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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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Momtaz D, Ahmad F, Singh A, Song E, Slocum D, Ghali A, Abdelfattah A. Inpatient or outpatient total elbow arthroplasty: a comparison of patient populations and 30-day surgical outcomes from the American College of Surgeons National Surgical Quality Improvement Program. Clin Shoulder Elb 2023; 26:351-356. [PMID: 37994008 DOI: 10.5397/cise.2023.00486] [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: 06/18/2023] [Accepted: 08/04/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Total elbow arthroplasty (TEA) is uncommon, but growing in incidence. Traditionally an inpatient operation, a growing number are performed outpatient, consistent with general trends in orthopedic surgery. The aim of this study was to compare TEA outcomes between inpatient and outpatient surgical settings. Secondarily, we sought to identify patient characteristics that predict the operative setting. METHODS Patient data were collected from the American College of Surgeons National Quality Improvement Program. Preoperative variables, including patient demographics and comorbidities, were recorded, and baseline differences were assessed via multivariate regression to predict operative setting. Multivariate regression was also used to compare postoperative complications within 30 days. RESULTS A total of 468 patients, 303 inpatient and 165 outpatient procedures, were identified for inclusion. Hypoalbuminemia (odds ratio [OR], 2.5; P=0.029), history of chronic obstructive pulmonary disorder or pneumonia (OR, 2.4; P=0.029), and diabetes mellitus (OR, 2.5; P=0.001) were significantly associated with inpatient TEA, as were greater odds of any complication (OR, 4.1; P<0.001) or adverse discharge (OR, 4.5; P<0.001) and decreased odds of reoperation (OR, 0.4; P=0.037). CONCLUSIONS Patients undergoing inpatient TEA are generally more comorbid, and inpatient surgery is associated with greater odds of complications and adverse discharge. However, we found higher rates of reoperation in outpatient TEA. Our findings suggest outpatient TEA is safe, although patients with a higher comorbidity burden may require inpatient surgery. Level of evidence: III.
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Affiliation(s)
- David Momtaz
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX, USA
| | - Farhan Ahmad
- Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA
| | - Aaron Singh
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX, USA
| | - Emilie Song
- Department of Orthopedics, Baylor College of Medicine, Houston, TX, USA
| | - Dean Slocum
- Department of Orthopaedics, UT Health San Antonio, San Antonio, TX, USA
| | - Abdullah Ghali
- Department of Orthopedics, Baylor College of Medicine, Houston, TX, USA
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Liao GJ, Su Q, Zhang YQ, Chang LM. Resection for malignant tumors in the elbow and individualized reconstruction under assistance of 3D printing technology: A case report. Medicine (Baltimore) 2023; 102:e34854. [PMID: 37657014 PMCID: PMC10476851 DOI: 10.1097/md.0000000000034854] [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: 05/28/2023] [Accepted: 07/31/2023] [Indexed: 09/03/2023] Open
Abstract
RATIONALE With a high failure rate and multiple postoperative complications, the resection for tumors in the elbow and reconstruction present a formidable challenge to orthopedic surgeons. The maturation of 3-dimension (3D) printing technology has facilitated the preoperative design, intraoperative navigation, and reconstruction of bone defects in patients with complex malignant tumors of the elbow joint. In order to improve prognosis, we explored a method of tumor resection and elbow reconstruction aided by 3D printing technology in this research. PATIENT CONCERNS The patient underwent nephrectomy for clear cell carcinoma of the left kidney 3 years ago. Six months ago, the patient presented with limited movement and lateral tenderness in the right elbow joint. The tumor puncture biopsy demonstrated renal clear cell carcinoma metastasis. DIAGNOSES Renal clear cell carcinoma with distal humerus bone metastasis. INTERVENTIONS Thin-layer CT scan data of the patient was acquired, and a 3D reconstruction of both upper limb bones and joints was conducted, followed by a simulation of diseased tissue excision. According to the model, individualized osteotomy guidelines and elbow prostheses were designed and manufactured. Then, prior to the completion of the actual operation, a simulation of the preoperative phase was performed. OUTCOMES The operation was completed without incident. At the 1-, 3-, and 6-month postoperative examinations, both the position and mobility of the prosthesis were found to be satisfactory, and no complications were observed. The hospital for special surgery score and mayo elbow performance score scores increased in comparison to the preoperative period. LESSONS For patients with complex tumors in the elbow joint, 3D printing technology may assist in the precise excision of the tumor and provide an individualized elbow joint prosthesis that is more precise and effective than traditional surgery. It can accomplish a satisfactory treatment effect for patients when combined with early postoperative scientific rehabilitation training, so it is a method worth promoting.
