for posttraumatic arthropathy after MLF leading to TEA. While the overall clinical results are satisfying, the indications should be reserved for selected cases due to high revision rates.

Clinical and Radiographic Outcomes of Total Elbow Arthroplasty Using a Semi-constrained Prosthesis with a Triceps-preserving Approach over a Minimum Follow-up Period of 4 Years.

Complications related to triceps after total elbow arthroplasty (TEA) have become a major surgical concern. The triceps-preserving approach has the advantage of not disturbing the insertion of triceps but is disadvantaged by the reduced exposure of the elbow joint. The aim of this study was to investigate the clinical and radiological outcomes of TEA with a triceps-preserving approach and to compare the outcomes of TEA to treat arthropathy with that of TEA to treat acute distal humerus fracture. From January 2010 to December 2018, 23 patients undergoing primary TEAs were retrospectively reviewed with a mean follow-up time of 92.6 months (range, 52-136months). Each TEA was performed using the triceps-preserving approach with a semi-constrained Coonrad-Morrey prosthesis. Patient demographics, range of motion (ROM), pain visual analogue scale (VAS), and triceps strength (Medical Research Council [MRC] scale) were compared before and after surgery. The Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, radiographic outcome, and complications were evaluated at follow-up. In total, seven males and 16 females were included in this study, with a mean age of 66.1 years (range:46-85 years). By the last follow-up, pain had been significantly relieved in all patients. The average MEPS in the arthropathy group and fracture group were 90.8 ± 10.3 points (range: 68-98 points) and 91.7 ± 0.4 (range: 76-100 points), respectively. The average DASH of the arthropathy group and fracture group was 37.3 ± 18.8 points (range: 18-52 points) and 38.4 ± 20.1 (range: 16-60 points). At the last follow-up after surgery, the mean flexion arcs in the arthropathy group and fracture group were 100.4° ± 24.1° and 97.8° ± 28.1°, respectively. The mean pro-supination arcs in the arthropathy group and fracture group were 142.4° ± 15.2° and 139.2° ± 17.5°, respectively. There were no significant differences in clinical outcomes between the two groups (P≥ 0.05). Triceps strength was normal (MRC grade V) in 15 elbows and good in eight elbows. None of the cases experienced weakness of the triceps strength, infection, periprosthetic fractures, or prosthesis breakage. The clinical and radiographical outcomes of TEA with the triceps-preserving approach were satisfactory in patients with distal humerus fracture, osteoarthritis and rheumatoid arthritis.

Study of a constrained finite element elbow prosthesis: the influence of the implant placement

BackgroundThe functional results of total elbow arthroplasty (TEA) are controversial and the medium- to long-term revision rates are relatively high. The aim of the present study was to analyze the stresses of TEA in its classic configuration, identify the areas of greatest stress in the prosthesis–bone–cement interface, and evaluate the most wearing working conditions.Materials and methodsBy means of a reverse engineering process and using a 3D laser scanner, CAD (computer-aided drafting) models of a constrained elbow prosthesis were acquired. These CAD models were developed and their elastic properties, resistance, and stresses were studied through finite element analysis (finite element method—FEM). The obtained 3D elbow-prosthesis model was then evaluated in cyclic flexion–extension movements (> 10 million cycles). We highlighted the configuration of the angle at which the highest stresses and the areas most at risk of implant mobilization develop. Finally, we performed a quantitative study of the stress state after varying the positioning of the stem of the ulnar component in the sagittal plane by ± 3°.ResultsThe greatest von Mises stress state in the bone component for the 90° working configuration was 3.1635 MPa, which occurred in the most proximal portion of the humeral blade and in the proximal middle third of the shaft. At the ulnar level, peaks of 4.1763 MPa were recorded at the proximal coronoid/metaepiphysis level. The minimum elastic resistance and therefore the greatest stress states were recorded in the bone region at the apex of the ulnar stem (0.001967 MPa). The results of the analysis for the working configurations at 0° and 145° showed significant reductions in the stress states for both prosthetic components; similarly, varying the positioning of the ulnar component at 90° (− 3° in the sagittal plane, 0° in the frontal plane) resulted in better working conditions with a greater resulting developed force and a lower stress peak in the ulnar cement.ConclusionThe areas of greatest stress occur in specific regions of the ulnar and humeral components at the bone–cement–prosthesis interface. The heaviest configuration in terms of stresses was when the elbow was flexed at 90°. Variations in the positioning in the sagittal plane can mechanically affect the movement, possibly resulting in longer survival of the implant.Level of evidence: 5

Coonrad-Morrey total elbow arthroplasty implications in young patients with post-traumatic sequelae.

