Long-term outcomes after Instrumented Bone Preserving total elbow arthroplasty: a radiostereometric study with a minimum follow-up of 10 years

Patient-specific instrumentation technology enhances clinical outcomes in total elbow arthroplasty

OBJECTIVE

To evaluate and compare the outcomes of utilizing patient-specific instrumentation (PSI) technology, which incorporates personalized three-dimensional (3D) preoperative planning and customized 3D printing (3DP) osteotomy guides, against those achieved with traditional instruments in total elbow arthroplasty (TEA).

METHODS

A retrospective study was conducted to analyze the clinical data of 20 patients diagnosed with elbow arthritis who underwent TEA at the Center for Joint Surgery, The First Hospital Affiliated to Army Medical University, China, between January 2010 and July 2023. Patients were categorized into two groups according to the surgical techniques employed: 9 patients underwent personalized preoperative 3D planning and used customized 3DP osteotomy guides for TEA (3DP group); another 11 patients underwent TEA using traditional instruments and experience-based techniques (traditional group). The intraoperative fluoroscopy frequency, Mayo elbow performance score (MEPS), and Mayo elbow score before and after surgery in both groups were recorded. Additionally, in the 3DP group, changes in the imaging indicators such as the angle between the axis of humerus medullary cavity and the hinge axis of elbow (H-H angle), the angle between the axis of middle ulna medullary cavity and the hinge axis of elbow (MU-H angle), the angle between the axis of proximal ulna medullary cavity and the hinge axis of elbow (PU-H angle) were assessed before and after surgery.

RESULTS

No significant differences were observed in the baseline characteristics between the 3DP group and the traditional group (P > 0.05). We followed all patients for a period ranging from 12 to 36 months, with an average follow-up duration of 14.8 months. When comparing the two groups, the 3DP group required fewer intraoperative fluoroscopic view (P < 0.01). Postoperatively, the 3DP group showed notable improvements in the H-H angle, MU-H angle, and PU-H angle, all of which were significantly better than those in the traditional group (P < 0.01). Despite these advantages, the postoperative MEPS and Mayo elbow function scores did not differ significantly between the 3DP and traditional groups (P > 0.05).

CONCLUSION

Compared with traditional surgical methods, the use of PSI technology with preoperative 3D planning and customized 3DP osteotomy guides can significantly reduce the number of intraoperative fluoroscopies, which enhances both the efficiency and safety of TEA. PSI technology facilitates more accurate angle correction during elbow arthroplasty, ensuring precise osteotomies and effective correction of joint deformities.

Long-term outcomes of total elbow arthroplasty: a systematic review of studies at 10-year follow-up

BACKGROUND

The purpose of this study was to systematically review the literature to evaluate the functional outcomes, dislocation, and revision rates following total elbow arthroplasty (TEA) at a minimum 10 years' mean follow-up.

MATERIALS AND METHODS

Two independent reviewers performed a literature search using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using PubMed, Embase, and Cochrane Library databases. Studies were only included if they focused on outcomes post-TEA at a minimum 10 years' mean follow-up.

RESULTS

Our search found 23 studies including 1429 elbows (60.4% linked TEA) that met our inclusion criteria. There were 1276 patients (79.0% female), with an average age of 64.7 years (19-93) and a mean follow-up of 137.2 months (120-216). At final follow-up, the mean Mayo Elbow Performance Score, Oxford Elbow Score, and Quick Disabilities of the Arm, Shoulder, and Hand scores were 89.1 (35-100), 64.4 (16-48), and 39.2 (3-93), respectively, and 63.3% of patients reported having no pain. The rates of aseptic loosening, infection, implant dislocation, and nerve injury were 12.9%, 3.3%, 4.2%, and 2.1%, respectively. The overall complication and revision rates were 16.3% and 14.6%, respectively.

DISCUSSION AND CONCLUSION

Our systematic review established that TEA offers patients satisfactory clinical outcomes at long-term follow-up, with relatively stable revision and complication rates compared to short and medium term.