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Krane F, Heck VJ, Leyendecker J, Klug K, Klug A, Hackl M, Kircher J, Müller LP, Leschinger T. The Future of Total Elbow Arthroplasty: A Statistical Forecast Model for Germany. Healthcare (Basel) 2024; 12:1322. [PMID: 38998857 PMCID: PMC11241371 DOI: 10.3390/healthcare12131322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 06/25/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024] Open
Abstract
This study provides a statistical forecast for the development of total elbow arthroplasties (TEAs) in Germany until 2045. The authors used an autoregressive integrated moving average (ARIMA), Error-Trend-Seasonality (ETS), and Poisson model to forecast trends in total elbow arthroplasty based on demographic information and official procedure statistics. They predict a significant increase in total elbow joint replacements, with a higher prevalence among women than men. Comprehensive national data provided by the Federal Statistical Office of Germany (Statistisches Bundesamt) were used to quantify TEA's total number and incidence rates. Poisson regression, exponential smoothing with Error-Trend-Seasonality, and autoregressive integrated moving average models (ARIMA) were used to predict developments in the total number of surgeries until 2045. Overall, the number of TEAs is projected to increase continuously from 2021 to 2045. This will result in a total number of 982 (TEAs) in 2045 of mostly elderly patients above 80 years. Notably, female patients will receive TEAs 7.5 times more often than men. This is likely influenced by demographic and societal factors such as an ageing population, changes in healthcare access and utilization, and advancements in medical technology. Our projection emphasises the necessity for continuous improvements in surgical training, implant development, and rehabilitation protocols.
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Affiliation(s)
- Felix Krane
- University Hospital Cologne, Department of Orthopedics, Trauma and Plastic Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Vincent Johann Heck
- University Hospital Cologne, Department of Orthopedics, Trauma and Plastic Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Jannik Leyendecker
- University Hospital Cologne, Department of Orthopedics, Trauma and Plastic Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Kristina Klug
- Department of Psychology, Goethe-University Frankfurt, Theodor-W.-Adorno Platz 6, PEG, 60629 Frankfurt am Main, Germany
| | - Alexander Klug
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389 Frankfurt am Main, Germany
| | - Michael Hackl
- University Hospital Cologne, Department of Orthopedics, Trauma and Plastic Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Jörn Kircher
- Department of Shoulder and Elbow Surgery, ATOS Klinik Fleetinsel Hamburg, Admiralitätstrasse 3-4, 20459 Hamburg, Germany
- Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40255 Düsseldorf, Germany
| | - Lars Peter Müller
- University Hospital Cologne, Department of Orthopedics, Trauma and Plastic Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Tim Leschinger
- University Hospital Cologne, Department of Orthopedics, Trauma and Plastic Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
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Stone A, Chan G, Sinclair L, Phadnis J. Elbow arthroplasty in trauma-current concepts review. J Orthop 2023; 35:126-133. [PMID: 36471696 PMCID: PMC9718957 DOI: 10.1016/j.jor.2022.11.013] [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: 07/24/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Despite advancements in modern locking plate technology, distal humerus fractures in the elderly remain difficult to treat. A subset of fractures in this osteoporotic bone includes multiple, shallow articular fragments that renders fixation unreliable, precluding early motion and acceptable functional outcomes. Arthroplasty, in the form of either Total Elbow Arthroplasty (TEA) or Distal Humeral Hemiarthroplasty (DHH) are alternative treatment options in this cohort and are being increasingly used. Methods This article reviews the use of TEA or DHH for acute distal humerus fracture, including patient selection, pre-operative planning, surgical approach, implant positioning, rehabilitation, outcomes and complications. Results Arthroplasties are being increasingly used for acute distal humerus fractures, however they introduce potential complications not seen with fixation. Due care must be employed to correct implant positioning which is a function of implant rotation, implant length and implant sizing. We describe a robust technique for epicondyle repair in DHH and unlinked TEA to avoid instability. Outcomes of DHH and TEA for acute distal humerus fracture are encouraging, however further long-term outcome and comparative data regarding arthroplasty is required. Conclusions Short to medium term outcomes demonstrate that both DHH and TEA are valuable options for selected patients, although attention to technique is required to minimise potential complications.
