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Tarallo L, Celli A, Delvecchio M, Costabile L, Ciacca G, Porcellini G, Catani F. Long-term outcomes and trends in elbow arthroplasty with Coonrad-Morrey prosthesis: a retrospective study in large group of patients. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06272-8. [PMID: 39172271 DOI: 10.1007/s00264-024-06272-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 08/05/2024] [Indexed: 08/23/2024]
Abstract
PURPOSE Total Elbow Arthroplasty (TEA) was first developed to treat severe rheumatoid arthritis, but its uses have grown to encompass end-stage osteoarthritis, post-traumatic arthritis, and distal humeral fractures. This study analyzes indications changes, long-term survival, complications, and post-operative functional results of the Coonrad-Morrey prostheses, enhancing the existing literature on this technique and substantial case history. METHODS We included 122 arthroplasties in 117 patients, 28 males and 89 females (mean age of 67 years) treated in our hospital between 2002 and 2016. Minimum follow-up was four years. We collect functional parameters of 48 patients (51 elbows), due to death of patients due to old age and loss at follow-up. RESULTS Survival rate at five years was 90%, 85% at 10 years and 83% at 15 years. The overall medium Mayo elbow score was 79.7 ± 18.3 with the highest result in osteoarthritis patients (p < 0.005); QuickDASH score was 33.1 ± 25.5 with the worse result in rheumatoid group. Average post-operative arc of motion (ROM) was 95°±27°. There were complications in 46 out of 122 cases (37.7%) and revision surgeries were performed in 12 of them (9.8%): seven aseptic loosening, four late septic loosening, one bushing wear. In 27 instances (22.1%) was reported ulnar nerve involvement. CONCLUSION Coonrad-Morrey prosthesis has shown satisfactory clinical results in the treatment of a wide range of pathologies. The long-term implant survivorship was satisfactory, yet the occurrence of failures and complications cannot be overlooked, above all the ulnar nerve paresthesia. There was a good recovery in quality of life, pain-free with limited residual limb disability.
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Affiliation(s)
- Luigi Tarallo
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
| | - Andrea Celli
- Department of Orthopaedics and Traumatology, Hesperia Hospital, Modena, Italy
| | - Matilde Delvecchio
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Lorenzo Costabile
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Grazia Ciacca
- Department of Orthopaedics and Traumatology, Hesperia Hospital, Modena, Italy
| | - Giuseppe Porcellini
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Fabio Catani
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
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Hill JR, Fadell N, Olson JJ, Kahan LG, Aleem AW, Keener JD, Yamaguchi K, Zmistowski BM. Incidence of and Risk Factors for Reoperation and Revision Following Total Elbow Arthroplasty with an Anatomic Convertible Prosthesis. J Bone Joint Surg Am 2024:00004623-990000000-01131. [PMID: 38875350 DOI: 10.2106/jbjs.23.01171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
BACKGROUND Total elbow arthroplasty (TEA) remains a valuable tool for treating inflammatory, degenerative, and traumatic elbow conditions. This study aimed to understand the incidence of and risk factors for reoperation following TEA at a high-volume center utilizing an implant with a convertible linkage and the potential for anatomic lateral column reconstruction. METHODS All patients undergoing primary TEA with the Latitude prosthesis (Stryker) from July 2001 to May 2020 were identified. Patient characteristics, the surgical indication, and implant characteristics were obtained. Additionally, the indications and timing were identified for reoperations. Postoperative radiographs were analyzed to assess cement quality, implant position, lateral column reconstruction, and distal humeral bone loss. RESULTS Two hundred and nineteen TEAs were performed in 206 patients; 162 (74.0%) were in female patients, the mean patient age was 61 years (range, 23 to 95 years), and the mean follow-up was 11.8 years (range, 2 to 21 years). The most common indication for surgery was sequelae of trauma (36%). Ninety elbows (41.1%) required 200 reoperations at a mean of 19.6 months. Forty TEAs (18.3%) required revision of nonmodular implants, with 14 (6.4%) undergoing definitive explantation. The 5 and 10-year survivorship was 86.1% and 79.7%, respectively. The most common of the reasons for revision was aseptic loosening (53.8%), and the most common cause for non-revision reoperation was infection (23%). Younger age and greater follow-up duration were associated with greater revision and reoperation risks. Aseptic ulnar loosening was associated with a short ulnar stem length and component linkage (30% of short linked ulnar stems loosened; p < 0.001). Aseptic humeral loosening was associated with less-than-adequate cement-mantle quality (p = 0.04). CONCLUSIONS Extended follow-up of the Latitude prosthesis at a high-volume center demonstrates that TEA continues to be hampered by a high reoperation rate, primarily due to infection and aseptic loosening. Technical factors such as good cement-mantle quality, longer stem length, and unlinked implants may play a role in preventing aseptic loosening. Further work is required to optimize long-term outcomes following TEA through improved understanding of appropriate surgical indications, techniques, and implant utilization. LEVEL OF EVIDENCE Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- J Ryan Hill
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Nick Fadell
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Jeffrey J Olson
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Orthopaedic Associates of Hartford, Hartford, Connecticut
| | - Lindsey G Kahan
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Alexander W Aleem
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Jay D Keener
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Ken Yamaguchi
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois
| | - Benjamin M Zmistowski
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
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Chadwick NS, Weaver JS, Shechtel JL, Hall GL, Shultz CL, Taljanovic MS. Update on elbow arthroplasties with emphasis on imaging. Pol J Radiol 2024; 89:e249-e266. [PMID: 38938657 PMCID: PMC11210383 DOI: 10.5114/pjr/186592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/28/2024] [Indexed: 06/29/2024] Open
Abstract
Elbow arthroplasty is increasing in popularity and can be used to treat many conditions, such as trauma, primary and secondary osteoarthritis, inflammatory arthritis, and osteonecrosis. Total elbow arthroplasty (TEA) is reserved for patients with severe symptoms refractory to more conservative management. In addition to TEA, hemi-arthroplasty, interposition arthroplasty, and resection arthroplasty also play roles in the management of elbow pain. There are specific indications for each type of arthroplasty. Postoperative complications may occur with elbow arthroplasties and may be surgery or hardware related. Imaging is important in both pre-operative planning as well as in post-surgical follow-up. This article reviews the different types of elbow arthroplasties, their indications, their normal postoperative imaging appearances, and imaging findings of potential complications.
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Affiliation(s)
| | | | | | | | | | - Mihra S. Taljanovic
- University of New Mexico, School of Medicine, United States
- Banner University Medical Center, United States
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Dumoulin A, Chivot M, Dobelle E, Argenson JN, Lami D. Mid-term results of total elbow arthroplasties in the treatment of geriatric distal humerus fractures. Orthop Traumatol Surg Res 2024:103887. [PMID: 38615884 DOI: 10.1016/j.otsr.2024.103887] [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: 01/24/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 04/16/2024]
Abstract
BACKGROUND While double plate fixation is the gold standard treatment for distal humerus fractures in the general population, it is the source of many complications in the elderly. Total elbow arthroplasty (TEA) has been proposed as an alternative treatment, with satisfactory short-term functional outcomes. However, little is known about the longevity of the implant and the mid- and long-term complications of this procedure. MATERIALS AND METHODS A total of 58 TEAs were performed in 57 patients with comminuted distal humerus fractures between September 2008 and September 2019. All patients were clinically (ranges of motion, Mayo Elbow Performance Score [MEPS] and Disabilities of the Arm, Shoulder and Hand [QuickDASH] functional scores) and radiographically assessed. The minimum follow-up was 2years, and the mean follow-up was 4.7years. RESULTS The overall complication rate was 20.7%, with ulnar nerve damage, complex regional pain syndrome, and severe stiffness being the main complications. The mean MEPS was 85.3, and the mean QuickDASH was 28.1. The mean flexion was 122°, and the mean extension was -23.5°. There were no prosthetic revisions. Of these patients, 17% had radiolucent lines, and 13% had bushing wear at the last follow-up. DISCUSSION TEA is an effective technique for treating comminuted distal humerus fractures in the geriatric population. The prosthesis's mid-term survivorship was highly satisfactory, with a complication rate that remained low and was generally lower than that of osteosynthesis, with identical functional outcomes. TEAs are indicated in elderly patients, for whom maintaining the fullest possible autonomy is paramount. Our findings suggest that TEAs have sufficient longevity to guarantee a functional, pain-free elbow with no need for reoperation. LEVEL OF EVIDENCE IV; case series.
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Affiliation(s)
- Arthur Dumoulin
- Service de chirurgie orthopédique et traumatologique, institut du mouvement et de l'appareil locomoteur, hôpital Sainte-Marguerite, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France.
| | - Matthieu Chivot
- Hôpital privé Clairval, 317, boulevard du Redon, 13009 Marseille, France
| | - Emile Dobelle
- Service de chirurgie orthopédique et traumatologique, institut du mouvement et de l'appareil locomoteur, hôpital Sainte-Marguerite, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Jean-Noël Argenson
- Service de chirurgie orthopédique et traumatologique, institut du mouvement et de l'appareil locomoteur, hôpital Sainte-Marguerite, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Damien Lami
- Service de chirurgie orthopédique et traumatologique, institut du mouvement et de l'appareil locomoteur, hôpital Sainte-Marguerite, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France
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Zhang Q, Xiang M, Yang J, Dai F. 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. Orthop Surg 2023; 15:2091-2101. [PMID: 37076437 PMCID: PMC10432419 DOI: 10.1111/os.13698] [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: 10/12/2022] [Revised: 02/10/2023] [Accepted: 02/10/2023] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVE 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. METHODS 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, 52-136 months). 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. RESULTS 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. CONCLUSIONS The clinical and radiographical outcomes of TEA with the triceps-preserving approach were satisfactory in patients with distal humerus fracture, osteoarthritis and rheumatoid arthritis.