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Affiliation(s)
- Guang-Jun Liao
- Department of Orthopedic Oncology, Yantaishan Hospital, Yantai, Shandong, China
- Yantai Key Laboratory for Repair and Reconstruction of Bone & Joint, Yantai, Shandong, China
| | - Qing Su
- Department of Orthopedic Oncology, Yantaishan Hospital, Yantai, Shandong, China
- Yantai Key Laboratory for Repair and Reconstruction of Bone & Joint, Yantai, Shandong, China
| | - Yong-Quan Zhang
- Department of Orthopedic Oncology, Yantaishan Hospital, Yantai, Shandong, China
- Yantai Key Laboratory for Repair and Reconstruction of Bone & Joint, Yantai, Shandong, China
| | - Li-Ming Chang
- Department of Orthopedic Oncology, Yantaishan Hospital, Yantai, Shandong, China
- Yantai Key Laboratory for Repair and Reconstruction of Bone & Joint, Yantai, Shandong, China
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Nishida K, Nasu Y, Hashizume K, Okita S, Nakahara R, Saito T, Ozaki T, Inoue H. Outcome of unlinked total elbow arthroplasty for rheumatoid arthritis in patients younger than 50 years old. Bone Jt Open 2023; 4:19-26. [PMID: 36636881 PMCID: PMC9887340 DOI: 10.1302/2633-1462.41.bjo-2022-0151.r1] [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] [Indexed: 01/14/2023] Open
Abstract
AIMS There are concerns regarding complications and longevity of total elbow arthroplasty (TEA) in young patients, and the few previous publications are mainly limited to reports on linked elbow devices. We investigated the clinical outcome of unlinked TEA for patients aged less than 50 years with rheumatoid arthritis (RA). METHODS We retrospectively reviewed the records of 26 elbows of 21 patients with RA who were aged less than 50 years who underwent primary TEA with an unlinked elbow prosthesis. The mean patient age was 46 years (35 to 49), and the mean follow-up period was 13.6 years (6 to 27). Outcome measures included pain, range of motion, Mayo Elbow Performance Score (MEPS), radiological evaluation for radiolucent line and loosening, complications, and revision surgery with or without implant removal. RESULTS The mean MEPS significantly improved from 47 (15 to 70) points preoperatively to 95 (70 to 100) points at final follow-up (p < 0.001). Complications were noted in six elbows (23%) in six patients, and of these, four with an ulnar neuropathy and one elbow with postoperative traumatic fracture required additional surgeries. There was no revision with implant removal, and there was no radiological evidence of loosening around the components. With any revision surgery as the endpoint, the survival rates up to 25 years were 78.1% (95% confidence interval 52.8 to 90.6) as determined by Kaplan-Meier analysis. CONCLUSION The clinical outcome of primary unlinked TEA for young patients with RA was satisfactory and comparable with that for elderly patients. A favourable survival rate without implant removal might support the use of unlinked devices for young patients with this disease entity, with a caution of a relatively high complication rate regarding ulnar neuropathy.Level of Evidence: Therapeutic Level IVCite this article: Bone Jt Open 2023;4(1):19-26.
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Affiliation(s)
- Keiichiro Nishida
- Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan,Correspondence should be sent to Keiichiro Nishida. E-mail:
| | - Yoshihisa Nasu
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Kenzo Hashizume
- Department of Orthopaedic Surgery, Chugoku Central Hospital, Fukuyama, Japan
| | - Shunji Okita
- Department of Orthopaedic Surgery, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Ryuichi Nakahara
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Taichi Saito
- Department of Intelligent Orthopaedic System, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Hajime Inoue
- Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Aliyev AG, Tikhilov RM, Shubnyakov II, Ambrosenkov AV, Zhabin GI, Boyarov AA, Cherkasov MA, Antipov AP. Coonrad-Morrey total elbow arthroplasty implications in young patients with post-traumatic sequelae. J Shoulder Elbow Surg 2022; 31:1874-1883. [PMID: 35533979 DOI: 10.1016/j.jse.2022.03.021] [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: 06/30/2021] [Revised: 03/24/2022] [Accepted: 03/27/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND We aimed to evaluate the clinical and radiological results of total elbow arthroplasty (TEA) performed for trauma sequelae in patients <45 years of age. METHODS This retrospective study included 63 patients aged <45 years who underwent TEA between 2005 and 2017 for previous elbow injuries. The average follow-up period was 5.23 years (range, 2-13 years). The clinical analysis included limb function according to the Mayo Elbow Performance Score, Oxford Elbow Score, and range of motion. The degree of radiolucency was determined using plain radiographic images. RESULTS The average amplitude of elbow flexion/extension increased from 49.1 ± 36.7 to 98.7 ± 28.2 (P < .01), and the average amplitude of elbow pronation/supination increased from 87.2 ± 52.3 to 118.7 ± 26.3 (P = .02). Functional results improved from 21.4 ± 13.1 to 67.3 ± 14.5 (P < .01) on the Mayo scale, and those measured according to the Oxford scale improved from 15.4% ± 7.0% to 28.0% ± 10.6% (P < .01). Complications were observed in 16 (32.7%) patients. Among them, 10 patients (20.4%) required revision elbow arthroplasty with replacement of implant components. The overall 5-year implant survival rate was 79.4% (95% confidence interval: 63.4-91.2), and the 10-year survival rate was 77.5% (95% confidence interval: 59.3-88.2). CONCLUSION TEA allows restoration of the full range of motion in the elbow joint and significantly improves limb function in most cases. However, the low survival rate of implants and high incidence of complications do not permit TEA to become a routine intervention for treating post-traumatic consequences in young patients.
