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Lynch CP, Garcia VC, Grandizio LC. The Risk of Early Postoperative Complications Associated With Preoperative Immunosuppression in Patients Undergoing Total Elbow Arthroplasty. J Hand Surg Am 2023; 48:1236-1243. [PMID: 37897471 DOI: 10.1016/j.jhsa.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 09/23/2023] [Accepted: 09/27/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE Patients considering total elbow arthroplasty (TEA) may be receiving immunosuppressive therapy; however, the relationship between immunosuppressive medications and postoperative complications is not well defined. Our purpose was to assess the relationship between preoperative immunosuppression and short-term complications following TEA. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was reviewed from 2005 to 2020 to identify patients undergoing TEA. Procedures indicated for malignancy or infection were excluded. Patients were grouped according to preoperative chronic immunosuppressive status. Demographic and operative characteristics were compared between groups. The 30-day incidence of complications and reoperations were compared between groups. Multiple logistic regression models, inverse-weighted by propensity scores, were used to calculate odds ratio (OR) of experiencing any complication or return to the operating room based on immunosuppression status and other demographic characteristics. RESULTS A total of 769 patients undergoing TEA were included, of whom 142 (18.5%) received chronic immunosuppression. Distribution of age, sex, race, body mass index, diabetes, and American Society of Anesthesiologists classification differed significantly between groups. Most procedures were performed on an inpatient basis, and the median operative duration was 148 minutes. Most procedures were indicated for fracture in the nonimmunosuppressed group and rheumatoid arthritis in the immunosuppressed group. Overall complication rates were 7.0% for immunosuppressed patients and 10.2% for nonimmunosuppressed patients. The incidence of complications and reoperations did not significantly differ between groups. After controlling for confounding and adjusting for patient characteristics, immunosuppressed patients were 0.52 times less likely to experience a complication. Additionally, there was no association between immunosuppression status and odds of return to the operating room. CONCLUSION Similar rates of complications were observed following TEA, regardless of preoperative immunosuppression status. Chronic immunosuppression does not appear to increase the rates of postoperative complications for patients undergoing TEA. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Conor P Lynch
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Victoria C Garcia
- Biostatistics Core, Geisinger Health System, Henry Hood Research Center, Danville, PA
| | - Louis C Grandizio
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA.
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The Impact of Cement Mantle Characteristics on Early Loosening in Primary Total Elbow Arthroplasty. J Hand Surg Am 2022; 47:1146-1156. [PMID: 36216682 DOI: 10.1016/j.jhsa.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/15/2022] [Accepted: 07/29/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE To assess the association between cement mantle characteristics and early radiographic loosening in total elbow arthroplasty (TEA). We aimed to determine whether shorter mantle heights (<20 mm) were associated with loosening. METHODS We reviewed primary TEAs from a single healthcare system from 2006 to 2020. TEAs complicated by infection or performed for oncologic conditions were excluded. Initial postoperative radiographs were reviewed to determine cement mantle and component characteristics (mantle quality, mantle height, and component angulation). One-year postoperative radiographs were reviewed to assess for implant loosening, and we compared demographics and radiographic criteria for cases with and without early loosening. We noted whether cases underwent subsequent revision for aseptic osteolysis. RESULTS A total of 54 TEA cases were included. Forty percent of ulnar and 24% of humeral mantles were classified as short (between 1 and 19 mm). According to the Morrey classification, 6 (11%) cases had an inadequate cement mantle Twenty-four (45%) cases had radiographic evidence of loosening at 1 year. Of the cases with early loosening, 6 (25%) had initial inadequate mantle quality. There were no inadequate mantles in the group without loosening. There were no statistically significant differences in mantle heights for cases with and without loosening at 1 year after surgery. Eight (33%) cases underwent revision in the group with early loosening compared with 1 (3%) case without early loosening. CONCLUSIONS Inadequate cement mantle quality was associated with an increased risk of early aseptic loosening after primary TEA. Cement mantles that extended past the tip of the prosthesis were not associated with loosening. Considering the potential need for future revision and morbidity of cement removal, surgeons should focus on mantle quality and carefully plan mantle height because shorter heights may not be associated with early implant failure. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Tran Trung D, Tran Q, Vu Tu N, Nguyen Tran Quang S, Nguyen Huu M, Pham Trung H. Non-oncologic indication for elbow megaprothesis replacement: 2 cases report. Int J Surg Case Rep 2021; 86:106356. [PMID: 34507188 PMCID: PMC8430374 DOI: 10.1016/j.ijscr.2021.106356] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 11/03/2022] Open