We aimed to evaluate the clinical and radiological results of total elbow arthroplasty (TEA) performed for trauma sequelae in patients <45years of age. This retrospective study included 63 patients aged <45years who underwent TEA between 2005 and 2017 for previous elbow injuries. The average follow-up period was 5.23years (range, 2-13years). The clinical analysis included limb function according to the Mayo Elbow Performance Score, Oxford Elbow Score, and range of motion. The degree of radiolucency was determined using plain radiographic images. The average amplitude of elbow flexion/extension increased from 49.1±36.7 to 98.7±28.2 (P<.01), and the average amplitude of elbow pronation/supination increased from 87.2±52.3 to 118.7±26.3 (P=.02). Functional results improved from 21.4±13.1 to 67.3±14.5 (P<.01) on the Mayo scale, and those measured according to the Oxford scale improved from 15.4%±7.0% to 28.0%±10.6% (P<.01). Complications were observed in 16 (32.7%) patients. Among them, 10 patients (20.4%) required revision elbow arthroplasty with replacement of implant components. The overall 5-year implant survival rate was 79.4% (95% confidence interval: 63.4-91.2), and the 10-year survival rate was 77.5% (95% confidence interval: 59.3-88.2). TEA allows restoration of the full range of motion in the elbow joint and significantly improves limb function in most cases. However, the low survival rate of implants and high incidence of complications do not permit TEA to become a routine intervention for treating post-traumatic consequences in young patients.

Survivorship and clinical outcomes of total elbow arthroplasty using the Zimmer Nexel Elbow system

BackgroundTotal elbow arthroplasty (TEA) is a treatment option for patients with rheumatoid arthritis, post-traumatic arthritis, or distal humerus fracture. The objective of this study was to evaluate the clinical, functional, and radiographic outcomes of the semiconstrained Nexel Total Elbow (Nexel) at a single center. MethodsThis is a retrospective case series of consecutive Nexel TEA procedures at a single center between 2014 and 2019. Of the 21 TEAs, 18 were alive and asked to return to the clinic to complete a physical exam, radiographs, the Mayo Elbow Performance Score, Quick Disabilities of the Arm, Shoulder, and Hand, and EuroQol 5D. Patients who could not return in person were offered a remote participation option. Outcomes included the following: implant survival, surgical complications, reoperation for any reason, radiographic assessment to identify loosening and bushing wear, and mean scores on patient-reported outcomes. ResultsThere were 11 TEA procedures who responded (61%), with eight returning to the clinic and three remote participants. The mean follow-up was 53.3 months (28-89 months). None of the TEAs were revised or reoperated on for any reason; the survival rate was 100%. One TEA (13%) had radiographic evidence of loosening, limited to the humeral component. There was no evidence of bushing wear. One TEA experienced ulnar nerve neuropraxia postoperatively, without permanent dysfunction (13%). The majority of patients reported satisfactory outcomes as measured by the Mayo Elbow Performance Score (73%), with a mean score of 90 (standard deviation [sd] = 13). On average, patients reported minimal disability on the Quick Disabilities of the Arm, Shoulder, and Hand (mean = 29, sd = 23) and relatively high health-related quality of life (EuroQol 5D, mean = 0.83, sd = 0.08). ConclusionsClinical and radiographic results of the Nexel TEA, a semiconstrained implant, were favorable. In contrast to the high complication rate and concerning radiographic findings reported previously, the current study reports 100% implant survival, with revision or indication for revision as the endpoint, and low rates of complications with an average of 53 months of follow-up. Bushing wear was not identified as a problem in this series; however, loosening of the humeral component may emerge as an indication for revision. More studies on the Nexel TEA are needed to better understand clinical and radiographic outcomes.

