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Jonsson EÖ, Ekholm C, Hallgren HB, Nestorson J, Etzner M, Adolfsson L. Elbow hemiarthroplasty and total elbow arthroplasty provided a similar functional outcome for unreconstructable distal humeral fractures in patients aged 60 years or older: a multicenter randomized controlled trial. J Shoulder Elbow Surg 2024; 33:343-355. [PMID: 37778655 DOI: 10.1016/j.jse.2023.08.026] [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: 02/16/2023] [Revised: 08/11/2023] [Accepted: 08/27/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Semiconstrained total elbow arthroplasty (TEA) is an established treatment for elderly patients with distal humeral fractures not amenable to stable internal fixation (unreconstructable). In recent years, there has been increasing interest in elbow hemiarthroplasty (EHA), a treatment option which does not entail restrictions on weight-bearing as opposed to TEA. These 2 treatments have not been compared in a randomized controlled trial (RCT). The aim of this study was to compare the functional outcome of EHA and TEA for the treatment of unreconstructable distal humeral fractures in elderly patients. MATERIAL AND METHODS This was a multicenter randomized controlled trial (RCT). Patients were included between January 2011 and November 2019 at one of 3 participating hospitals. The inclusion criteria were an unreconstructable distal humeral fracture, age ≥60 years and independent living. The final follow-up took place after ≥2 years. The primary outcome measure was the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Secondary outcome measures were the Mayo Elbow Performance Score (MEPS), the EQ-5D index, range of motion (flexion, extension, pronation, and supination) and grip strength. RESULTS Forty patients were randomized to TEA (n = 20) and EHA (n = 20). Five patients died before completing the final follow-up, leaving 18 EHA and 17 TEA patients for analysis. There were 31 women. The mean age was 74.0 (SD, 8.5) years in the EHA group and 76.9 (SD, 7.6) in the TEA group (P = .30). The mean DASH score was 21.6 points in the EHA group and 27.2 in the TEA group (P = .39), a difference of -5.6 points (95% CI: -18.6 to 7.5). There were no differences between treatment with EHA and TEA for the mean values of the MEPS (85.0 vs. 88.2, P = .59), EQ-5D index (0.92 vs. 0.86, P = .13), extension (29° vs. 29°, P = .98), flexion (126° vs. 136°, P = .05), arc of flexion-extension (97° vs. 107°, P = .25), supination (81° vs. 75°, P = .13), pronation (78° vs. 74°, P = .16) or grip strength (17.5 kg vs. 17.2 kg, P = .89). There were 6 adverse events in each treatment group. CONCLUSION In this RCT, both elbow hemiarthroplasty (EHA) and total elbow arthroplasty (TEA) resulted in a good and similar functional outcome for unreconstructable distal humeral fractures in elderly patients at a minimum of 2 years of follow-up.
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Affiliation(s)
- Eythor Ö Jonsson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden.
| | - Carl Ekholm
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Hanna Björnsson Hallgren
- Division of Orthopaedic Surgery, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Jens Nestorson
- Division of Orthopaedic Surgery, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | | | - Lars Adolfsson
- Division of Orthopaedic Surgery, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Orthopaedics, Örebro University, Örebro, Sweden
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Kodama A, Mizuseki T, Adachi N. Outcomes of Revision Unlinked Total Elbow Arthroplasty for Rheumatoid Elbow. J Hand Surg Asian Pac Vol 2023; 28:479-485. [PMID: 37758498 DOI: 10.1142/s2424835523500558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Background: Although unlinked total elbow arthroplasty (TEA) is a treatment option for end-stage rheumatoid arthritis (RA) of the elbow, its long-term outcomes were inferior. Moreover, revision TEA could be technically challenging. The unlinked TEA procedure comprises the ease of implant removal at revision and advantage of bone preservation. This study evaluated the clinical outcomes in patients who underwent revision TEA using primary unlinked TEA for rheumatoid elbows. It also aimed to determine whether selecting the unlinked prosthesis for the primary TEA would make revision more accessible and successful. Methods: We retrospectively reviewed data of 13 consecutive patients (14 elbows) who underwent revision TEAs for implant failure due to different aetiologies, excluding septic loosening. Three different unlinked TEA implants were used: the Kudo type-5 with all-polyethylene (AP) ulnar component, Kudo type-5 with metal-backed (MB) ulnar component and K-Now TEA. We evaluated the patients' pre- and postoperative