Abstract
Introduction Treatment of elbow bone defects is still a huge challenge in orthopaedic in order to restore the shape and function of the elbow joint. Bone defect reconstruction is very difficult due to biomechanical complexity of the elbow joint and the poor coverage tissue of this area, so mega-prothesis can be considered the most optimal solution in these cases. Case report We present two clinical cases of megaprosthesis elbow replacement for treatment of bone defects caused by sequelae of trauma. There is one case of 3 cm bone defect at proximal ulna and one case of 3 cm bone defect at distal humerus. In the 1st case, the elbow joint is fusioned and the second case, the elbow joint is degenerated totally after 3 previous surgery. We performed total elbow replacement with a customized megaprosthesis for them. The Mayo elbow function assessment scale [1] pre-surgery was poor at 50 points. The average age is 35 years old. The mean post-operative follow-up time was 14 months. Range of elbow flexed motion was 135 degrees, both patients were maximally extension, the forearm pronation and supination were 90 and 75 degrees, respectively. The Mayo score is very good with 97,5 points. Both patients were completely satisfied with the postoperative results. Conclusion Our results show that megaprosthesis elbow replacement is a very effective option for cases large elbow bone defects due to trauma sequelae. However, careful preoperative preparation is required for the best outcome. Megaprosthesis replacement is more popular for bone tumor around elbow Massive bone defect sequelae around elbow after trauma is really challenged to treat successfully. It will be more difficult if there is a problem with elbow joint: stiffness, degeneration, or fusion. In the past, functional arthrodesis of elbow was the main indication to resolve this problem. With the development of 3D technology and biomaterial science, megaprosthesis is the best solution for limb preservation after bone tumor wide resection. Application of megaprosthesis was not only limited for bone tumor, but we can also use it in some rare non-oncologic case, especially around elbow. We introduced 2 cases with posttraumatic massive bone loss of distal humerus and proximal ulnar which are treated by. megaprosthesis successfully.
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Affiliation(s)
| | - Quyet Tran
- Vinmec Healthcare System, Hanoi City, Vietnam
| | - Nam Vu Tu
- Vinmec Healthcare System, Hanoi City, Vietnam.
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Samdanis V, Manoharan G, Jordan RW, Watts AC, Jenkins P, Kulkarni R, Thomas M, Rangan A, Hay SM. Indications and outcome in total elbow arthroplasty: A systematic review. Shoulder Elbow 2020; 12:353-361. [PMID: 33093874 PMCID: PMC7545529 DOI: 10.1177/1758573219873001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 08/07/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Total elbow arthroplasty (TEA) is the established treatment for end-stage rheumatoid arthritis but improved surgical techniques have resulted in expanded indications. The aim of this study is to review the literature to evaluate the evolution of surgical indications for TEA. METHODS A systematic review of PubMed and EMBASE databases was conducted. Case series and comparative studies reporting results after three types of primary TEA were eligible for inclusion. RESULTS Forty-nine eligible studies were identified (n = 1995). The number of TEA cases published annually increased from 6 cases in 1980 to 135 cases in 2008. The commonest indication for TEA throughout the review period was rheumatoid arthritis but its annual proportion reduced from 77% to 50%. The mean Mayo Elbow Performance Score significantly improved for all indications. Three comparative studies reported statistically improved functional outcomes in rheumatoid arthritis over the trauma sequelae group. Complication and revision rates varied; rheumatoid arthritis 5.2-30.9% and 11-13%, acute fracture 0-50% and 10-11%, trauma sequelae 14.2-50% and 0-30%, osteoarthritis 50% and 11%, respectively. DISCUSSION TEA can provide functional improvements in inflammatory arthritis, acute fractures, trauma sequelae and miscellaneous indications. Long-term TEA survivorship appears satisfactory in rheumatoid arthritis and fracture cases; however, further research into alternative surgical indications is still required.