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Affiliation(s)
- A. Stone
- Shoulder & Elbow Post-CCT Fellow, University Hospitals Sussex NHS Foundation Trust, UK
| | - G. Chan
- Specialty Registrar, University Hospitals Sussex NHS Foundation Trust, Honorary Clinical Lecturer, Brighton & Sussex Medical School, UK
| | - L. Sinclair
- Clinical Librarian, University Hospitals Sussex NHS Foundation Trust, UK
| | - J. Phadnis
- Consultant Trauma & Orthopaedic Surgeon, University Hospitals Sussex NHS Foundation Trust, Honorary Clinical Reader, Brighton & Sussex Medical School, UK
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Chang NB, Zhang Y, Athwal GS, Faber KJ, King GJW. Outcomes of radial head implants in total elbow arthroplasty. J Shoulder Elbow Surg 2022; 31:501-508. [PMID: 34695593 DOI: 10.1016/j.jse.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/23/2021] [Accepted: 10/06/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is no consensus on the management of the radial head in total elbow arthroplasty (TEA). In 3-part TEA designs, options include radial head retention, excision, or arthroplasty. Biomechanical studies suggest improved varus-valgus stability with radial head implants in unlinked total elbows. Unfortunately, complications with radial head implants have been common with historical designs. The aim of this study was to evaluate the clinical and radiographic outcomes of radial head implants in a current 3-part TEA and identify risk factors for mechanical failure. METHODS We performed a retrospective review of radial head implants with a 3-part convertible TEA from 2001 to 2016. Clinical outcomes, functional scores, and radiographic outcomes were recorded. The preoperative radiocapitellar alignment was measured using the radiocapitellar ratio (RCR). Statistics include descriptive statistics, t tests, logistic regression, and Kaplan-Meier survival curves. RESULTS We identified 44 TEAs in 40 patients, with a mean follow-up period of 7.2 years. The average age at surgery was 58 ± 11 years; 80% of the TEAs were performed in women. The indication for surgery was rheumatoid arthritis in 86%; of the implants, 61% were unlinked. The average preoperative RCR was 10.7 ± 17.9. Postoperatively, 2 radial head implants (5%) were subluxated, 6 (14%) were dissociated, and 2 (5%) were dissociated with implant dislocation on radiographic review. The revision rate for radial head subluxation, dissociation, or dislocation was 7% (n = 3). Univariate logistic regression showed that male sex (P = .002), abnormal preoperative RCR (P = .02), linked implant (P = .03), and older age (P = .04) were risk factors for radial head subluxation, dissociation, or implant dislocation. A multivariate model with all 4 variables did not demonstrate statistical significance. CONCLUSION The incidence of radial head arthroplasty subluxation, dissociation, or implant dislocation was high (23%). In a univariate logistic regression model, male sex, abnormal preoperative RCR, and linked implants were all statistically significant risk factors for mechanical failure of the radial head implant. Our multivariate model did not show any statistically significant independent risk factors. Polyethylene wear or loosening of the radial head implants was not observed in this study; failure of the bipolar linkage was the principal mode of failure. Although further study is required, caution should be used when considering inserting a radial head implant in male patients with significant preoperative radiocapitellar malalignment. Radial head subluxation or dissociation is not an absolute indication for revision in an asymptomatic patient. Improvements in radial head implant designs in TEA are needed.
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Affiliation(s)
- Nicholas B Chang
- Roth
- McFarlane Hand and Upper Limb Center, Western University, London, ON, Canada
| | - Yiyang Zhang
- Roth
- McFarlane Hand and Upper Limb Center, Western University, London, ON, Canada
| | - George S Athwal
- Roth
- McFarlane Hand and Upper Limb Center, Western University, London, ON, Canada
| | - Kenneth J Faber
- Roth
- McFarlane Hand and Upper Limb Center, Western University, London, ON, Canada
| | - Graham J W King
- Roth
- McFarlane Hand and Upper Limb Center, Western University, London, ON, Canada.
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Augmented Total Elbow Arthroplasty with Femoral Strut Allograft for Revision of Prosthetic Joint Infection with Distal Humerus Bone Loss and Incomplete Union of Periprosthetic Humeral Shaft Fracture. Case Rep Orthop 2021; 2021:6661870. [PMID: 33968457 PMCID: PMC8084658 DOI: 10.1155/2021/6661870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 03/02/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022] Open
Abstract
Total elbow arthroplasty (TEA) prosthetic joint infection (PJI) in the setting of distal humerus bone loss poses a challenge for restoration of function. This can be complicated by a periprosthetic humeral fracture. Revision surgery in the setting of these pathologies possesses a significant challenge, especially when two or, in this case, all three problems are treated simultaneously. We present the clinical course, operative findings, and definitive treatment with the use of an augmented total elbow arthroplasty and femoral strut allograft reinforcement in detail. A review of the literature regarding the identification and management of infected TEA with augmented prosthesis and bone allograft augmentation of humerus fractures will be outlined in this case report.