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Affiliation(s)
- Qing Zhang
- Department of Upper LimbSichuan Provincial Orthpaedics HospitalChengduChina
| | - Ming Xiang
- Department of Upper LimbSichuan Provincial Orthpaedics HospitalChengduChina
| | - Jin‐song Yang
- Department of Upper LimbSichuan Provincial Orthpaedics HospitalChengduChina
| | - Fei Dai
- Department of Upper LimbSichuan Provincial Orthpaedics HospitalChengduChina
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6
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Tiwari V, Dwidmuthe S. Total Elbow Arthroplasty from Indian Perspective: A Systematic Review. Indian J Orthop 2022; 56:2029-2041. [PMID: 36507203 PMCID: PMC9705626 DOI: 10.1007/s43465-022-00744-y] [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: 10/05/2021] [Accepted: 09/02/2022] [Indexed: 02/04/2023]
Abstract
Background Total elbow arthroplasty (TEA) provides satisfactory pain relief and restores elbow range of motion and function in patients with end-stage arthritis. Due to advances in implant design and surgical techniques, the indications for surgery have expanded to include various other conditions affecting the elbow. The previous studies and systematic reviews reported satisfactory mid-term and long-term clinical outcomes after TEA with relatively stable complication and revision rates. However, there is lack of information in the literature about the results of TEA in Indian patients. Methods Two reviewers performed a comprehensive literature search using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in three online databases-Pubmed/MEDLINE, Google scholar and the Cochrane database for clinical trials. Only original studies published in the English literature reporting outcomes of primary TEA in Indian patients were included for analysis. Using pre-defined inclusion and exclusion criteria, articles were screened and the relevant articles identified. Data were extracted with the primary objective to assess pain relief and functional outcome after TEA in Indian patients, and secondary objective to identify indications for surgery, complication rates and incidence of implant removals. Results A total of 212 TEAs (210 patients) from ten articles were included in this systematic review. All the TEAs were done using Baksi's semi-constrained sloppy-hinged elbow prosthesis. The most common indication of TEA was post-traumatic sequelae (124 elbows, 58.5%), followed by comminuted intra-articular fracture distal humerus (53 elbows, 25%). At a weighted mean follow-up of 7.5 years, 80.7% cases had complete pain relief. The weighted mean flexion, extension restriction, supination and pronation were 122.6°, 20.8°, 57.3°, and 48.6°; respectively. The weighted mean Mayo Elbow Performance Score was 92.1 points with excellent outcome. Overall, a total of 68 complications were reported (32%) and the implants needed to be removed in 14 elbows (6.6%) including two revisions. Conclusions This systematic review found that the functional outcome and pain relief obtained with TEA using Baksi's sloppy-hinged prosthesis in Indian patients were satisfactory overall. The complication rates and implant removal rates were lower than those reported with other patient populations.
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Affiliation(s)
- Vivek Tiwari
- Department of Orthopaedics, All India Institute of Medical Sciences, Nagpur, Maharashtra 441108 India
| | - Samir Dwidmuthe
- Department of Orthopaedics, All India Institute of Medical Sciences, Nagpur, Maharashtra 441108 India
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Temporin K, Shimada K, Oura K, Owaki H. Arthroscopic Partial Excision of the Radial Head for Advanced Rheumatoid Elbow. Orthopedics 2022; 45:209-214. [PMID: 35245140 DOI: 10.3928/01477447-20220225-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We treated humeroradial joint disorder in rheumatoid elbows with arthroscopic partial excision of the radial head, in which the radial head is minimally resected under arthroscopy to ensure adequate joint space and articular congruity. To examine the effect of this method, we investigated outcomes using a retrospective case series. The hypothesis of this study was that this method decreases symptoms related to the humeroradial joint and ensures articular congruity. Since 2008, we have performed arthroscopic partial excision of the radial head for 14 patients (15 rheumatoid elbows) with more than 2 years of follow-up. Surgical indications for this method were motion pain with crepitus around the humeroradial joint and joint narrowing and sclerosis on plain radiography. After synovectomy, the surface of the radial head was resected 4 to 5 mm under arthroscopy, ensuring adequate joint space and articular congruity. Osteophyte removal and anterior capsular release were performed if necessary. At the final follow-up of 54 months, pain around the humeroradial joint had resolved in all cases. Range of motion improved from 115° flexion, -39° extension, 55° pronation, and 54° supination preoperatively to 127° flexion, -27° extension, 60° pronation, and 65° supination postoperatively. The articular congruity of the humeroradial joint was well maintained at final follow-up, with the exception of 2 cases in which the space decreased after 4 years. Arthroscopic partial excision of the radial head is a promising procedure for improvement of humeroradial symptoms. This method is effective, even for advanced cases, and should be considered before total arthroplasty. [Orthopedics. 2022;45(4):209-214.].
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8
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Unexpected High Early Failure Rate of the Nexel Total Elbow Arthroplasty. JSES Int 2022; 6:690-695. [PMID: 35813147 PMCID: PMC9264017 DOI: 10.1016/j.jseint.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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9
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Parker P, Furness ND, Evans JP, Batten T, White WJ, Smith CD. A systematic review of the complications of contemporary total elbow arthroplasty. Shoulder Elbow 2021; 13:544-551. [PMID: 34659489 PMCID: PMC8512975 DOI: 10.1177/1758573220905629] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 01/13/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Total elbow arthroplasty is a low volume procedure. We aimed to evaluate complication rates and cumulative percentages associated with the most frequently used contemporary implants and for the commonest indications. METHODS A systematic literature search of all studies reporting complications following total elbow arthroplasty with 12-month minimum follow-up was undertaken. Quality of studies was assessed with the Methodological-Index-for-Non-Randomised-studies criteria. British NJR data identified the most common UK prostheses and indications. The complication rates for all undesirable events contributing to patient outcome were extracted and cumulative percentages were calculated. RESULTS One hundred seventeen studies were screened, 12 studies included, totalling 815 procedures. Mean follow-up was 3.8 years. The overall complication cumulative percentage was 60.7%, significantly higher than that seen in other joint arthroplasty, including a 6.5% deep infection rate. Nerve injury was comparable between implants at around 4.1%. Radiographic loosening had a cumulative rate of 17.2%. Revision for symptomatic aseptic loosening was 6.3%. CONCLUSIONS This is the largest systematic review of the complications of total elbow arthroplasty. Surgeons should be aware of differing complications related to their implant of choice, each having its own specific complication. Trauma as an indication appears to have an increased complication rates compared to inflammatory arthropathy. There is a lack of literature regarding the independent results of osteoarthritis as a specific indication for total elbow arthroplasty.
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Affiliation(s)
- Phoebe Parker
- Health Services Policy Research Group,
University of Exeter, Exeter, UK
| | - Nicholas D Furness
- Shoulder & Elbow Unit, Princess
Elizabeth Orthopaedic Centre, Royal Devon & Exeter Hospital, NHS Foundation
Trust, Exeter, UK
| | - Jonathan P Evans
- Shoulder & Elbow Unit, Princess
Elizabeth Orthopaedic Centre, Royal Devon & Exeter Hospital, NHS Foundation
Trust, Exeter, UK
| | - Timothy Batten
- Shoulder & Elbow Unit, Princess
Elizabeth Orthopaedic Centre, Royal Devon & Exeter Hospital, NHS Foundation
Trust, Exeter, UK
| | - William J White
- Guy’s and St Thomas’ Hospital NHS Trust
(GSTT), London, UK,William J White, Guy’s and St Thomas’
Hospital NHS Trust (GSTT), Great Maze Pond, London SE1 9RT, UK.
| | - Christopher D Smith
- Shoulder & Elbow Unit, Princess
Elizabeth Orthopaedic Centre, Royal Devon & Exeter Hospital, NHS Foundation
Trust, Exeter, UK
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10
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Michielsen M, Masson M, van Haver A, Vanhees M, van Riet R. A quantitative analysis of two cementing techniques in total elbow replacement: A cadaveric study. Shoulder Elbow 2021; 13:552-556. [PMID: 34659490 PMCID: PMC8512976 DOI: 10.1177/1758573220987853] [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: 04/19/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/16/2022]
Abstract
One of the reasons for failure of total elbow replacement is loosening of the ulnar component. Cementing techniques are often outdated. A special small nozzle is needed for the ulnar component, when a cement gun is used. This may not always be available, or surgeons may prefer to use a syringe. We postulated that the use of a cement gun and smaller nozzle would result in improved filling of the ulnar canal. A cadaveric study was performed in which the ulnas of paired specimens were cemented with a cement gun or with a syringe. A 3D printed ulnar component was inserted and computed tomography scanning was performed on all specimens. Filling of the ulnar intramedullary canal was analysed using 3D reconstructions of the specimens. A greater degree of filling was seen by the use of the cement gun in 85.7%. Filling was 52.7% in the syringe group (25.1-78.7%), compared to 63.3% for the cement gun group (p < 0.05). The use of a small nozzle cement gun provided a significantly higher filling degree of the ulnar canal. We recommend to always use a cement gun with a specific small nozzle to cement the ulnar component in total elbow arthroplasty.