outcomes, including the range of motion, pain score and Mayo Elbow Performance Index (MEPI). Results: Among the 14 elbows, 11 were revised using the Kudo type-5 ulnar component (nine and two with AP and MB ulnar component, respectively), and three using the K-Now. We found that each model of TEA had different tendencies to indication for revision surgery. Three more resulted in further failure. The clinical outcomes were assessed in the 11 surviving elbows. Eight of the 11 elbows showed no pain at the final follow-up. However, the remaining three showed only mild pain. The MEPI revealed that seven cases were excellent, two were good and two were fair. Conclusions: The mode of implant failure was largely dependent on the implant design. Furthermore, partial revision with the same implant design was sufficient in managing implant failure in the early phase. However, conversion from unlinked to linked design could be recommended in patients with progressive failure or instability. Level of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- Akira Kodama
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, Taguchi, Saijo, Higashihiroshima, Hiroshima, Japan
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi, Minami-ku, Hiroshima, Japan
| | - Takaya Mizuseki
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, Taguchi, Saijo, Higashihiroshima, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi, Minami-ku, Hiroshima, Japan
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Kwak JM, So SP, Jeon IH. Staged revision still works for chronic and deep infection of total elbow arthroplasty? SICOT J 2022; 8:21. [PMID: 35616598 PMCID: PMC9135019 DOI: 10.1051/sicotj/2022019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/01/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: Infected total elbow arthroplasty (TEA) is challenging. We evaluate the clinical and radiologic outcomes for chronic and deep infection of TEA with two-stage revision surgery. Methods: A total of 10 elbows were included in the study. The mean age was 69.1 ± 15 years (range, 34–83 years). The mean follow-up was 62 (range, 24–108) months. The clinical outcomes were assessed using a visual analog scale (VAS), range of motion (ROM) arc, and Mayo elbow performance score (MEPS). Moreover, radiographic outcomes, time to revision, pathogenic bacteria, preoperative complications, and disease period were evaluated. Results: Mean preoperative VAS score of 6.1 had improved to 3.3. Mean preoperative ROM was 68° (flexion-extension), which improved to 86.7°. Mean preoperative MEPS was 46 (range, 0–70), which improved to 75.5 (range, 35–85). The mean disease duration was 8.4 months (range, 5–20 months). The most common causative organism was methicillin-resistant Staphylococcus aureus. The second revision rate was 80% at the final follow-up. Radiographic outcome at final follow-up showed that 3 (30%) of 10 patients exhibited radiolucency evidence around the components. Three patients showed nonprogressive radiolucency around the implant interfaces without other indications of infection at the most recent follow-up. Conclusion: In patients with chronic and deep infection of TEA, two-stage revision can be an affordable option for eradication of the infection, relieving pain, and restoring joint function. However, the high second revision rate owing to bone and soft-tissue deficits remains a critical issue. Level of evidence: Level IV, Case series, Treatment study
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Affiliation(s)
- Jae-Man Kwak
- Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, College of Medicine, Eulji University, Uijeongbu 11759, South Korea
| | - Sang-Pil So
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul 05505, South Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul 05505, South Korea
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Abstract
The objective of this review is to summarize the surgical options for primary osteoarthritis of the elbow, reported clinical outcomes, and suggested indications in previous literatures. The surgical management of primary elbow arthritis has evolved because of an improved understanding of pathologic mechanisms and manifestations as well as the development of novel surgical techniques and devices. Osteocapsular arthroplasty (OCA), elbow debridement, distraction arthroplasty, and total elbow arthroplasty (TEA) have been employed for managing elbow osteoarthritis. Elbow debridement and OCA can be helpful in most cases of symptomatic elbow arthritis. TEA is usually recommended for end-stage arthritis in elderly patients after prosthetic implants have been in place for long periods or after complications. Distraction arthroplasty might find a place in the treatment of younger, active patients with end-stage arthritis.