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Macken AA, Prkic A, Kodde IF, Lans J, Chen NC, Eygendaal D. Global trends in indications for total elbow arthroplasty: a systematic review of national registries. EFORT Open Rev 2020; 5:215-220. [PMID: 32377389 PMCID: PMC7202040 DOI: 10.1302/2058-5241.5.190036] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
National registries provide useful information in understanding outcomes of surgeries that have late sequelae, especially for rare operations such as total elbow arthroplasty (TEA).A systematic search was performed and data were compiled from the registries to compare total elbow arthroplasty outcomes and evaluate trends. We included six registries from Australia, the Netherlands, New Zealand, Norway, the United Kingdom and Sweden.Inflammatory arthritis was the most common indication for total elbow arthroplasty, followed by acute fracture and osteoarthritis. When comparing 2000-2009 to 2010-2017 data, total elbow arthroplasty for inflammatory arthritis decreased and total elbow arthroplasty for fracture and osteoarthritis increased. There was an increase in the number of revision TEAs over this time period.The range of indications for total elbow arthroplasty is broadening; total elbow arthroplasty for acute trauma and osteoarthritis is becoming increasingly more common. However, inflammatory arthritis remains the most common indication in recent years. This change is accompanied by an increase in the incidence of revision surgery. Cite this article: EFORT Open Rev 2020;5:215-220. DOI: 10.1302/2058-5241.5.190036.
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Affiliation(s)
- Arno A Macken
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, Netherlands
| | - Ante Prkic
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, Netherlands
| | - Izaäk F Kodde
- Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam, Netherlands
| | - Jonathan Lans
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Neal C Chen
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam, Netherlands
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Ravalli S, Pulici C, Binetti S, Aglieco A, Vecchio M, Musumeci G. An Overview of the Pathogenesis and Treatment of Elbow Osteoarthritis. J Funct Morphol Kinesiol 2019; 4:E30. [PMID: 33467345 PMCID: PMC7739329 DOI: 10.3390/jfmk4020030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 05/23/2019] [Accepted: 05/28/2019] [Indexed: 12/30/2022] Open
Abstract
The elbow joint could be associated with degenerative processes of primary and post-traumatic aetiology. Among these, osteoarthritis may also be secondary to repeated use as well as trauma. Pain, discomfort and progressive loss of functionality are common signs of this condition. The evaluation of elbow osteoarthritis should comprise an in-depth study to detect the primary cause of the illness and to facilitate the decision-making process regarding personalized treatment. Discordance between clinical manifestations and radiological findings is common. Conservative approaches may provide symptomatic relief in the early stages of disease for most patients. The goal of the treatment is to reduce pain and ensure an adequate range of motion and proper functioning of the joint while preserving the anatomical structure, to postpone elbow arthroplasty interventions for as long as possible. According to treatment guidelines, surgery should be considered depending on aetiology and severity, patient age, and functional demands. This narrative review aims to investigate the current literature regarding the pathogenesis and treatment of primary and post-traumatic arthritis of the elbow.
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Affiliation(s)
- Silvia Ravalli
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Via S. Sofia n°87, 95124 Catania, Italy
| | - Carmelo Pulici
- Department of Biomedical and Biotechnological Sciences, Division of Physical and Rehabilitative Medicine, University of Catania, via S. Sofia 67, 95123 Catania, Italy
| | - Stefano Binetti
- Department of Biomedical and Biotechnological Sciences, Division of Physical and Rehabilitative Medicine, University of Catania, via S. Sofia 67, 95123 Catania, Italy
| | - Alessandra Aglieco
- Department of Biomedical and Biotechnological Sciences, Division of Physical and Rehabilitative Medicine, University of Catania, via S. Sofia 67, 95123 Catania, Italy
| | - Michele Vecchio
- Department of Biomedical and Biotechnological Sciences, Division of Physical and Rehabilitative Medicine, University of Catania, via S. Sofia 67, 95123 Catania, Italy
| | - Giuseppe Musumeci
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Via S. Sofia n°87, 95124 Catania, Italy
- Research Center on Motor Activities (CRAM), University of Catania, via S. Sofia 97, 95123 Catania, Italy
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Medial Approach for Total Elbow Arthroplasty: A New Surgical Technique for Tumor Resection and Joint Replacement. Tech Orthop 2018. [DOI: 10.1097/bto.0000000000000335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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