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Affiliation(s)
- Maartje Michielsen
- Department of Orthopedic Surgery, AZ Monica Hospital, Antwerp, Belgium,Department of Orthopedic Surgery, University
Hospital Antwerp, Antwerp, Belgium
| | | | - Annemieke van Haver
- Department of Orthopedic Surgery, AZ Monica Hospital, Antwerp, Belgium,Monica Orthopedic Research Institute (MoRe),
Antwerp, Belgium
| | - Matthias Vanhees
- Department of Orthopedic Surgery, AZ Monica Hospital, Antwerp, Belgium,Department of Orthopedic Surgery, University
Hospital Antwerp, Antwerp, Belgium
| | - Roger van Riet
- Department of Orthopedic Surgery, AZ Monica Hospital, Antwerp, Belgium,Department of Orthopedic Surgery, University
Hospital Antwerp, Antwerp, Belgium,Monica Orthopedic Research Institute (MoRe),
Antwerp, Belgium,Roger van Riet, Department of Orthopedic Surgery, AZ
Monica Hospital, Stevenslei 20, Antwerp 2100, Belgium.
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11
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Siala M, Callamand G, Delclaux S, Bonnevialle N, Mansat P. Short-term outcomes of the Nexel total elbow arthroplasty. J Shoulder Elbow Surg 2021; 30:2105-2112. [PMID: 33675969 DOI: 10.1016/j.jse.2021.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/31/2021] [Accepted: 02/08/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Third-generation total elbow arthroplasties (TEAs) have shown better mechanical characteristics than older designs. However, these results remain purely mechanical and lack clinical evidence. The purpose of this study was to evaluate clinical and radiographic outcomes of the new-generation semiconstrained Nexel TEA performed at our center. MATERIALS AND METHODS Between 2015 and 2017, 9 Nexel TEAs were implanted in 9 patients (mean age 61 years, range 38-71). Indication for further surgery, range of motion, mean Mayo Elbow Performance Score (MEPS), Subjective Elbow Value (SEV), radiolucency lines, outcome measures that included implant survival, complications, and revisions were assessed. RESULTS The mean follow-up was 28 months (5-46 months). Average range of motion significantly improved from pre- to postoperation, with flexion from 120° (70°-140°) to 140° (130°-155°) and supination from 60° (0°-80°) to 80° (80°). Average MEPS improved from 33 (5-45) to 85 points (30-95). During the study period, 5 elbows (56%) experienced complications and 2 (22%) underwent revision. Aseptic humeral loosening was the main indication for revision. The survivorship rate without revision was 75% at 45 months. CONCLUSIONS The short-term clinical results of the Nexel TEA are satisfactory. However, an unusually high rate of complications and revisions was observed, mainly at the humeral component. Further research with longer follow-up and more patients included are needed to validate this new prosthesis.
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Affiliation(s)
- Mahdi Siala
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France.
| | - Gabriel Callamand
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Stephanie Delclaux
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Nicolas Bonnevialle
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Pierre Mansat
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France
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12
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Meijering D, Welsink CL, Boerboom AL, Bulstra SK, Vegter RJK, Stevens M, Eygendaal D, van den Bekerom MPJ. Triceps Insufficiency After Total Elbow Arthroplasty: A Systematic Review. JBJS Rev 2021; 9:01874474-202107000-00008. [PMID: 34270508 DOI: 10.2106/jbjs.rvw.20.00281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The incidence of triceps insufficiency after total elbow arthroplasty (TEA) varies in the literature, and a consensus on treatment strategy is lacking. We review the incidence, the risk factors, the clinical presentation, and the diagnosis and treatment of triceps insufficiency after TEA. Based on this information, we have formulated recommendations for clinical practice. METHODS We performed a systematic review of the literature from January 2003 to April 2020 to identify studies that investigated triceps function following TEA by searching the PubMed, Cochrane, and Embase databases. Eligible studies (1) reported on triceps function following primary or revision TEA for every indication, regardless of technique (e.g., bone grafts), (2) included ≥6 adult patients, (3) had the full-text article available, and (4) had a minimum follow-up of 1 year. RESULTS Eighty studies with a total of 4,825 TEAs were included. The quality was low in 15 studies, moderate in 64 studies, and high in 1 study. The mean incidence of triceps insufficiency was 4.5%. The rates were highest in patients after revision TEA (22%), in those with posttraumatic arthritis as an indication for surgery (10.2%), and after a triceps-reflecting approach (4.9%). Most studies used the Medical Research Council scale to score triceps function, although cutoff points and the definition of triceps insufficiency differed among studies. Surgical treatment showed favorable results with anconeus tendon transfer and Achilles allograft repair when compared with direct repair. CONCLUSIONS The incidence of triceps insufficiency varies greatly, probably due to a lack of consensus on the definition of the term. Therefore, we recommend the guidelines for clinical practice that are presented in this article. These guidelines assist clinicians in providing the best possible treatment strategy for their patients and help researchers optimize their future study designs in order to compare outcomes. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Daniëlle Meijering
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Chantal L Welsink
- Department of Orthopedic Surgery, Isala Klinieken, Zwolle, the Netherlands
| | - Alexander L Boerboom
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sjoerd K Bulstra
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Riemer J K Vegter
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Martin Stevens
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Denise Eygendaal
- Department of Orthopedic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands.,Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopedic Surgery, OLVG, Amsterdam, the Netherlands.,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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13
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Badre A, King GJ. Primary total elbow arthroplasty. J Clin Orthop Trauma 2021; 18:66-73. [PMID: 33996451 PMCID: PMC8099774 DOI: 10.1016/j.jcot.2021.04.015] [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: 04/02/2021] [Accepted: 04/11/2021] [Indexed: 10/21/2022] Open
Abstract
There have been significant improvements in surgical techniques and implant designs of elbow arthroplasty over the last five decades. These advances have resulted in improved outcomes and expansion of indications for total elow arthroplasty (TEA). As the proportion of TEAs being performed for inflammatory arthritis has been decreasing in recent years, TEAs are being performed more commonly for the management of acute distal humerus fractures in the elderly, post-traumatic sequelae, and primary osteoarthritis. Appropriate patient selection and meticulous attention to surgical technique including the surgical approach, implant positioning and fixation will result in acceptable outcomes. Future advances in the design, instrumentation, and surgical technique will allow for further improvement in outcomes as the indications for TEA continue to expand.
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Affiliation(s)
- Armin Badre
- Western Upper Limb Facility, Sturgeon Hospital, St. Albert, Alberta, Canada,Division of Orthopaedic Surgery, Department of Surgery, Edmonton, Alberta, Canada,Corresponding author. #1502, 400 Campbell Rd., St. Albert, Alberta, T8N 0R8, Canada.
| | - Graham J.W. King
- Roth-McFarlane Hand & Upper Limb Centre, St. Joseph’s Health Care, London, Ontario, Canada,Division of Orthopaedic Surgery, Department of Surgery, London, Ontario, Canada
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14
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Barret H, Laumonerie P, Delclaux S, Arboucalot M, Bonnevialle N, Mansat P. Revision Total Elbow Arthroplasty with the Semiconstrained Coonrad/Morrey Prosthesis: Follow-up to 21 Years. J Bone Joint Surg Am 2021; 103:618-628. [PMID: 33617163 DOI: 10.2106/jbjs.20.00889] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Revision total elbow arthroplasty (TEA) has increased, especially in young patients with high functional expectations. The objective of this study was to evaluate the long-term results of revision TEA with a single semiconstrained prosthesis. METHODS Thirty-four revision TEAs were performed with a Coonrad/Morrey prosthesis in 32 patients; 2 patients had bilateral procedures. The mean patient age was 61 years (range, 22 to 76 years), and the revision TEA was performed at a mean time of 7.8 years (range, 1.6 to 21 years) after the primary TEA. Etiologies for revisions were humeral and ulnar aseptic loosening (n = 14), ulnar aseptic loosening (n = 8), humeral aseptic loosening (n = 6), septic arthritis (n = 4), and unstable unlinked prostheses (n = 2). Clinical and radiographic evaluations were performed with systematic preoperative infection workup and quantification of bone loss. The mean follow-up was 11.4 years (range, 2 to 21 years). RESULTS The Mayo Elbow Performance Score (MEPS) at the last follow-up was excellent in 6 cases, good in 18 cases, fair in 8 cases, and poor in 2 cases, with a mean improvement (and standard deviation) between the preoperative values at 42.4 ± 16.1 points and the postoperative values at 81.8 ± 12 points (p < 0.001). The mean pain scores improved significantly from 6.7 ± 1.3 points preoperatively to 1.4 ± 1.4 points postoperatively (p < 0.001). The flexion-extension arc increased significantly (p = 0.02) from 74° ± 27° preoperatively to 100° ± 31° postoperatively. The total number of complications was 29 in 19 revision TEAs (56%). Twenty of the 29 complications simply required monitoring without surgical intervention. Six repeat surgical procedures were required, and 3 implant revisions (9%) were performed. CONCLUSIONS Revision TEA with a semiconstrained prosthesis can provide good clinical results that can be maintained during follow-up. The rate of complications is high. Proper evaluation of the risk-benefit ratio is essential for each revision TEA and should be discussed with the patient. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hugo Barret
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Pierre Paul Riquet, Toulouse, France
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15
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Cibula Z, Hrubina M, Kiss J, Melisik M, Necas L. Complex open elbow fracture Gustilo-Anderson type IIIB treated with the primary elbow arthroplasty: A case report. Chin J Traumatol 2021; 24:120-124. [PMID: 33358331 PMCID: PMC8071715 DOI: 10.1016/j.cjtee.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 11/07/2020] [Accepted: 11/17/2020] [Indexed: 02/04/2023] Open
Abstract
Total elbow arthroplasty as a treatment option for open elbow fracture is relatively rare described. We reported a 39 years old polytrauma patient with complex open elbow fracture (Gustilo-Anderson type IIIB). The patient presented with large soft tissues defect on dorsal part of the left elbow, ulnar palsy due to the irreparable loss of the ulnar nerve, distal triceps loss due to the complete loss of the olecranon, loss of both humeral condyles with collateral ligaments and complex elbow instability. Only few similar cases have been published. Reconstructive surgery included repetitive radical debridement, irrigation, vacuum assisted closure system therapy, external fixation, coverage of the soft tissue defect with fascia-cutaneous flap from the forearm. Four months after the injury, total elbow arthroplasty with autologous bone graft (from the proximal radius) inserted in the ulnar component, was performed. At 3 years postoperatively, the patient is able to perform an active flexion from 0° to 110° with full prono-supination. Only passive extension is allowed. The ulnar neuropathy is persistent. Patient has no signs of infection or loosening of the prosthesis.