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Affiliation(s)
- Jae-Man Kwak
- 65526Department of Orthopedic Surgery, Eulji Medical Center, College of Medicine, Eulji University, Uijeongbu, South Korea
| | - In-Ho Jeon
- 65526Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, South Korea
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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: 2] [Impact Index Per Article: 0.7] [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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Solarz MK, Patel MK, Struk AM, Matthias R, King JJ, Wright TW, Schoch BS. A Clinical Comparison of Triceps-Sparing and Triceps-Detaching Approaches for Revision Total Elbow Arthroplasty. J Hand Surg Am 2020; 45:66.e1-66.e6. [PMID: 31227203 DOI: 10.1016/j.jhsa.2019.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 12/22/2018] [Accepted: 05/03/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Triceps-sparing (TS) approaches have been reported to provide improved triceps strength, better patient outcomes, and a lower incidence of complications in primary total elbow arthroplasty (TEA). It remains unclear whether the advantages of this approach are similar in the revision setting, especially in cases with prior triceps detachment. The purpose of this study was to compare triceps strength and clinical outcomes between TS and triceps-detaching (TD) approaches in revision TEA. METHODS All revision TEAs performed over a 17-year period with a minimum 1-year follow-up were retrospectively reviewed. Elbows with preoperative triceps insufficiency or subsequent component removal for infection were excluded. Patients were grouped according to the surgical approach performed at the last revision TEA. Outcome measures included triceps strength, range of motion, visual analog scale (VAS), Mayo Elbow Performance Score (MEPS), and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. RESULTS Ten TS and 6 TD elbows were evaluated. Four elbows within the TS group had documented TD surgery prior to revision. Median follow-up was longer in the TD group (137 ± 75 months vs 53 ± 20 months). Functional strength and DASH scores were significantly better in the TS group. Arc of motion, VAS, and MEPS were similar between the TS and the TD groups. CONCLUSIONS The TS approach preserves greater postoperative functional triceps strength after revision TEA, regardless of the type of approach used previously. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Mark K Solarz
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL
| | - Maharsh K Patel
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL
| | - Aimee M Struk
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL
| | - Robert Matthias
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL
| | - Joseph J King
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL
| | - Thomas W Wright
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL
| | - Bradley S Schoch
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL.
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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: 28] [Impact Index Per Article: 5.6] [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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8
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Cinats D, Bois AJ, Hildebrand KA. Clinical outcomes and complications following primary total elbow arthroplasty using the Latitude prosthesis. Shoulder Elbow 2019; 11:359-371. [PMID: 31534486 PMCID: PMC6739748 DOI: 10.1177/1758573218768510] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 02/01/2018] [Accepted: 03/06/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Latitude total elbow arthroplasty (TEA) is an implant with limited published data on its performance and outcomes. The aim of this study was to report the short-term outcomes of the Latitude TEA as well as to describe the radiographic outcomes and complications. METHODS The Latitude was implanted in 20 patients (23 elbows) in a linked configuration. Patients were recalled to clinic for the assessment of their range-of-motion and compared to preoperative values. Administration of functional outcome measures was also performed. RESULTS Mean follow-up was 4.7 years (range, 1 to 7.5 years) with four elbows requiring revision. The flexion-extension arc improved from 86.6 to 101.3 (range, 76 to 126) postoperatively (p = 0.04). The average Disabilities of the Arm, Shoulder, and Hand score was 28.1 (range, 5.8 to 50.4) and the average Mayo Elbow Performance Score was 89.6 (range, 76 to 100), with 83% of elbows scoring in the good or excellent range. Radiolucencies were detected in 60% of patients and 31% of these lucencies progressed in size at the time of follow-up. CONCLUSIONS The Latitude prosthesis provides patients with favorable clinical outcomes with improvements in their range-of-motion and a complication rate comparable to other elbow arthroplasty implants.