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Affiliation(s)
- Alimurad G Aliyev
- Vreden' National Medical Research Centre for Traumatology and Orthopedics, St. Petersburg, Russia.
| | - Rashid M Tikhilov
- Vreden' National Medical Research Centre for Traumatology and Orthopedics, St. Petersburg, Russia
| | - Igor' I Shubnyakov
- Vreden' National Medical Research Centre for Traumatology and Orthopedics, St. Petersburg, Russia
| | - Andrey V Ambrosenkov
- Vreden' National Medical Research Centre for Traumatology and Orthopedics, St. Petersburg, Russia
| | - Georgiy I Zhabin
- Vreden' National Medical Research Centre for Traumatology and Orthopedics, St. Petersburg, Russia
| | - Andrey A Boyarov
- Vreden' National Medical Research Centre for Traumatology and Orthopedics, St. Petersburg, Russia
| | - Magomed A Cherkasov
- Vreden' National Medical Research Centre for Traumatology and Orthopedics, St. Petersburg, Russia
| | - Alexander P Antipov
- Vreden' National Medical Research Centre for Traumatology and Orthopedics, St. Petersburg, Russia
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Patrick CM, Tadlock JC, Nesti LJ, Dunn JC, Parnes N. Treatment trends in distal humerus fractures between ABOS part II candidates. Injury 2022; 53:1044-1048. [PMID: 34654550 DOI: 10.1016/j.injury.2021.09.058] [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: 06/22/2021] [Revised: 09/17/2021] [Accepted: 09/26/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to determine how fellowship training influences the treatment of distal humerus fractures with either total elbow arthroplasty (TEA) or open reduction internal fixation (ORIF). METHODS The American Board of Orthopaedic Surgery (ABOS) Part II Examination Database was queried for all orthopaedic surgeons who sat for the Part II examination between the years 2003-2019. Inclusion criteria were ORIF or TEA cases, selected by individual CPT codes for each procedure, and patients of at least age 65 years who sustained acute distal humerus fractures. Analysis was performed for each type of fellowship training completed, total number of procedures performed, the type of procedure performed, patient demographics, and any complications. RESULTS There were 149 TEAs and 1306 ORIFs performed for distal humerus fractures between the exam years of 2003-2019. The proportion of TEA to ORIF increased from 7.6% to 11.0%. Partitioned by fellowship training, Hand and Upper Extremity surgeons performed 69 (17.4%) TEAs and 328 (82.6%) ORIFs, Shoulder and Elbow surgeons performed 34 (29.6%) TEAs and 81 (70.4%) ORIFs, Sports Medicine surgeons performed 14 (5.1%) TEAs and 263 (94.6%) ORIFs, and Trauma surgeons performed 16 (4.2%) TEAs and 366 (95.8%) ORIFs. Hand and Upper Extremity surgeons treated the most distal humerus fractures (397, 27.3%), followed by Trauma surgeons (382, 26.3%). CONCLUSION Our data suggests that fellowship training does influence the surgical decision-making process for treating distal humerus fractures in elderly populations. Hand and Upper Extremity surgeons performed the greatest number of TEA for acute distal humerus fractures, followed by Shoulder and Elbow surgeons. Conversely, trauma surgeons performed the lowest proportion of TEA to ORIF. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Cole M Patrick
- William Beaumont Army Medical Center, Department of Orthopaedic Surgery, El Paso, Texas, USA; Texas Tech University Health Science Center, Department of Orthopaedic Surgery, El Paso, Texas, USA.