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Affiliation(s)
- Vasileios Samdanis
- Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | | | - Robert W Jordan
- Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK,Robert W Jordan, Hand and Upper Limb Unit, RJAH Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK.
| | - Adam C Watts
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | | | | | | | - Amar Rangan
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Stuart M Hay
- Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
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Heterotopic ossification after total elbow arthroplasty: a systematic review. J Shoulder Elbow Surg 2019; 28:587-595. [PMID: 30639172 DOI: 10.1016/j.jse.2018.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/24/2018] [Accepted: 10/05/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Heterotopic ossification (HO) is a known complication that can arise after total elbow arthroplasty (TEA). In most cases, it is asymptomatic; however, in some patients, it can limit range of motion and lead to poor outcomes. The objective of this review was to assess and report the incidence, risk factors, prophylaxis, and management of HO after TEA. METHODS A systematic search was conducted using MEDLINE, Embase, and PubMed to retrieve all relevant studies evaluating the occurrence of HO after TEA. The search was performed in duplicate, and a quality assessment of all included studies was performed. RESULTS A total of 1907 studies were retrieved, of which 45 were included involving 2256 TEA patients. HO was radiographically present in 10% of patients and was symptomatic in 3%. Fewer than 1% of patients went on to undergo surgical excision of HO, with outcomes after surgery reported as good or excellent as assessed by range of motion and the Mayo Elbow Performance Score. HO appears more likely to develop in patients undergoing TEA because of ankylosis, primary osteoarthritis, and distal humeral fractures. Surgical intervention is more likely to be required in patients in whom HO develops after TEA performed for ankylosis and post-traumatic osteoarthritis. CONCLUSION HO is an uncommon complication after TEA, with most patients in whom HO develops being asymptomatic and requiring no surgical management. Routine HO prophylaxis for TEA is not supported by the literature. The effectiveness of prophylaxis in high-risk patients is uncertain, and future studies are required to clarify its usefulness.
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Kim HJ, Kim JY, Kee YM, Rhee YG. Total elbow arthroplasty under unfavourable soft tissue conditions. INTERNATIONAL ORTHOPAEDICS 2017; 42:367-374. [PMID: 29209741 DOI: 10.1007/s00264-017-3704-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 11/21/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the clinical and radiographic outcomes of patients with total elbow arthroplasty (TEA) and soft tissue reconstruction. METHODS We investigated six patients who underwent TEA and soft tissue reconstruction (two elbows with 1-stage surgery and four elbows with 2-stage surgery). The mean patient age at the time of the surgical procedure was 43.2 years; the mean follow-up duration was 88.2 months. RESULTS The mean pain visual analogue scale (VAS) during motion was improved from 6.3 pre-operatively to 0.7 at the last follow-up. The mean Mayo Elbow Performance Score (MEPS) improved from 26.7 pre-operatively to 81.7 at the last follow-up. The mean flexion-extension arcs of the 1- and 2-stage surgery groups increased from 12.5° and 13.8° pre-operatively to 72.5° and 100° at the last follow-up, respectively. The mean MEPS of the one and two stage surgery groups were 75 and 85, respectively, at the last follow-up. One of the six elbows had loosening on the simple radiograph at the last follow-up, and there were no cases with bushing wear. Three elbows needed additional skin debridement owing to wound complications (2/2 elbows in the 1-stage surgery group and 1/4 elbows in the 2-stage surgery group). CONCLUSIONS Under unfavorable soft tissue conditions, performing soft tissue reconstruction with TEA provides satisfactory functional improvement and pain relief. The two stage surgery provided a lower rate of wound complication and better elbow function than the one stage surgery, which led to high patient satisfaction post-operatively. LEVEL OF EVIDENCE Therapeutic Level IV.
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Affiliation(s)
- Hwan Jin Kim
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, Korea
| | - Jung Youn Kim
- Department of Orthopaedic Surgery, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Young Moon Kee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, Korea
| | - Yong Girl Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, Korea.