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Affiliation(s)
- Zoltan Cibula
- Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollarova 2, Martin, 03659, Slovak Republic,University Department of Orthopaedic Surgery, University Hospital Martin, Kollarova 2, Martin, 03659, Slovak Republic
| | - Maros Hrubina
- Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollarova 2, Martin, 03659, Slovak Republic,University Department of Orthopaedic Surgery, University Hospital Martin, Kollarova 2, Martin, 03659, Slovak Republic,Corresponding author. Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollarova 2, Martin, 03659, Slovak Republic.
| | - Jeno Kiss
- Department of Orthopaedic and Traumatologic Surgery, Szent Janos Hospital Budapest, Dios Arok 1-3, Budapest, 1125, Hungary
| | - Marian Melisik
- Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollarova 2, Martin, 03659, Slovak Republic,University Department of Orthopaedic Surgery, University Hospital Martin, Kollarova 2, Martin, 03659, Slovak Republic
| | - Libor Necas
- Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollarova 2, Martin, 03659, Slovak Republic,University Department of Orthopaedic Surgery, University Hospital Martin, Kollarova 2, Martin, 03659, Slovak Republic
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16
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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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17
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Viswanath AI, Frampton CM, Poon PC. A review of the New Zealand National Joint Registry to compare the outcomes of Coonrad-Morrey and Latitude total elbow arthroplasty. J Shoulder Elbow Surg 2020; 29:838-844. [PMID: 32197768 DOI: 10.1016/j.jse.2019.12.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 12/06/2019] [Accepted: 12/10/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total elbow arthroplasty has traditionally been used in the treatment of inflammatory arthropathy patients. More and more, however, its use is expanding to include acute trauma and sequelae of trauma. In New Zealand, the most commonly used prosthesis is the Coonrad-Morrey prosthesis, but the Latitude prosthesis has gained in popularity, with a 3-fold increase in implantation over the past 5 years. METHODS Prospectively collected national joint registry data were used to compare the survival rates of these prostheses. Underlying diagnoses, reasons for revision, and patient-reported outcome measures, as well as patient age and exact implants used, were all recorded. Statistical analysis involved survival analysis using Kaplan-Meier curves and the paired Student t test. RESULTS Over the 18-year study interval, the Coonrad-Morrey prosthesis has shown consistently lower revision rates than the Latitude prosthesis. This was true for both the linked and unlinked Latitude prostheses and was not affected by radial head replacement or underlying diagnosis. In all cases, the risk of revision for the Coonrad-Morrey prosthesis was reduced by at least 65% compared with the Latitude prosthesis. CONCLUSION This study using New Zealand Joint Registry data shows a lower failure rate of the Coonrad-Morrey elbow prosthesis compared with the Latitude prosthesis. The hazard ratio for a revision procedure for the Coonrad-Morrey prosthesis compared with the Latitude prosthesis was 0.28 (95% confidence interval, 0.14-0.55). This lower rate was evident irrespective of linkage and radial head replacement. The reason for the lower rate of revision with the Coonrad-Morrey prosthesis is likely multifactorial, but perhaps when used by lower-volume surgeons, the Coonrad-Morrey prosthesis may confer better implant longevity.
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Affiliation(s)
- Aparna I Viswanath
- Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand.
| | | | - Peter C Poon
- Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand
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18
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Siala M, Laumonerie P, Hedjoudje A, Delclaux S, Bonnevialle N, Mansat P. Outcomes of semiconstrained total elbow arthroplasty performed for arthritis in patients under 55 years old. J Shoulder Elbow Surg 2020; 29:859-866. [PMID: 31629652 DOI: 10.1016/j.jse.2019.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 07/29/2019] [Accepted: 08/07/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total elbow arthroplasty (TEA) is a treatment option for end-stage arthritis. Even though results are satisfactory for the elderly population, TEA surgery is subject to controversy in younger patients. The purpose of this study was to evaluate clinical and radiographic outcomes of semiconstrained TEA performed for arthritis in patients younger than 55 years. MATERIALS AND METHODS Between 1998 and 2008, 19 TEAs were implanted in 17 patients younger than 55 years (mean age, 46 years; range, 29-54 years). We assessed the indication for further surgery; range of motion; mean Mayo Elbow Performance Score; QuickDASH (short version of the Disabilities of the Arm, Shoulder and Hand questionnaire) score; radiolucent lines; and outcome measures that included implant survival, complications, and revisions. RESULTS The average follow-up period was 10 years (range, 2-16 years). Average range of motion significantly improved, from 120° (range, 90°-140°) to 140° (range, 130°-155°) for flexion and from 40° (range, 0°-60°) to 25° (range, 0°-90°) for extension. The average Mayo Elbow Performance Score was 85 (range, 55-100). During the study period, 11 elbows (58%) experienced complications and 8 (42%) underwent revision. Aseptic loosening (3 ulnar and 2 bipolar) was the main indication for revision. The survivorship rate without revision was 94% at 5 years and 75% at 10 years. CONCLUSIONS TEA gave satisfactory results in a younger patient population. However, a high rate of complications and revisions was observed with follow-up. Thus, TEA should be considered with caution in young patients, and other therapeutic options must be discussed.
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Affiliation(s)
- Mahdi Siala
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France.
| | - Pierre Laumonerie
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Abdellah Hedjoudje
- Department of Gastro-enterology, Centre hospitalier régional universitaire Jean Minjoz, Besançon, France
| | - Stephanie Delclaux
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Nicolas Bonnevialle
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Pierre Mansat
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France
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19
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Brinke BT, Kosse NM, Flikweert PE, van der Pluijm M, Eygendaal D. Long-term outcomes after Instrumented Bone Preserving total elbow arthroplasty: a radiostereometric study with a minimum follow-up of 10 years. J Shoulder Elbow Surg 2020; 29:126-131. [PMID: 31564575 DOI: 10.1016/j.jse.2019.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 07/01/2019] [Accepted: 07/08/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Aseptic loosening is a main concern in elbow arthroplasty. Evaluation of implant migration using radiostereometric analysis (RSA) might increase understanding of implant loosening. Previously, 2-year RSA results of 16 Instrumented Bone Preserving (IBP) elbow prostheses showed migration of the humeral component in the first weeks but most components stabilized within 6 months postoperatively. In follow-up, the present study evaluated long-term survival, the relation between early migration and survival, and the long-term migration and clinical outcomes. METHODS Sixteen patients who received an IBP prosthesis were prospectively followed with a median follow-up time of 136 months (range 82-165). Migration was measured using RSA. Clinical results were described using the Elbow Function Assessment (EFA), Broberg and Morrey elbow functional rating index, Oxford Elbow Score (OES), and visual analog scale (VAS) for pain and satisfaction. RESULTS Four patients underwent a revision within 10 years, and 2 more were planned for revision surgery after 14 years. Five patients died with their prosthesis in situ. Early migration was not associated with survival. Long-term migration patterns varied widely. Median EFA score was 58.5, Broberg and Morrey score was 50, and OES score was 32. Median VAS score for pain was 2 and that for satisfaction was 7.5. CONCLUSION Ten-year survival of the IBP total elbow prosthesis was 75%, decreasing to 63% after 14 years of follow-up. Long-term implant failure could not be predicted by 2-year migration results in this study. Although short-term clinical results were promising, long-term outcomes worsened in all patients.
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Affiliation(s)
- Bart Ten Brinke
- Department of Orthopaedic Surgery, Reinier de Graaf, Delft, the Netherlands.
| | - Nienke M Kosse
- Sint Maartenskliniek Research, Nijmegen, the Netherlands
| | - Petra E Flikweert
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Marco van der Pluijm
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam, the Netherlands; Department of Orthopaedic Surgery, Amphia Ziekenhuis, Breda, the Netherlands
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20
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Wang JH, Ma HH, Chou TFA, Tsai SW, Chen CF, Wu PK, Chen WM. Outcomes following total elbow arthroplasty for rheumatoid arthritis versus post-traumatic conditions: a systematic review and meta-analysis. Bone Joint J 2019; 101-B:1489-1497. [PMID: 31786989 PMCID: PMC6896228 DOI: 10.1302/0301-620x.101b12.bjj-2019-0799.r1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIMS The 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 METHODS We 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). RESULTS This 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. CONCLUSION The 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.