| | - Joshua C Tadlock
- William Beaumont Army Medical Center, Department of Orthopaedic Surgery, El Paso, Texas, USA; Texas Tech University Health Science Center, Department of Orthopaedic Surgery, El Paso, Texas, USA
| | - Leon J Nesti
- Uniformed Services University, Clinical and Experimental Orthopedics, Bethesda, Maryland, USA
| | - John C Dunn
- William Beaumont Army Medical Center, Department of Orthopaedic Surgery, El Paso, Texas, USA; Texas Tech University Health Science Center, Department of Orthopaedic Surgery, El Paso, Texas, USA; Uniformed Services University, Clinical and Experimental Orthopedics, Bethesda, Maryland, USA
| | - Nata Parnes
- Carthage Area Hospital, Department of Orthopaedic Surgery, Carthage, NY, USA
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Wilfred AM, Akhter S, Horner NS, Aljedani A, Khan M, Alolabi B. Outcomes and complications of distal humeral hemiarthroplasty for distal humeral fractures - A systematic review. Shoulder Elbow 2022; 14:65-74. [PMID: 35154405 PMCID: PMC8832700 DOI: 10.1177/17585732211023100] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/07/2021] [Accepted: 05/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Distal humeral hemiarthroplasty has been performed for a variety of indications with the most common being management of distal humeral fractures. This systematic review evaluates the outcomes and complications of distal humeral hemiarthroplasty for this pathology. METHODS We searched PubMed, EMBASE, and MEDLINE for studies reporting indications and outcomes of patients undergoing distal humeral hemiarthroplasty. Study screening, risk of bias assessment, and data extraction were performed. Summery statistics were provided. RESULTS We included 11 studies (N = 163) in this review. In all studies, the indication for distal humeral hemiarthroplasty was the presence of an intraarticular, comminuted, unreconstructable fracture. The mean post-operative MEPS, FullDASH, and QuickDASH (SD) scores were 83.6 (6.1) points, 25.4 (10.3), and 15.7 (7.4) points, respectively. The mean post-operative range of motion (SD) was 106° (11°) in the flexion and extension arc and 153° (19°) in the protonation and supination arc. The overall rate of adverse events and complication was 63%. The rate for major complications was 11%. The mean total revision rate was 4% (0% to 15) and total re-operation rate was 29% (0% to 88%). CONCLUSION Distal humeral hemiarthroplasty is a suitable option for unreconstructable distal humeral fractures and offers good functional outcomes with acceptable complication rates.
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Affiliation(s)
- Ann M Wilfred
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Shakib Akhter
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada,Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Nolan S Horner
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Ahmed Aljedani
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada,Moin Khan, McMaster University St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, Canada L8N 4A6.
| | - Bashar Alolabi
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
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Stephens JD, Kohrs B, Bushnell L, Gabriel S, Brent Bamberger H. Distal Humerus Fractures Managed With Elbow Hemiarthroplasty. J Shoulder Elb Arthroplast 2021; 4:2471549220960052. [PMID: 34497964 PMCID: PMC8282154 DOI: 10.1177/2471549220960052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/26/2020] [Accepted: 08/25/2020] [Indexed: 11/15/2022] Open
Abstract
Background Distal humerus fractures not amenable to open reduction internal fixation (ORIF) present a unique dilemma, especially for patients that weight bear through assistive devices. The one accepted operative treatment for irreparable distal humerus fractures is total elbow arthroplasty (TEA). However, TEA commonly requires lifetime weight lifting restrictions and has limited long term results. Elbow hemiarthroplasty (EHA) represents an alternative treatment modality. This study reviews patients treated with EHA permitted to weight bear postoperatively. Methods Twelve patients underwent EHA for comminuted distal humerus fractures deemed non-reconstructable by ORIF. Patient survey data was collected retrospectively. All patients were allowed to weight bear as tolerated through the operative extremity. Outcome measures included Patient rated elbow evaluation (PREE), Mayo elbow performance score (MEPS), and whether revision surgery was required. Results The average MEPS score was 76.1 indicating fair outcomes and the average PREE score was 41. One patient required revision. Average follow up was 44.1 months. Three patients required an assistive device prior to injury. Discussion EHA serves as a viable option for non-reconstructable distal humerus fractures. EHA does not require a weight lifting restriction, which is a benefit over TEA. Overall, patients reported preserved functional capabilities but did report moderate pain. EHA demonstrated durability, although one patient required revision. Conclusion With growing interest in use of EHA, further studies are required to evaluate EHA as a superior treatment for patients with nonreconstructable traumatic distal humerus fractures; however, this study does support use in elderly patients with intermediate follow up.