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Affiliation(s)
- David Cinats
- Section of Orthopaedic Surgery,
Department of Surgery, University of Calgary, Calgary, Canada,David Cinats, Section of Orthopaedic
Surgery, Department of Surgery, University of Calgary, 3330 Hospital Drive NW,
Calgary, Alberta T2N 4N1, Canada.
| | - Aaron J Bois
- Section of Orthopaedic Surgery,
Department of Surgery, University of Calgary, Calgary, Canada,McCaig Institute for Bone and Joint
Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Kevin A Hildebrand
- Section of Orthopaedic Surgery,
Department of Surgery, University of Calgary, Calgary, Canada,McCaig Institute for Bone and Joint
Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Geurts EJ, Viveen J, van Riet RP, Kodde IF, Eygendaal D. Outcomes after revision total elbow arthroplasty: a systematic review. J Shoulder Elbow Surg 2019; 28:381-386. [PMID: 30658776 DOI: 10.1016/j.jse.2018.08.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/14/2018] [Accepted: 08/19/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although revision arthroplasty surgery is a frequently used treatment for failed total elbow arthroplasty (TEA), published results are conflicting. The aim of this systematic review was to provide an overview of the outcomes of revision TEA surgery. METHODS A systematic literature search was performed in major databases to find articles relating to outcomes after revision of TEA. Two reviewers independently screened the articles for inclusion, and a third reviewer screened them before final inclusion. RESULTS Twenty-one articles containing 532 cases were included. The mean age at revision was 61 years. The mean interval between primary and revision arthroplasty was 77 months, and the average follow-up period was 65 months. Different types of prostheses were included, with 69% of the revision prostheses having linked designs and 31% having unlinked designs. The visual analog scale score, Mayo Elbow Performance Score, Oxford Elbow Score, and range of motion improved significantly after revision surgery. Complications were reported in 232 of 532 cases (44%), leading to reoperations in 22%. After revision with linked prostheses, the Mayo Elbow Performance Score, range of flexion-extension, and pronation improved significantly more than with unlinked designs. CONCLUSION Improved functional outcomes can be expected after revision TEA, but the complication rate remains high. Revision TEA should still be considered a salvage procedure for failed TEA. Linked designs for revision TEA result in better outcomes than unlinked designs in the midterm follow-up.
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Affiliation(s)
- Elisabeth J Geurts
- Department of Orthopedics, Academic Medical Center, Amsterdam, The Netherlands.
| | - Jetske Viveen
- Department of Orthopedics, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Izaäk F Kodde
- Department of Orthopedics, Academic Medical Center, Amsterdam, The Netherlands
| | - Denise Eygendaal
- Department of Orthopedics, Academic Medical Center, Amsterdam, The Netherlands; Upper Limb Unit, Department of Orthopedic Surgery, Amphia, Breda, The Netherlands
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Kwak JM, Kholinne E, Sun Y, Kim MS, Koh KH, Jeon IH. Clinical results of revision total elbow arthroplasty: comparison of infected and non-infected total elbow arthroplasty. INTERNATIONAL ORTHOPAEDICS 2019; 43:1421-1427. [DOI: 10.1007/s00264-018-4267-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/03/2018] [Indexed: 11/29/2022]
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Nishida K, Hashizume K, Nasu Y, Ozawa M, Fujiwara K, Inoue H, Ozaki T. Mid-term results of alumina ceramic unlinked total elbow arthroplasty with cement fixation for patients with rheumatoid arthritis. Bone Joint J 2018; 100-B:1066-1073. [PMID: 30062938 PMCID: PMC6413761 DOI: 10.1302/0301-620x.100b8.bjj-2017-1451.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Aims The aim of this study was to report the mid-term clinical outcome of cemented unlinked J-alumina
ceramic elbow (JACE) arthroplasties when used in patients with rheumatoid arthritis (RA). Patients and Methods We retrospectively reviewed 87 elbows, in 75 patients with RA, which was replaced using a
cemented JACE total elbow arthroplasty (TEA) between August 2003 and December 2012, with a follow-up
of 96%. There were 72 women and three men, with a mean age of 62 years (35 to 79). The mean
follow-up was nine years (2 to 14). The clinical condition of each elbow before and after surgery
was assessed using the Mayo Elbow Performance Index (MEPI, 0 to 100 points). Radiographic loosening
was defined as a progressive radiolucent line of >1 mm that was completely circumferential
around the prosthesis. Results The mean MEPI scores significantly improved from 40 (10 to 75) points preoperatively to 95 (30 to
100) points at final follow-up (p < 0.0001). Complications were noted in ten elbows
(ten patients; 11%). Two had an intraoperative humeral fracture which was treated by fixation and
united. One had a postoperative fracture of the olecranon which united with conservative treatment
and one had a radial neuropathy which resolved. Further surgery was required for one with a
dislocation, three with an ulnar neuropathy and one with a postoperative humeral fracture. Revision
with removal of the components was performed in one elbow due to deep infection. There was no
radiographic evidence of loosening around the components.With any revision surgery or revision with
implant removal as the endpoint, the rates of survival up to 14 years were 93% (95% confidence
interval (CI), 83.9 to 96.6) and 99% (95% CI 91.9 to 99.8), respectively, as determined by
Kaplan-Meier analysis. Conclusion With the appropriate indications, the mid-term clinical performance of the cemented JACE TEA is
reliable and comparable to other established TEAs in the management of the elbow in patients with
RA. Cite this article: Bone Joint J 2018;100-B:1066–73.