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Affiliation(s)
- Jou-Hua Wang
- Department of Orthopaedics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Hsuan-Hsiao Ma
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Te-Feng A Chou
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shang-Wen Tsai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Fong Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Po-Kuei Wu
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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21
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Parker P, Furness ND, Evans JP, White WJ, Smith CD. RETRACTED: A systematic review of the complications of contemporary total elbow arthroplasty. Shoulder Elbow 2019; 11:NP2-NP9. [PMID: 34394729 PMCID: PMC7094070 DOI: 10.1177/1758573219834934] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 01/30/2019] [Accepted: 02/09/2019] [Indexed: 11/15/2022]
Affiliation(s)
| | - Nicholas D Furness
- Shoulder & Elbow Unit, Royal Devon
& Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - Jonathan P Evans
- Shoulder & Elbow Unit, Royal Devon
& Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - William J White
- Shoulder & Elbow Unit, Princess
Elizabeth Orthopaedic Centre, Royal Devon & Exeter Hospital, Exeter, UK,William J White, Shoulder & Elbow Unit,
Princess Elizabeth Orthopaedic Centre, Royal Devon & Exeter Hospital,
Barrack Road, Exeter EX2 5DW, UK.
| | - Christopher D Smith
- Shoulder & Elbow Unit, Princess
Elizabeth Orthopaedic Centre, Royal Devon & Exeter Hospital, Exeter, UK
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22
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Kwak JM, Koh KH, Jeon IH. Total Elbow Arthroplasty: Clinical Outcomes, Complications, and Revision Surgery. Clin Orthop Surg 2019; 11:369-379. [PMID: 31788158 PMCID: PMC6867907 DOI: 10.4055/cios.2019.11.4.369] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/22/2019] [Indexed: 01/25/2023] Open
Abstract
Total elbow arthroplasty is a common surgical procedure used in the management of advanced rheumatoid arthritis, posttraumatic arthritis, osteoarthritis, and unfixable fracture in elderly patients. Total elbow prostheses have evolved over the years and now include the linked, unlinked, and convertible types. However, long-term complications, including infection, aseptic loosening, instability, and periprosthetic fracture, remain a challenge. Here, we introduce each type of implant and evaluate clinical outcomes and complications by reviewing the previous literature.
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Affiliation(s)
- Jae-Man Kwak
- Department of Orthopedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Kyoung-Hwan Koh
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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23
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D'Ambrosi R, Formiconi F, Ursino N, Rubino M. Treatment of complete ankylosed elbow with total arthroplasty. BMJ Case Rep 2019; 12:12/7/e231123. [PMID: 31331932 DOI: 10.1136/bcr-2019-231123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We reported the case of a 38-year-old patient who in 2017 presented to our institution after post-traumatic complete ankylosis of the elbow. He complained of stiffness and pain, and the radiographs revealed complete fusion of the humeroulnar joint. The Mayo Elbow Performance Score (MEPS) on admission was 31, and the elbow was fused at 90° flexed position. The patient underwent semiconstrained total elbow arthroplasty with Bryan-Morrey approach; after a 2.1 years follow-up, active arc of movement was 120°. The MEPS was excellent with a 100 points score, the patient was able to complete all activities of daily living. We did not report any complications. Total elbow arthroplasty has shown to be a good therapeutic option that make it possible to restore adequate functional range of motion and relieve pain in young patients with post-traumatic stiffness/arthritis of the elbow.
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Zhang D, Chen N. Total Elbow Arthroplasty. J Hand Surg Am 2019; 44:487-495. [PMID: 30635202 DOI: 10.1016/j.jhsa.2018.11.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 10/18/2018] [Accepted: 11/13/2018] [Indexed: 02/02/2023]
Abstract
Total elbow arthroplasty design has evolved in recent decades. Indications for total elbow arthroplasty include advanced rheumatoid arthritis to osteoarthritis, post-traumatic arthritis, adverse sequelae of trauma, and unreconstructable acute fractures. This article summarizes the current evidence for total elbow arthroplasty, including the history of total elbow arthroplasty, an overview of the recent trends and designs, and current evidence-based outcomes. Outcomes are assessed for specific indications, namely rheumatoid arthritis, osteoarthritis, post-traumatic arthritis, acute trauma, and younger patients. Complication rates, reoperation rates, and survivorship of modern prostheses are discussed. Technical pearls and pitfalls are discussed for primary and revision cases.
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Affiliation(s)
- Dafang Zhang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Neal Chen
- Harvard Medical School, Boston, MA; Department of Orthopaedic Surgery, Massachusetts Hospital, Boston, MA
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Merlet MC, Vaichinger AM, Cil A, O'Driscoll SW. Long-term outcome of custom triflange outrigger ulnar component in revision total elbow arthroplasty. J Shoulder Elbow Surg 2018; 27:2045-2051. [PMID: 30340805 DOI: 10.1016/j.jse.2018.07.003] [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: 01/05/2018] [Revised: 06/27/2018] [Accepted: 07/03/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients missing the distal humeral condyles are prone to premature bushing wear after total elbow arthroplasty. A midterm study has demonstrated that a custom triflange outrigger ulnar component was successful in preventing this. The aim of this study was to determine whether these results remained stable over time. MATERIALS AND METHODS The outcomes of 6 patients who underwent revision of a loose ulnar component using a custom triflange outrigger component were reviewed in this retrospective case study. The average patient age at the time of revision was 51. The average number of prior operations was 2 (range, 1-3). The mean follow-up was 15 years (range, 10-18 years). RESULTS At final follow-up, the mean range of extension-flexion was 35° to 135°, and pronation-supination was 65° to 63°. The average Mayo Elbow Performance Score improved to 75 of 100. Four implants were still in place with no radiolucencies or osteolysis. Three patients required revision surgery for broken humeral stems. Two required conversion to another total elbow arthroplasty system after 18 and 14 years for humeral component loosening. CONCLUSIONS These components lasted an average of 4 times longer than the original ulnar components. In our experience, periarticular osteolysis caused by polyethylene wear creates a region of unsupported stem and a stress riser at the junction with the remaining well-supported stem and causes component stem fractures. The concept of an outrigger type of hinge might be useful for active patients requiring an elbow prosthesis in the setting of deficient condyles.
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Affiliation(s)
- Marie Caroline Merlet
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery and Traumatology, Rouen University Hospital, Rouen, France
| | | | - Akin Cil
- Department of Orthopedic Surgery, Division of Shoulder, Elbow and Sports Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
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Pham TT, Delclaux S, Huguet S, Wargny M, Bonnevialle N, Mansat P. Coonrad-Morrey total elbow arthroplasty for patients with rheumatoid arthritis: 54 prostheses reviewed at 7 years' average follow-up (maximum, 16 years). J Shoulder Elbow Surg 2018; 27:398-403. [PMID: 29306664 DOI: 10.1016/j.jse.2017.11.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 11/02/2017] [Accepted: 11/06/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total elbow arthroplasty is a therapeutic option for severe rheumatoid arthritis. We hypothesized that the semiconstrained characteristics of the Coonrad-Morrey prosthesis do not compromise the survival rate of the implant in a rheumatoid elbow. METHODS Between 1997 and 2012, there were 54 Coonrad-Morrey total elbow prostheses performed for rheumatoid arthritis in 46 patients. Minimum follow-up was 2 years. There were 35 women and 11 men with a mean age of 60 years (29-83 years). According to the Mayo classification for rheumatoid elbow, there were 30 type IIIA, 21 type IIIB, and 3 type IV. The surgical procedure was the same for all patients. Survivorship was assessed with use of the Kaplan-Meier method, with revision surgery as the end point. RESULTS The survival rate was 97% (95% confidence interval, 83.6-99.6) at 5 years and 85% (95% confidence interval, 68.3-93.7) at 10 years. At an average of 7 years of follow-up (2-16 years), the mean Mayo Elbow Performance Score was 91 points (55-100 points), and the shortened version of the Disabilities of the Arm, Shoulder, and Hand score was 34 points (0-75 points). There was a significant improvement in Mayo Elbow Performance Score and in all range of motion at latest follow-up in comparison to preoperative values (P < .0001). Radiolucencies were observed in 6 cases around the humeral component and in 6 cases around the ulnar component. Bushing wear was observed in 16 cases (29%). There were 14 complications (26%). Revisions were performed in 6 of them (11%). CONCLUSION The Coonrad-Morrey prosthesis provides satisfactory results with follow-up. The rate of complications remains high even if the rate of implant revision stayed low.
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Affiliation(s)
- Thuy Trang Pham
- Service de Chirurgie Orthopédique et Traumatologique Pédiatrique, Hôpital des Enfants, Toulouse, France.
| | - Stéphanie Delclaux
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Pierre Paul Riquet, CHU Toulouse, Toulouse, France
| | - Sandrine Huguet
- Service de Chirurgie de la Main et de Chirurgie Plastique et Reconstructrice de l'Appareil Locomoteur, Centre Chirurgical Emile Gallé, Nancy, France
| | | | - Nicolas Bonnevialle
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Pierre Paul Riquet, CHU Toulouse, Toulouse, France
| | - Pierre Mansat
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Pierre Paul Riquet, CHU Toulouse, Toulouse, France
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Mehta SS, Watts AC, Talwalkar SC, Birch A, Nuttall D, Trail IA. Early results of Latitude primary total elbow replacement with a minimum follow-up of 2 years. J Shoulder Elbow Surg 2017; 26:1867-1872. [PMID: 28844418 DOI: 10.1016/j.jse.2017.06.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 06/13/2017] [Accepted: 06/19/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to present outcomes of primary Latitude total elbow replacement (TER) with a minimum follow-up of 2 years. METHODS A retrospective cohort study was undertaken with prospective outcome data collection for the latest outcome. Included were 63 consecutive primary Latitude TERs in 58 patients performed during a period of 5 years at a specialist orthopedic hospital. RESULTS The mean age of the patients was 62 years (33-85 years). Five primary TERs (4 patients) were lost to follow-up. The primary diagnosis was rheumatoid arthritis in 49, osteoarthritis in 8, and trauma in 6 elbows. The mean flexion-extension arc was 75° preoperatively and 97° postoperatively. Mean postoperative Elbex pain score was 19/100, and function score was 37/100. Mean postoperative scores were 42/100 for the Quick Disabilities of the Arm, Shoulder, and Hand and 38/50 for the elbow-specific American Shoulder and Elbow Surgeons assessment. Four patients died of unrelated causes, and 8 of 63 underwent further surgical intervention, including explantation and conversion from unlinked to linked implant. On radiographic review of 41 surviving TERs, aseptic radiologic loosening was observed of the humeral component in 4 elbows and of the ulnar component in 9. Seven elbows had no radial component, and of the remaining 34 elbows, 16 (47%) had signs of loosening of the radial implant. Complications included 1 heterotopic ossification, 1 olecranon fracture, and 3 further procedures for ulnar nerve entrapment. CONCLUSION The results indicate that the early outcome of Latitude TER is comparable to that of other prostheses. There is concern about early radiologic loosening of the radial component.