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Welsink CL, Lambers KT, van Deurzen DF, Eygendaal D, van den Bekerom MP. Total Elbow Arthroplasty. JBJS Rev 2017; 5:e4. [DOI: 10.2106/jbjs.rvw.16.00089] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Prkic A, Welsink C, The B, van den Bekerom MPJ, Eygendaal D. Why does total elbow arthroplasty fail today? A systematic review of recent literature. Arch Orthop Trauma Surg 2017; 137:761-769. [PMID: 28391430 DOI: 10.1007/s00402-017-2687-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND Total elbow arthroplasty is a relatively uncommon type of arthroplasty, which has undergone several design changes in the past four decades. However, research on improvement requires knowledge of failure mechanisms that can be addressed. Therefore, we conducted a systematic review on modes of failure of total elbow arthroplasty. METHODS We conducted searches on PubMed/Medline, Embase and Cochrane databases to identify studies describing modes of failure of primary total elbow arthroplasties. The results were coupled per type of total elbow arthroplasty and individual arthroplasty models. RESULTS A total of 70 articles were included in this systematic review. 9308 individual total elbow arthroplasties were identified with 1253 revisions (13.5%). Aseptic loosening was the most prevalent reason for revision (38%), followed by deep infection (19%) and periprosthetic fractures (12%). CONCLUSION Revision rates have been found similar to a systematic review published in 2003. The revision percentage of total elbow arthroplasty for rheumatoid arthritis is significantly higher than for trauma and post-traumatic osteoarthritis. Aseptic loosening was seen less in linked implants. Infections and periprosthetic fractures did not differ between linkage design groups. Aseptic loosening remains the most frequent cause for revision of primary total elbow arthroplasty. Therefore, more research on the occurrence, progression and risk factors of aseptic loosening should be performed and lead to higher implant survival.
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Affiliation(s)
- Ante Prkic
- Upper Limb Unit, Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands.
| | - Chantal Welsink
- Department of Orthopaedic and Trauma Surgery, OLVG, Amsterdam, The Netherlands
| | - Bertram The
- Upper Limb Unit, Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | | | - Denise Eygendaal
- Upper Limb Unit, Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
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Plaschke HC, Thillemann TM, Brorson S, Olsen BS. Outcome after total elbow arthroplasty: a retrospective study of 167 procedures performed from 1981 to 2008. J Shoulder Elbow Surg 2015; 24:1982-90. [PMID: 26456433 DOI: 10.1016/j.jse.2015.07.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 07/20/2015] [Accepted: 07/23/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total elbow arthroplasties (TEAs) are traditionally grouped into linked and unlinked design. The aim was to analyze the difference in clinical outcomes after TEA based on implant design and indication for surgery and to evaluate primary and revision TEAs. METHODS A total of 167 TEAs (126 primary and 41 revision TEAs) in 141 patients were evaluated with patient-reported outcome measure by the Oxford Elbow Score (OES) and clinically assessed with the Mayo Elbow Performance Score (MEPS), range of motion (ROM), and standard radiographs. RESULTS The mean follow-up was 10.5 years for primary and 7.5 years for revision TEAs. There was no difference in OES or MEPS between linked and unlinked primary TEAs. The OES score in the social-psychological domain was significantly lower in TEAs performed due to fracture (67) compared with rheumatoid arthritis (81; P = .025). ROM in extension-flexion was 116° for primary linked TEAs compared with 110° for primary unlinked TEAs (P = .02). Revision TEAs were associated with a poorer outcome in OES, MEPS, and ROM compared with primary TEAs. Radiographic signs of loosening were seen in 15 primary and 7 revision TEAs at follow-up. CONCLUSIONS We found no clinically significant differences in outcomes after linked or unlinked TEAs. Patients with TEAs due to fracture had poorer social-psychological results than rheumatoid arthritis patients. The results after revision surgery were significantly inferior compared with primary procedures. The OES contributes to the evaluations of the outcome after TEA surgery with a nuanced picture of the patient's perception.