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Affiliation(s)
- K Nishida
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - K Hashizume
- Department of Rehabilitation, Japan Labour Health and Welfare Organization, Okayama Rosai Hospital, Okayama, Japan
| | - Y Nasu
- Department of Medical Materials for Musculoskeletal Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - M Ozawa
- Department of Orthopaedic Surgery, Okayama City Hospital, Okayama, Japan
| | - K Fujiwara
- Department of Intelligent Orthopaedic System Development, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - H Inoue
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - T Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Abstract
Aims The aim of this study was to report the long-term outcome and implant survival of the lateral resurfacing elbow (LRE) arthroplasty in the treatment of elbow arthritis. Patients and Methods We reviewed a consecutive series of 27 patients (30 elbows) who underwent LRE arthroplasty between December 2005 and January 2008. There were 15 women and 12 men, with a mean age of 61 years (25 to 82). The diagnosis was primary hypotrophic osteoarthritis (OA) in 12 patients (14 elbows), post-traumatic osteoarthritis (PTOA) in five (five elbows) and rheumatoid arthritis (RA) in ten patients (11 elbows). The mean clinical outcome scores including the Mayo Elbow Performance Score (MEPS), the American Shoulder and Elbow Surgeons elbow score (ASES-e), the mean range of movement and the radiological outcome were recorded at three, six and 12 months and at a mean final follow-up of 8.3 years (7.3 to 9.4). A one sample t-test comparing pre and postoperative values, and survival analysis using the Kaplan-Meier method were undertaken. Results A statistically significantly increased outcome score was noted for the whole group at each time interval. This was also significantly increased at each time in each of the subgroups (OA, RA, and PTOA). Implant survivorship was 100%. Conclusion We found that the LRE arthroplasty, which was initially developed for younger patients with osteoarthritis, is an effective form of surgical treatment for a wider range of patients with more severe degenerative changes, irrespective of their cause. It is therefore a satisfactory alternative to total elbow arthroplasty (TEA) and has lower rates of complications in the subgroups of patients we have studied. It does not require activities to be restricted to the same extent as following TEA. Based on this experience, we now recommend LRE arthroplasty rather than TEA as the primary form of implant for the treatment of patients with OA of the elbow. Cite this article: Bone Joint J 2018;100-B:338-45.
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Affiliation(s)
- C E L Watkins
- Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
| | - D W Elson
- Queen Elizabeth Hospital, Gateshead Health NHS Foundation Trust, Sheriff Hill, Gateshead, Tyne and Wear NE9 6SX, UK
| | - J W K Harrison
- Queen Elizabeth Hospital, Gateshead Health NHS Foundation Trust, Sheriff Hill, Gateshead, Tyne and Wear NE9 6SX, UK
| | - J Pooley
- Queen Elizabeth Hospital, Gateshead Health NHS Foundation Trust, Sheriff Hill, Gateshead, Tyne and Wear NE9 6SX, UK
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