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Affiliation(s)
- Saurabh S Mehta
- Upper Limb Unit, Department of Orthopaedics, Wrightington Hospital, Appley Bridge, Wigan, UK
| | - Adam C Watts
- Upper Limb Unit, Department of Orthopaedics, Wrightington Hospital, Appley Bridge, Wigan, UK
| | - Sumedh C Talwalkar
- Upper Limb Unit, Department of Orthopaedics, Wrightington Hospital, Appley Bridge, Wigan, UK
| | - Ann Birch
- Upper Limb Unit, Department of Orthopaedics, Wrightington Hospital, Appley Bridge, Wigan, UK
| | - David Nuttall
- Upper Limb Unit, Department of Orthopaedics, Wrightington Hospital, Appley Bridge, Wigan, UK
| | - Ian A Trail
- Upper Limb Unit, Department of Orthopaedics, Wrightington Hospital, Appley Bridge, Wigan, UK.
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Lami D, Chivot M, Caubere A, Galland A, Argenson JN. First-line management of distal humerus fracture by total elbow arthroplasty in geriatric traumatology: Results in a 21-patient series at a minimum 2years' follow-up. Orthop Traumatol Surg Res 2017; 103:891-897. [PMID: 28733108 DOI: 10.1016/j.otsr.2017.06.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 04/30/2017] [Accepted: 06/06/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Total elbow arthroplasty (TEA) is one option in distal humerus fracture in elderly osteoporotic patients. HYPOTHESIS The study hypothesis was that, in patients aged 70years or more, TEA provides functional results and ranges of motion compatible with everyday activity, with a complications rate equal to or lower than with internal fixation, and no loss of autonomy or cognitive impairment. MATERIAL AND METHODS In this retrospective study, 21 patients receiving TEA for distal humerus fracture were included. Mean follow-up was 3.2years, with functional (Quick DASH and MEPS), cognitive (MMSE), autonomy-related (ADL) and radiological assessment (Morrey). RESULTS Mean MEPS was 84 and QuickDASH 32.4. Mean extension deficit was 22°, and mean flexion 125°. There was no loss of autonomy or cognitive impairment. The complications rate was 9.5%. There were no revision surgeries. DISCUSSION TEA proved reliable in comminuted distal humerus fracture in elderly patients. Functional results were comparable to those in the literature, and the complications rate was lower. Long-term implant survival needs confirmation to validate this option as a treatment of choice in these indications in geriatric traumatology. TYPE OF STUDY Retrospective non-comparative, single-center. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- D Lami
- UMR CNRS 787/AMU, Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, 270, boulevard Sainte Marguerite, BP 29, 13274 Marseille, France.
| | - M Chivot
- UMR CNRS 787/AMU, Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, 270, boulevard Sainte Marguerite, BP 29, 13274 Marseille, France
| | - A Caubere
- UMR CNRS 787/AMU, Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, 270, boulevard Sainte Marguerite, BP 29, 13274 Marseille, France
| | - A Galland
- Institut de la main et du membre supérieur, clinique Monticelli, 393, avenue du prado, 13008 Marseille, France
| | - J N Argenson
- UMR CNRS 787/AMU, Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, 270, boulevard Sainte Marguerite, BP 29, 13274 Marseille, France
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Frostick SP, Elsheikh AA, Mohammed AA, Wood A. Results of cementless total elbow arthroplasty using the Discovery elbow system at a mean follow-up of 61.8 months. J Shoulder Elbow Surg 2017; 26:1348-1354. [PMID: 28601487 DOI: 10.1016/j.jse.2017.03.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/21/2017] [Accepted: 03/27/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The available literature on the use of a cementless total elbow arthroplasty (TEA) design and its results are limited. This clinical study reports the outcome of the cementless Discovery elbow system. METHODS Patients were operated on by a single surgeon between 2007 and 2014. Nineteen patients (20 elbows) were available for review, 2 women (1 bilateral TEA) and 17 men. The age of the patients ranged from 27 to 75 years (mean, 48 years). The mean follow-up was 61.8 months (range, 12-156 months). Patients were assessed for range of motion, pain, and satisfaction level. Outcome scores included the Mayo Elbow Performance Score, the Liverpool Elbow Score, and the 12-Item Short Form Health Survey (version 1). Radiographs were reviewed to evaluate for loosening. RESULTS The mean Mayo Elbow Performance Score was 77.25, and the mean Liverpool Elbow Score was 6.76. The mean flexion range was 123°, and the mean extension lag was 35°. The mean pronation was 59°, and the mean supination was 58°. On radiologic evaluation, there were no signs of loosening; however, in 2 cases, nonprogressive radiolucent lines were observed. No signs of infection were detected at final follow-up, and no elbows were revised. More than 90% of patients were satisfied with the overall outcome. CONCLUSION The cementless TEA seems to be a reliable option for treatment of varying elbow diseases. Long-term results are needed to assess the survivorship of this design.
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Affiliation(s)
- Simon P Frostick
- Musculoskeletal Science Research Group, Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
| | | | | | - Amanda Wood
- Musculoskeletal Science Research Group, Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
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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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Ten Brinke B, Beumer A, Koenraadt KLM, Eygendaal D, Kraan GA, Mathijssen NMC. The accuracy and precision of radiostereometric analysis in upper limb arthroplasty. Acta Orthop 2017; 88:320-325. [PMID: 28464752 PMCID: PMC5434603 DOI: 10.1080/17453674.2017.1291872] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Radiostereometric analysis (RSA) is an accurate method for measurement of early migration of implants. Since a relation has been shown between early migration and future loosening of total knee and hip prostheses, RSA plays an important role in the development and evaluation of prostheses. However, there have been few RSA studies of the upper limb, and the value of RSA of the upper limb is not yet clear. We therefore performed a systematic review to investigate the accuracy and precision of RSA of the upper limb. Patients and methods - PRISMA guidelines were followed and the protocol for this review was published online at PROSPERO under registration number CRD42016042014. A systematic search of the literature was performed in the databases Embase, Medline, Cochrane, Web of Science, Scopus, Cinahl, and Google Scholar on April 25, 2015 based on the keywords radiostereometric analysis, shoulder prosthesis, elbow prosthesis, wrist prosthesis, trapeziometacarpal joint prosthesis, humerus, ulna, radius, carpus. Articles concerning RSA for the analysis of early migration of prostheses of the upper limb were included. Quality assessment was performed using the MINORS score, Downs and Black checklist, and the ISO RSA Results - 23 studies were included. Precision values were in the 0.06-0.88 mm and 0.05-10.7° range for the shoulder, the 0.05-0.34 mm and 0.16-0.76° range for the elbow, and the 0.16-1.83 mm and 11-124° range for the TMC joint. Accuracy data from marker- and model-based RSA were not reported in the studies included. Interpretation - RSA is a highly precise method for measurement of early migration of orthopedic implants in the upper limb. However, the precision of rotation measurement is poor in some components. Challenges with RSA in the upper limb include the symmetrical shape of prostheses and the limited size of surrounding bone, leading to over-projection of the markers by the prosthesis. We recommend higher adherence to RSA guidelines and encourage investigators to publish long-term follow-up RSA studies.
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Affiliation(s)
- Bart Ten Brinke
- Department of Orthopaedic Surgery, Amphia Ziekenhuis, Breda;,Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft;,Correspondence:
| | | | - Koen L M Koenraadt
- FORCE Foundation, Department of Orthopaedic Surgery, Amphia Ziekenhuis, Breda
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Amphia Ziekenhuis, Breda;,Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Gerald A Kraan
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft
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Kane PM, Stull JD, Culp RW. Concomitant Total Wrist and Total Elbow Arthroplasty in a Rheumatoid Patient. J Wrist Surg 2016; 5:137-142. [PMID: 27104080 PMCID: PMC4838467 DOI: 10.1055/s-0035-1569483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 07/14/2015] [Indexed: 10/22/2022]
Abstract
Background Concomitant arthroplasty has been described to have several benefits over multistage procedures. Ipsilateral total elbow and total shoulder arthroplasty has been reported with good outcomes in upper extremity concomitant arthroplasty. Case Description A 65-year-old woman presented with ipsilateral left-sided wrist and elbow joint degeneration as a result of longstanding rheumatoid arthritis. Concomitant total wrist and total elbow arthroplasty was performed with satisfactory results at both joints. She tolerated the procedure well and had an uneventful clinical course postoperatively. Literature Review Currently, no literature exists that describes one-stage total wrist and total elbow arthroplasty. Individually, total wrist and total elbow arthroplasty have both been reported to result in good outcomes and patient satisfaction. Previous studies have reported the utility of concomitant ipsilateral upper extremity procedures with a one-stage total elbow and total shoulder arthroplasty having been identified as a cost-saving procedure with expedited return to functionality versus a two-stage procedure. Clinical Relevance Patients with ipsilateral degenerative changes in the wrist and elbow should be considered on an individual case basis for concomitant total wrist and total elbow arthroplasty.