Тотальное эндопротезирование локтевого сустава при травмах

The aim of the study was to identify the features of total elbow arthroplasty in traumatic cases and their consequences in patients of different age groups and to conduct a comparative retrospective analysis of differentiated treatment tactics. Materials and Methods A retrospective analysis of the results of total elbow arthroplasty (TEА) in the period from 2009 to 2019 was carried out in 101 patients with injuries and severe consequences of elbow joint injuries, 56 (55.4 %) men and 45 (44.5 %) women among them in the average age of 48.5 ± 12.5 years. Three groups of patients were formed. Group I were 29 (28.7 %) subjects who underwent conservative treatment of fractures before TEА; the second group (II) of 52 (51.5 %) patients underwent TEА after ORIF, the third group of 20 (19.8) individuals (III) were patients who had primary TEА. We investigated pain (VAS), range of motion, tests with the DASH and MEPS scales, hand strength. Results One year later, there was a statistical difference in the results (p = 0.0213) between group III DASH = 7.3 ± 2.1) compared with groups I (DASH = 20.6 ± 3.3) and II (DASH = 18.4 ± 4.2); in group III, MEPS was excellent (90.7 ± 8.4), and in groups I (MEPS = 83.8 ± 7.4) and II (MEPS = 84.2 ± 5.6) good (p = 0. 0344). There were no differences in the dynamometry of hand strength and pain. Discussion Treatment of fractures of the elbow joint is a challenge that has several aspects. Conservative treatment results in high incidence of pronounced contractures, which affect the range of motion in the elbow joint after TEA; in severe damage to bone and cartilage, it is necessary to evaluate many factors in order to make the right choice between ORIF and primary TEА. New prosthetic technologies are needed to ensure good long-term functioning of the elbow prosthesis, especially in young patients. Conclusion To choose the treatment tactics in severe injuries of the elbow joint, it is necessary to consider not only the severity of the injury, but also the age of the patient and the quality of the bone, especially in elderly patients. Rejection to perform osteosynthesis in favor of primary total arthroplasty is aimed at maintaining the range of motion, improving the functional results and survival of the endoprosthesis.

The history of the development of elbow arthroplasty

Total elbow arthroplasty is a good alternative surgical solution for many patients with severe traumatic and inflammatory joint injuries. In case of bones multiple fractures of the elbow joint, arthroplasty can restore the stability of the joint and provide early mobilization of the limb, which is not always possible when performing osteosynthesis. This literature review provides information on the design features of foreign and domestic endoprostheses of the elbow joint, long-term results of operations. The turbulent history of the development of elbow arthroplasty goes back over 60 years. At the same time, due to insufficient understanding of the biomechanics of the joint, the first attempts at its arthroplasty failed. Only in the early 70s, in connection with the improvement of the endoprostheses design and the operation technique, publications on the successful results of total elbow arthroplasty appear in the literature. In the 80s of the XX century implants with a semi-connected design and cemented placement technique have been developed, which still demonstrate better long-term results in comparison with implants with anatomical design. The analysis of publications on the topic of total elbow arthroplasty showed that significant achievements were observed only in the early 1990s, which is largely due to a better understanding of the biomechanics of the elbow joint, as a result, to the improvement of implant design and surgical technique.

The influence of short-term complications on the outcomes of total elbow arthroplasty

BackgroundThe reported complication rate after total elbow arthroplasty is high, and objective outcomes are not always predictive of satisfaction. This study aims to investigate the effect of a short-term complication on patient satisfaction and patient-reported outcome measures.MethodsWe retrospectively included 126 patients who received a primary total elbow arthroplasty at our hospital between 2008 and 2018 and compared outcomes between patients with a complication and patients without complications occurring within 1 year using t-tests or Mann-Whitney U tests. P-values were corrected using the Benjamini-Hochberg procedure.ResultsIn total, 26 patients developed a complication (21%). At the 1-year follow-up, there were no significant differences between the groups. At the 3-year follow-up, patients with a complication had a lower median satisfaction score (8 vs. 10; P = .0288) and Oxford Elbow Score (27 vs. 43; P = .0048). At the 5-year follow-up, there were no differences between the groups. However, the number of patients who completed the 5-year follow-up is low (42 patients).DiscussionComplications occurred in 21% of patients undergoing total elbow arthroplasty and lead to a decrease in satisfaction and Oxford Elbow Score after 3 years.

Discovery® elbow system arthroplasty: results of 10-year follow-up.