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Affiliation(s)
- Hans Christian Plaschke
- Shoulder and Elbow Clinic, Department of Orthopedic Surgery, Herlev, Copenhagen University Hospital, Herlev, Denmark.
| | - Theis M Thillemann
- Shoulder and Elbow Clinic, Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Stig Brorson
- Shoulder and Elbow Clinic, Department of Orthopedic Surgery, Herlev, Copenhagen University Hospital, Herlev, Denmark
| | - Bo S Olsen
- Shoulder and Elbow Clinic, Department of Orthopedic Surgery, Herlev, Copenhagen University Hospital, Herlev, Denmark
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Park JG, Cho NS, Song JH, Lee DS, Rhee YG. Clinical Outcomes of Semiconstrained Total Elbow Arthroplasty in Patients Who Were Forty Years of Age or Younger. J Bone Joint Surg Am 2015; 97:1781-91. [PMID: 26537166 DOI: 10.2106/jbjs.n.01325] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total elbow arthroplasty is not commonly used in young patients with advanced arthritis because of concerns regarding implant loosening and clinical failure. Until now, to our knowledge, there have only been a few studies on the outcome in younger patients undergoing total elbow arthroplasty. METHODS Twenty-three elbows in patients forty years of age or younger who underwent total elbow arthroplasty were reviewed retrospectively. There were nine elbows with posttraumatic arthritis and fourteen elbows with nontraumatic arthritis. The mean patient age at the time of the surgical procedure was thirty-three years (range, twenty to forty years), and the mean follow-up duration was 129 months (range, eighty-five to 227 months). RESULTS At the time of the latest follow-up, pain during motion decreased from a mean visual analog scale score (and standard deviation) of 5.8 ± 1.8 cm preoperatively to 1.6 ± 1.1 cm postoperatively (p < 0.001), and the mean Mayo Elbow Performance Score increased from 32.0 ± 9.4 points preoperatively to 81.1 ± 13.7 points postoperatively (p < 0.001). The mean subjective patients' satisfaction score was 83.5 ± 11.7 points. The mean flexion-extension arc in the posttraumatic arthritis group increased from 37.8° ± 30.3° preoperatively to 120.6° ± 11.3° at the time of the latest follow-up, whereas that in the nontraumatic arthritis group increased from 24.3° ± 27.6° to 96.4° ± 21.2° (p < 0.001 for both). At the time of the latest follow-up, the loosening rate was 13% and mild-to-moderate bushing wear was observed in four elbows (17%). A revision surgical procedure was performed in five elbows (22%), of which three had revision surgery after fifteen postoperative years. The overall implant survival rates were 95% at the eight-year follow-up and 89% at the fifteen-year follow-up. CONCLUSIONS Despite concerns regarding the longevity of total elbow replacements in young patients, long-term follow-up after total elbow arthroplasty showed significant functional improvement and pain relief. Although a desirable range of motion after the surgical procedure was difficult to achieve in patients with preoperative ankylosis, total elbow arthroplasty in selected young patients showed acceptable loosening, reoperation, and implant survival rates. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jung Gwan Park
- Department of Orthopaedic Surgery, Shoulder & Elbow Clinic, College of Medicine, Kyung Hee University, #1 Hoegi-dong, Dongaemun-gu, Seoul 130-702, South Korea. E-mail address for J.G. Park: . E-mail address for N.S. Cho: . E-mail address for J.H. Song: . E-mail address for Y.G. Rhee:
| | - Nam Su Cho
- Department of Orthopaedic Surgery, Shoulder & Elbow Clinic, College of Medicine, Kyung Hee University, #1 Hoegi-dong, Dongaemun-gu, Seoul 130-702, South Korea. E-mail address for J.G. Park: . E-mail address for N.S. Cho: . E-mail address for J.H. Song: . E-mail address for Y.G. Rhee:
| | - Jong Hoon Song
- Department of Orthopaedic Surgery, Shoulder & Elbow Clinic, College of Medicine, Kyung Hee University, #1 Hoegi-dong, Dongaemun-gu, Seoul 130-702, South Korea. E-mail address for J.G. Park: . E-mail address for N.S. Cho: . E-mail address for J.H. Song: . E-mail address for Y.G. Rhee:
| | - Doo Sung Lee
- Theranostic Macromolecules Research Center, School of Chemical Engineering, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do 440-746, South Korea. E-mail address:
| | - Yong Girl Rhee
- Department of Orthopaedic Surgery, Shoulder & Elbow Clinic, College of Medicine, Kyung Hee University, #1 Hoegi-dong, Dongaemun-gu, Seoul 130-702, South Korea. E-mail address for J.G. Park: . E-mail address for N.S. Cho: . E-mail address for J.H. Song: . E-mail address for Y.G. Rhee:
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Dachs RP, Vrettos BC, Chivers DA, Du Plessis JP, Roche SJ. Outcomes After Ulnar Nerve In Situ Release During Total Elbow Arthroplasty. J Hand Surg Am 2015; 40:1832-7. [PMID: 26254945 DOI: 10.1016/j.jhsa.2015.06.107] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 06/19/2015] [Accepted: 06/19/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE Ulnar nerve (UN) lesions are a significant complication after total elbow arthroplasty (TEA), with potentially debilitating consequences. Outcomes from a center, which routinely performs an in situ release of the nerve without transposition, were investigated. METHODS Eighty-three primary TEAs were retrospectively reviewed for the intraoperative management of the UN and presence of postoperative UN symptoms. RESULTS Three patients had documented preoperative UN symptoms. One patient had a prior UN transposition. The nerve was transposed at the time of TEA in 4 of the remaining 82 elbows (5%). The indication for transposition in all cases was abnormal tracking or increased tension on the nerve after insertion of the prosthesis. Of the 4 patients who underwent UN transposition, 2 had postoperative UN symptoms. Both were neuropraxias, which resolved in the early postoperative period. The remaining 78 TEAs received an in situ release of the nerve. The incidence of postoperative UN symptoms in the in situ release group was 5% (4 of 78). Two patients had resolution of symptoms, whereas 2 continued to experience significant UN symptoms requiring subsequent transposition. Seven patients had preoperative flexion of less than 100°. Of these, 2 had a UN transposition at the time of TEA. Of the remaining 5 elbows with preoperative flexion less than 100°, 2 had postoperative UN symptoms after in situ release, with 1 requiring subsequent UN transposition. CONCLUSIONS A 3% incidence of significant UN complications after TEA compares favorably with systematic reviews. We do not believe that transposition, which adds to the handling of the nerve and increases surgical time, is routinely indicated and should rather be reserved for cases with marked limitation of preoperative elbow flexion or when intraoperative assessment by the surgeon deems it necessary. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Robert P Dachs
- Department of Orthopaedic Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa.
| | - Basil C Vrettos
- Department of Orthopaedic Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - David A Chivers
- Department of Orthopaedic Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Jean-Pierre Du Plessis
- Department of Orthopaedic Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Stephen J Roche
- Department of Orthopaedic Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
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A prospective multicenter clinical study of the Discovery elbow. J Shoulder Elbow Surg 2014; 23:e95-e107. [PMID: 24745320 DOI: 10.1016/j.jse.2013.12.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 12/20/2013] [Accepted: 12/25/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Semiconstrained total elbow arthroplasty is used to improve elbow function and reduce pain. Although effective, high complication rates exist, with the polyethylene bushing especially susceptible to failure. The Discovery Elbow System (Biomet Inc, Warsaw, IN, USA) contains a spherical bearing designed to minimize polyethylene wear. This prospective, multicenter clinical study investigated the 4-year (mean) outcomes of this elbow. METHODS From 2002 to 2009, 92 patients (71 women, 21 men; mean age, 63.9 years; range, 33.4-88.7 years) received 99 Discovery elbows at 4 centers. The study cohort was limited to 46 elbows with complete preoperative and minimum 2-year clinical (modified American Shoulder and Elbow Surgeons elbow score) and radiographic follow-up. RESULTS Mean follow-up was 4.1 years (range, 2-5.9 years). All American Shoulder and Elbow Surgeons elbow score components improved significantly (P < .001). Mean flexion-extension arcs increased from 81° to 121° and pronation-supination arcs from 134° to 163° (P < .001). Loose locking screws in 2 elbows (first-generation screws), a loose polyethylene bearing in 1 (history of falls), and a condyle/bearing in 1 (deep infection) were exchanged. Among the 46 elbows, gross survivorship was humeral/ulnar components, 100%; condyles, 97.8%; bearings, 95.7%; and screws, 95.7%. One humeral component (2.2%) was radiographically loose but not revised. An additional elbow (elbow 47) that did not meet the criteria for inclusion (<2 years of follow-up) was revised due to a loose humeral component and was reported separately. CONCLUSION The Discovery elbow increased function and decreased pain with high survivorship at a mean of 4.1 years.
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