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Affiliation(s)
| | - Justin D. Stull
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Randall W. Culp
- The Philadelphia Hand Center, Philadelphia, Pennsylvania
- Department of Orthopaedic Surgery at Thomas Jefferson University, Philadelphia, Pennsylvania
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Bigsby E, Kemp M, Siddiqui N, Blewitt N. The long-term outcome of the Gschwend-Scheier-Bähler III elbow replacement. J Shoulder Elbow Surg 2016; 25:362-8. [PMID: 26776944 DOI: 10.1016/j.jse.2015.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 10/08/2015] [Accepted: 10/18/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Gschwend-Scheier-Bähler III (GSBIII) is a semiconstrained, sloppy-hinge total elbow replacement. We report the long-term functional and radiological outcome of a cohort of patients more than 10 years after surgery. METHODS All GSBIII prostheses implanted from September 1996 to June 2004 were identified from our surgical database. Functional and radiological assessments were performed at routine patient clinic visits, using the Oxford Elbow Score, the 11-item version of the Disabilities of Arm, Shoulder and Hand score (QuickDASH), and plain radiographs. RESULTS From 1996 to 2004, 52 elbows in 40 patients were implanted; of these, 18 patients (23 elbows) had died, leaving 22 patients with 29 elbows available for follow-up. Three patients (3 elbows) could not be contacted. Functional and radiological data were available for 19 patients with 26 elbows (90%). Overall survival was a mean of 13.1 years (range, 10.6-16.4 years). Mean age at operation was 63.0 years (range, 49.5-80.6 years). There were 5 male elbows and 21 female elbows. Five total elbow replacements were performed for osteoarthritis and 24 for rheumatoid arthritis. The mean Oxford Elbow Score was 26.9 (range, 18-48). The mean QuickDASH score was 42.6 (range, 2.5-93.2). Of the 52 elbows in 40 patients, 4 elbows (7.7%) required further surgery, 2 (3.8%) of which were revisions. In addition, there was 1 intraoperative complication and 2 postoperative complications not requiring further surgery. Kaplan-Meier 10-year survival shows a 95.9% implant survival with revision as the end point. CONCLUSIONS The GSBIII elbow replacement provides good long-term function with a low revision rate and few complications. LEVEL OF EVIDENCE Level IV; Case Series; Treatment Study.
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Affiliation(s)
- Ewan Bigsby
- Trauma and Orthopaedic Department, Southmead Hospital, Bristol, UK.
| | - Mark Kemp
- Trauma and Orthopaedic Department, Southmead Hospital, Bristol, UK
| | - Nashat Siddiqui
- Trauma and Orthopaedic Department, Kingston Hospital, Kingston upon Thames, UK
| | - Neil Blewitt
- Trauma and Orthopaedic Department, Southmead Hospital, Bristol, UK
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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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Pogliacomi F, Aliani D, Cavaciocchi M, Corradi M, Ceccarelli F, Rotini R. Total elbow arthroplasty in distal humeral nonunion: clinical and radiographic evaluation after a minimum follow-up of three years. J Shoulder Elbow Surg 2015; 24:1998-2007. [PMID: 26475638 DOI: 10.1016/j.jse.2015.08.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/07/2015] [Accepted: 08/09/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total elbow arthroplasties (TEAs) are usually indicated in chronic inflammatory arthropathies. This procedure has also recently been used in complex distal humeral fractures and nonunions in selected patients. This study analyzed the clinical and radiographic outcomes in patients treated for nonunions around the elbow region with a minimum follow-up of 3 years. METHODS Between May 2002 and June 2012, 20 patients affected with distal humeral nonunions were treated with TEA. All patients were assessed clinically using the Mayo Elbow Performance Score and radiographically to evaluate the positioning of the prosthetic components and signs of loosening. Statistical analyses were performed to investigate the presence of clinical and radiographic variables as predictive factors of poor functional outcomes. RESULTS The Mayo Elbow Performance Score of the affected arm improved significantly between the preoperative period and follow-up. Results were good or excellent in 90% of the patients even if a high rate of complications (30%) was encountered. The development of complications after surgery and stages II, III, and IV radiolucency, according to the Morrey criteria, were predictive factors of poor outcomes. CONCLUSIONS According to the satisfactory results observed in this study, TEA could be indicated in selected patients aged older than 70 years with low functional demands and affected with distal humeral nonunions in which obtaining a stable fixation is difficult.
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Affiliation(s)
| | - Davide Aliani
- Orthopaedic and Traumatologic Department, University of Parma, Parma, Italy.
| | | | - Maurizio Corradi
- Orthopaedic and Traumatologic Department, University of Parma, Parma, Italy
| | | | - Roberto Rotini
- Shoulder and Elbow Unit, Rizzoli Orthopedic Institute, Bologna, Italy
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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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Complications and revisions after semi-constrained total elbow arthroplasty: a mono-centre analysis of one hundred cases. INTERNATIONAL ORTHOPAEDICS 2015; 40:73-80. [DOI: 10.1007/s00264-015-3008-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 09/21/2015] [Indexed: 12/29/2022]
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Wagener ML, de Vos MJ, Hannink G, van der Pluijm M, Verdonschot N, Eygendaal D. Mid-term clinical results of a modern convertible total elbow arthroplasty. Bone Joint J 2015; 97-B:681-8. [DOI: 10.1302/0301-620x.97b5.34841] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Unlinked, linked and convertible total elbow arthroplasties (TEAs) are currently available. This study is the first to report the clinical results of the convertible Latitude TEA. This was a retrospective study of a consecutive cohort of 63 patients (69 primary TEAs) with a mean age of 60 years (23 to 87). Between 2006 and 2008 a total of 19 men and 50 women underwent surgery. The mean follow-up was 43 months (8 to 84). The range of movement, function and pain all improved six months post-operatively and either continued to improve slightly or reached a plateau thereafter. The complication rate is similar to that reported for other TEA systems. No loosening was seen. Remarkable is the disengagement of the radial head component in 13 TEAs (31%) with a radial head component implanted. Implantation of both the linked and the unlinked versions of the Latitude TEA results in improvement of function and decreased pain, and shows high patient satisfaction at mid-term follow-up. Cite this article: Bone Joint J 2015; 97-B:681–8.
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Affiliation(s)
- M. L. Wagener
- Rijnstate Hospital, PO
Box 9555, 6800TA Arnhem, The
Netherlands
| | - M. J. de Vos
- Ter Gooi Hospital, PO
Box 10016, 1201DA Hilversum, The
Netherlands
| | - G. Hannink
- Radboud University Medical Center, PO
Box 9101, 6500HB Nijmegen, The Netherlands
| | | | - N. Verdonschot
- Radboud University Medical Center, PO
Box 9101, 6500HB Nijmegen, The Netherlands
| | - D. Eygendaal
- Amphia Hospital, PO
Box 90157, 4800RL Breda, The
Netherlands
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40
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Dachs RP, Fleming MA, Chivers DA, Carrara HR, Du Plessis JP, Vrettos BC, Roche SJ. Total elbow arthroplasty: outcomes after triceps-detaching and triceps-sparing approaches. J Shoulder Elbow Surg 2015; 24:339-47. [PMID: 25591460 DOI: 10.1016/j.jse.2014.11.038] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 11/03/2014] [Accepted: 11/09/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total elbow arthroplasty (TEA) is associated with high complication rates compared with other large-joint arthroplasties. The frequency and type of complication may differ, depending on the surgical approach. A comparison of outcomes with triceps-off and triceps-on approaches was investigated. METHODS Seventy-three patients underwent 83 primary TEAs between 2003 and 2012. Forty-six elbows had a triceps-off approach, and 37 had a triceps-on approach. Results were reviewed at a mean of 4.2 years. Cementing technique was graded according to Morrey's criteria, and clinical outcomes were assessed by means of the Mayo Elbow Performance Score. RESULTS There was no statistically significant difference between the triceps-off and triceps-on groups with regard to the patient's age, gender, preoperative Mayo Elbow Performance Score or range of motion, or previous surgery on the affected elbow. Among patients who underwent a TEA for an inflammatory arthropathy, there was a significant difference in outcome between groups with regard to final flexion, extension, arc of motion, and pronation. Cementing technique in the triceps-off group was adequate in 70%. In the triceps-on group, cementing technique was adequate in 92%. The complication rate in the triceps-off group was 32.6% and included 7 triceps ruptures. Three patients who had attempted repairs of the triceps rupture developed deep infections requiring multiple further surgeries. The complication rate in the triceps-on group was 8.1%. CONCLUSION A triceps-on approach in TEA results in consistently good clinical outcomes with no risk of triceps rupture, and the approach does not compromise the cement mantle. We believe that this approach will reduce complication rates in TEA.
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Affiliation(s)
- Robert P Dachs
- Department of Orthopaedic Surgery, University of Cape Town, Cape Town, South Africa.
| | - Mark A Fleming
- Department of Orthopaedic Surgery, University of Cape Town, Cape Town, South Africa
| | - David A Chivers
- Department of Orthopaedic Surgery, University of Cape Town, Cape Town, South Africa
| | - Henri R Carrara
- Department of Medical Statistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Basil C Vrettos
- Department of Orthopaedic Surgery, University of Cape Town, Cape Town, South Africa
| | - Stephen J Roche
- Department of Orthopaedic Surgery, University of Cape Town, Cape Town, South Africa
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Large R, Tambe A, Cresswell T, Espag M, Clark DI. Medium-term clinical results of a linked total elbow replacement system. Bone Joint J 2014; 96-B:1359-65. [PMID: 25274922 DOI: 10.1302/0301-620x.96b10.33815] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Medium-term results of the Discovery elbow replacement are presented. We reviewed 51 consecutive primary Discovery total elbow replacements (TERs) implanted in 48 patients. The mean age of the patients was 69.2 years (49 to 92), there were 19 males and 32 females (37%:63%) The mean follow-up was 40.6 months (24 to 69). A total of six patients were lost to follow-up. Statistically significant improvements in range movement and Oxford Elbow Score were found (p < 0.001). Radiolucent lines were much more common in, and aseptic loosening was exclusive to, the humeral component. Kaplan-Meier survivorship at five years was 92.2% (95% CI 74.5% to 96.4%) for aseptic loosening. In four TERs, periprosthetic infection occurred resulting in failure. A statistically significant association between infection and increased BMI was found (p = 0.0268). Triceps failure was more frequent after the Mayo surgical approach and TER performed after previous trauma surgery. No failures of the implant were noted. Our comparison shows that the Discovery has early clinical results that are similar to other semi-constrained TERs. We found continued radiological surveillance with particular focus on humeral lucency is warranted and has not previously been reported. Despite advances in the design of total elbow replacement prostheses, rates of complication remain high.