The semi-constrained Discovery® Elbow System (LimaCorporate, San Daniele del Friuli, Italy) allows varus-valgus laxity of 7° [8]. It has been reported to provide good pain relief and increased range of motion [5, 9] on mid-term follow-up. The aim of the study was to evaluate long-term outcomes of total elbow arthroplasty using the Discovery® Elbow System (LimaCorporate, San Daniele del Friuli, Italy). The Mayo Elbow Performance Score (MEPS) and elbow range of motion (ROM) were assessed. Plain radiographs were obtained to assess radiolucency in the humerus and ulna. The data were extracted from electronic patient records. During the follow-up period of 105.4 (range 24.6-179.9) months, 132 patients (153 elbows) underwent surgery. The cause of surgery was rheumatoid arthritis in 105 (71%) cases, posttraumatic or primary arthritis in 17 (13%) and fracture in 10 (6%) patients. The total MEPS increased on average by 35.0 points. Elbow extension deteriorated by 5.0°. Respectively, flexion improved by 10.0° and pronation by 5.0°. The difference in supination was 0.0°. Pain severity improved by 2.5 points in motion and by 5.5 points at rest. During follow-up, 24 (16%) patients needed revision surgery. The most common cause for revision was periprosthetic fracture. Radiolucent lines were seen in all zones in both the ulna and the humerus. The Kaplan-Meier survival at 5years was 88% and 79% at 10-14years. The Discovery® Elbow System provides good results in ROM and pain relief of the elbow. The revision rate was relatively high (16% of patients). IV.

Total elbow arthroplasty in patients with rheumatoid arthritis.

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.

Total Elbow Arthroplasty for Distal Humerus Fractures Provided Similar Outcomes When Performed as a Primary Procedure or After Failed Internal Fixation.

To compare clinical and functional outcomes of total elbow arthroplasty (TEA) for distal humerus fractures (DHF) performed either as a primary procedure or after internal fixation. Retrospective, observational study. Mayo Clinic, Rochester, MN (1998 through 2016). Twenty-two TEA for acute DHF and 66 TEA after previous internal fixation. Primary outcome measures included the Mayo Elbow Performance Score and motion. Reoperation rates and complications were also compared. The mean time between internal fixation and arthroplasty was 7.3 years, and the main indications for conversion to TEA were nonunion (36%) and posttraumatic osteoarthritis (32%). There were female predominance (70%) and significant differences in age (74 years vs. 60 years, P < 0.0001) and tobacco use (0 vs. 23%; P = 0.02) between the primary and the salvage cohorts, respectively. Cohort demographics were otherwise comparable. TEA provided similar outcomes in both cohorts in terms of the Mayo Elbow Performance Score (acute 85, salvage 81, P = 0.32) and motion (acute 95/82/75 degrees, salvage 112/81/72 degrees in ulnohumeral/pronation/supination, P = 0.07/P = 0.85/P = 0.65). Reoperation rates were also similar (36% acute vs. 39% salvage, P = 1.00). Aseptic loosening (2 acute, 8 salvage) and deep infection (2 acute, 7 salvage) were the most common complications. The clinical outcomes and reoperation rates of TEA for DHF seem to be similar when performed as a primary procedure or as salvage after previous internal fixation. The benefit of avoiding elbow arthroplasty in the acute setting needs to be balanced with the potential for 2 surgical procedures if internal fixation was to be unsuccessful. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Survival and outcome of total elbow arthroplasty for distal humeral fracture at long term follow-up.

Background:Total elbow arthroplasty is an accepted procedure for the treatment of acute comminuted distal humeral fractures in elderly. Few long-term outcomes are available. The purpose of this study was to examine long-term clinical and radiological outcomes of prosthesis performed (January 2002-June 2015) for complex fractures of the distal humerus (AO/C) in patients older than 65 years with low functional demands.Materials and Methods:Further inclusion criteria were: the availability of a clinical and radiological follow-up of minimum 5 years and pattern of closed fracture. Demographic data and characteristics of patients were collected. All patients were clinically and radiographically assessed after 2 and 5 years from surgery.Results:Twelve patients were included with complete available data. The mean follow-up was 7.6 years. Five patients reported a worsening of the elbow functionality through the follow-ups. Five subjects had complications. There were no cases of revision surgery. The quality of fixation showed a progressive worsening with increase of radiolucency both on humeral and ulnar side. The recorded MEPS showed no correlation with the grade of periprosthetic osteolysis. Polyethylene bushing wear was scored of grade 2 in one subject who had showed type 4 Morrey radiolucency.Discussion and Conclusions:Total elbow arthroplasty is an effective and reliable procedure for comminuted fractures of the distal humerus in elderly, although the incidence of complications can not be considered as negligible. For the majority of these patients, a well-performed implant will give them a well-functioning elbow for their remaining life.