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Affiliation(s)
- R Large
- Mornington Orthopaedics, Beleura Private Hospital, 925 Nepean Highway, Mornington, Victoria, 3931, Australia
| | - A Tambe
- Royal Derby Hospital, Department of Orthopaedics, Uttoxeter New Road, Derby DE22 3NE, UK
| | - T Cresswell
- Royal Derby Hospital, Department of Orthopaedics, Uttoxeter New Road, Derby DE22 3NE, UK
| | - M Espag
- Royal Derby Hospital, Department of Orthopaedics, Uttoxeter New Road, Derby DE22 3NE, UK
| | - D I Clark
- Royal Derby Hospital, Department of Orthopaedics, Uttoxeter New Road, Derby DE22 3NE, UK
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Dunn J, Kusnezov N, Pirela-Cruz M. Distal humeral hemiarthroplasty: indications, results, and complications. A systematic review. Hand (N Y) 2014; 9:406-12. [PMID: 25414601 PMCID: PMC4235903 DOI: 10.1007/s11552-014-9681-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Distal humeral hemiarthroplasty (DHH) is a treatment option for unreconstructable intra-articular distal humerus fractures. DHH may also be used in the setting of rheumatoid arthritis, orthopaedic tumor with significant bone loss, malunion, or osteomyelitis. DHH has specific advantages over other, more common, treatment modalities: total elbow arthroplasty (TEA) and open reduction internal fixation (ORIF). DHH is especially a reasonable option in younger patients to preserve bone stock, avoid significant weight restrictions, and limit loosening. METHODS The literature was reviewed for all cases of DHH for fracture and non-fracture indications between 1947 and 2014. Two hundred thirty-six papers were identified; 4 studies including 17 patients met criteria for non-fracture indications and 13 studies including 116 patients were identified for fracture indications. A systematic review was generated; patient indications, outcomes, and complications were recorded. RESULTS For non-fracture indications, good to excellent results were achieved in 76.5 % of patients with a mean arc of motion of 62° at mean follow up of 46.3 months. Half of the patients experienced a complication, most commonly stiffness. Loosening of the prosthesis was not noted in any patient. For fractures, good to excellent results were achieved in 67.4 % of patients with a mean arc of motion of 98.3° at a mean follow up of 42.2 months. One third of the patients experienced a complication but only 1.7 % experienced loosening of the prosthesis. CONCLUSION Here, we present the first review of the indications for DHH. DHH is a reasonable treatment option for older patients with unreconstructable intra-articular fractures of the distal humerus as well as younger patients with rheumatoid arthritis, orthopaedic tumor with significant bone loss, malunion, or osteomyelitis.
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Affiliation(s)
- John Dunn
- William Beaumont Army Medical Center, Department of Orthopaedic Surgery, 5005 N Piedras, Fort Bliss, TX 79920 USA
| | - Nicholas Kusnezov
- William Beaumont Army Medical Center, Department of Orthopaedic Surgery, 5005 N Piedras, Fort Bliss, TX 79920 USA
| | - Miguel Pirela-Cruz
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, 4800 Alberta Avenue, El Paso, TX 79920 USA
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Pham TT, Bonnevialle N, Rongières M, Bonnevialle P, Mansat P. Mechanical failure of the Coonrad-Morrey linked total elbow arthroplasty: A case report. Orthop Traumatol Surg Res 2014; 100:831-4. [PMID: 25262098 DOI: 10.1016/j.otsr.2014.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 05/16/2014] [Accepted: 07/25/2014] [Indexed: 02/02/2023]
Abstract
Semiconstrained (linked design) total elbow arthroplasty is indicated in a wide variety of cases. Long-term survival is better than with non-linked prostheses. However, mechanical failure of the hinge mechanism is a complication that may occur during follow-up. We report a case of failure of the axle assembly of a Coonrad-Morrey elbow prosthesis 8 years after implantation for nonunion of a supracondylar distal humerus fracture. Initial revision surgery included changing the axle and the polyethylene bushings. Revision surgery was necessary 1 year later when the axle failed again. A custom-designed locking axle had to be used to stabilize the hinge mechanism. After 3 years follow-up, the hinge was intact, there was no loosening of the components and function of the elbow was good.
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Affiliation(s)
- T T Pham
- Institut de l'appareil locomoteur du CHU de Toulouse, Département d'Orthopédie et traumatologie, Hôpital Pierre-Paul-Riquet, place du Docteur-Baylac, 31059 Toulouse Cedex, France
| | - N Bonnevialle
- Institut de l'appareil locomoteur du CHU de Toulouse, Département d'Orthopédie et traumatologie, Hôpital Pierre-Paul-Riquet, place du Docteur-Baylac, 31059 Toulouse Cedex, France
| | - M Rongières
- Institut de l'appareil locomoteur du CHU de Toulouse, Département d'Orthopédie et traumatologie, Hôpital Pierre-Paul-Riquet, place du Docteur-Baylac, 31059 Toulouse Cedex, France
| | - P Bonnevialle
- Institut de l'appareil locomoteur du CHU de Toulouse, Département d'Orthopédie et traumatologie, Hôpital Pierre-Paul-Riquet, place du Docteur-Baylac, 31059 Toulouse Cedex, France
| | - P Mansat
- Institut de l'appareil locomoteur du CHU de Toulouse, Département d'Orthopédie et traumatologie, Hôpital Pierre-Paul-Riquet, place du Docteur-Baylac, 31059 Toulouse Cedex, France.
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Implant survival after total elbow arthroplasty: a retrospective study of 324 procedures performed from 1980 to 2008. J Shoulder Elbow Surg 2014; 23:829-36. [PMID: 24766794 DOI: 10.1016/j.jse.2014.02.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 02/04/2014] [Accepted: 02/10/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total elbow arthroplasty (TEA) is an established treatment for late-stage arthritis of the elbow. Indications have expanded to osteoarthritis and nonunion in distal humeral fractures. Information on implant survival and risk factors for revision is still sparse. The aim of this study was to evaluate implant survival and risk factors for revision of TEAs inserted in patients in the eastern part of Denmark in the period from 1980 until 2008. MATERIAL AND METHODS The Danish National Patient Register provided personal identification numbers for patients who underwent TEA procedures from 1980 until 2008. On the basis of a review of medical reports and linkage to the National Patient Register, we calculated revision rates and evaluated potential risk factors for revision, including, age, sex, period, indication for TEA, and implant design. RESULTS We evaluated 324 primary TEA procedures in 234 patients at a mean follow-up of 8.7 years (range, 0-27 years). The overall 5-year survival was 90% (95% confidence interval [CI], 88%-94%), and 10-year survival was 81% (95% CI, 76%-86%). TEAs performed with the unlinked design had a relative risk of revision of 1.9 (95% CI, 1.1-3.2) compared with the linked design. Fracture sequelae was associated with a relative risk of revision of 1.9 (95% CI, 1.05-3.45). CONCLUSIONS We found acceptable implant survival rates after 5 and 10 years, with a higher revision rate for the unlinked design and primary TEA due to fracture sequelae. Patient-related outcome measures should be included in future studies for further elaboration of the outcomes after TEA. LEVEL OF EVIDENCE Level III, Retrospective cohort design, treatment study.
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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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deVos MJ, Verdonschot N, Luites JWH, Anderson PG, Eygendaal D. Stable fixation of the IBP humeral component implanted without cement in total elbow replacement: a radiostereometric analysis study of 16 elbows at two-year follow-up. Bone Joint J 2014; 96-B:229-36. [PMID: 24493189 DOI: 10.1302/0301-620x.96b2.29050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We determined the short-term clinical outcome and migration within the bone of the humeral cementless component of the Instrumented Bone Preserving (IBP) total elbow replacement in a series of 16 patients. There were four men and 12 women with a mean age at operation of 63 years (40 to 81). Migration was calculated using radiostereometric analysis. There were no intra-operative complications and no revisions. At two-year follow-up, all patients showed a significant reduction in pain and functional improvement of the elbow (both p < 0.001). Although ten components (63%) showed movement or micromovement during the first six weeks, 14 (88%) were stable at one year post-operatively. Translation was primarily found in the proximal direction (median 0.3 mm (interquartile range (IQR) -0.09 to 0.8); the major rotational movement was an anterior tilt (median 0.7° (IQR 0.4° to 1.6°)). One malaligned component continued to migrate during the second year, and one component could not be followed beyond three months because migration had caused the markers to break off the prosthesis. This study shows promising early results for the cementless humeral component of the IBP total elbow replacement. All patients had a good clinical outcome, and most components stabilised within six months of the operation.
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Affiliation(s)
- M J deVos
- Ter Gooi Hospital, Department of Orthopaedics, P. O. Box 10016, 1201DA, Hilversum, the Netherlands
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