Outcomes following total elbow arthroplasty for rheumatoid arthritis versus post-traumatic conditions: a systematic review and meta-analysis.

AimsThe aim of this meta-analysis was to compare the outcome of total elbow arthroplasty (TEA) undertaken for rheumatoid arthritis (RA) with TEA performed for post-traumatic conditions with regard to implant failure, functional outcome, and perioperative complications.Materials and MethodsWe completed a comprehensive literature search on PubMed, Web of Science, Embase, and the Cochrane Library and conducted a systematic review and meta-analysis. Nine cohort studies investigated the outcome of TEA between RA and post-traumatic conditions. The preferred reporting items for systematic reviews and meta-analysis (Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)) guidelines and Newcastle-Ottawa scale were applied to assess the quality of the included studies. We assessed three major outcome domains: implant failures (including aseptic loosening, septic loosening, bushing wear, axle failure, component disassembly, or component fracture); functional outcomes (including arc of range of movement, Mayo Elbow Performance Score (MEPS), and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire), and perioperative complications (including deep infection, intraoperative fracture, postoperative fracture, and ulnar neuropathy).ResultsThis study included a total of 679 TEAs for RA (n = 482) or post-traumatic conditions (n = 197). After exclusion, all of the TEAs included in this meta-analysis were cemented with linked components. Our analysis demonstrated that the RA group was associated with a higher risk of septic loosening after TEA (odds ratio (OR) 3.96, 95% confidence interval (CI) 1.11 to 14.12), while there was an increased risk of bushing wear, axle failure, component disassembly, or component fracture in the post-traumatic group (OR 4.72, 95% CI 2.37 to 9.35). A higher MEPS (standardized mean difference 0.634, 95% CI 0.379 to 0.890) was found in the RA group. There were no significant differences in arc of range of movement, DASH questionnaire, and risk of aseptic loosening, deep infection, perioperative fracture, or ulnar neuropathy.ConclusionThe aetiology of TEA surgery appears to have an impact on the outcome in terms of specific modes of implant failures. RA patients might have a better functional outcome after TEA surgery.Cite this article: Bone Joint J 2019;101-B:1489–1497

Long-term outcomes of total elbow arthroplasty for distal humeral fracture: results from a prior randomized clinical trial

Total elbow arthroplasty (TEA) is a reliable treatment for elderly patients with comminuted intra-articular distal humeral fractures. However, the longevity and long-term complications associated with this procedure are unknown. The objectives of this study were to examine long-term outcomes and implant survival in elderly patients undergoing TEA for fracture. Patients from a previously published randomized controlled trialof 42 patients in which TEA was compared with open reduction-internal fixation (ORIF) were followed up long term. Patients were aged 65 years or older with comminutedintra-articular distal humeral fractures. Outcomes included patient-reported grading of function and pain, revision surgical procedures, and implant survival. Data were obtained for 40 patients, 15 treated with ORIF and 25 treated with TEA, with a mean follow-up period of 12.5 years for surviving patients and 7.7 years for deceased patients. The reoperation rate was 3 of 25 in the TEA group and 4 of 15 in the ORIF group (P = .39). Of the 25 patients with TEAs, only 1 required (early) revision arthroplasty; 7 were living with their original arthroplasty, and 15 died with a well-functioning implant in situ. Three were lost to follow-up. TEA is an effective and reliable procedure for the treatment of comminuted distal humeral fractures in the elderly patient. Our study reveals reliable implant long-term survival, with no patient requiring a late revision. For the majority of these patients, a well-performed TEA will give them a well-functioning elbow for life and will be the last elbow procedure required.

関節リウマチ肘に対するK-NOW version 1を用いた人工肘関節置換術の中期治療成績

関節リウマチ肘に対するK-NOW version 1を用いた人工肘関節置換術の中期治療成績