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Affiliation(s)
- J D Stephens
- Department of Orthopedics, Grandview Medical Center, Affiliate of Kettering Health Network and Ohio, University Heritage College of Osteopathic Medicine, Dayton, Ohio
| | - Brandon Kohrs
- Department of Orthopedics, Grandview Medical Center, Affiliate of Kettering Health Network and Ohio, University Heritage College of Osteopathic Medicine, Dayton, Ohio
| | - Logan Bushnell
- Department of Orthopedics, Grandview Medical Center, Affiliate of Kettering Health Network and Ohio, University Heritage College of Osteopathic Medicine, Dayton, Ohio
| | - Speros Gabriel
- Department of Orthopedics, Grandview Medical Center, Affiliate of Kettering Health Network and Ohio, University Heritage College of Osteopathic Medicine, Dayton, Ohio
| | - H Brent Bamberger
- Department of Orthopedics, Grandview Medical Center, Affiliate of Kettering Health Network and Ohio, University Heritage College of Osteopathic Medicine, Dayton, Ohio
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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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10
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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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11
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Zeltser DW, Prentice HA, Navarro RA, Mirzayan R, Dillon MT, Foroohar A. Total Elbow Arthroplasty: A Descriptive Analysis of 170 Patients From a United States Integrated Health Care System. J Hand Surg Am 2021; 46:552-559. [PMID: 33896647 DOI: 10.1016/j.jhsa.2021.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 01/11/2021] [Accepted: 03/11/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Total elbow arthroplasty (TEA) can be used, with varying degrees of success, for the treatment of rheumatoid arthritis, osteoarthritis, and distal humerus fractures and their sequelae in elderly patients. Some of the largest studies of TEA have included data from more than 20 years ago and may not reflect the current practice of TEA. We sought to describe a modern cohort of patients who underwent TEA in a United States integrated health care system. METHODS All patients aged 18 years and older who underwent primary unilateral TEA from January 1, 2009, through March 31, 2018, were identified to conduct a descriptive study. The patients' characteristics and demographics, including age, body mass index, sex, diabetes status, American Society of Anesthesiologists classification, and surgical indication, were recorded. The crude cumulative revision probability as well as the 90-day postoperative incidence rate of emergency department visit, readmission, and mortality was calculated. RESULTS A total of 170 patients met our inclusion criteria. The annual procedure volume nearly doubled, from 11 procedures in 2009 to 21 procedures in 2017. The most common indication for TEA was fracture (40.6%), followed by rheumatoid arthritis (36.5%). At 4-year follow up, the crude cumulative revision probability was 9.8% (95% confidence interval, 5.6%-16.9%). Of the 170 patients who underwent TEA, 43 (25.3%) experienced a 90-day emergency department visit, 24 (14.1%) experienced a 90-day readmission, and 2 (1.2%) died within 90 days postoperatively. CONCLUSIONS This cohort of patients who underwent TEA using modern implants showed a notable increase in the volume of TEA over the study period, with more TEAs performed for trauma. The incidence of readmission and emergency department visits following TEA were high in this study. Further studies are needed to better define the current practice of TEA in the community at large. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- David W Zeltser
- Department of Orthopedic Surgery, The Permanente Medical Group, South San Francisco, CA.
| | | | - Ronald A Navarro
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, Harbor City, CA
| | - Raffy Mirzayan
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, Baldwin Park, CA
| | - Mark T Dillon
- Department of Orthopedic Surgery, The Permanente Medical Group, Sacramento, CA
| | - Abtin Foroohar
- Department of Orthopedic Surgery, Southern California Permanente Medical Group, Harbor City, CA
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12
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Long-term outcomes of total elbow arthroplasty: a systematic review of studies at 10-year follow-up. J Shoulder Elbow Surg 2021; 30:1423-1430. [PMID: 33418089 DOI: 10.1016/j.jse.2020.11.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/08/2020] [Accepted: 11/16/2020] [Indexed: 02/01/2023]
Abstract
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.
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13
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Reoperation Risk After Total Elbow Arthroplasty Versus Open Reduction Internal Fixation for Distal Humerus Fractures in Elderly Patients. J Orthop Trauma 2020; 34:503-509. [PMID: 32815838 DOI: 10.1097/bot.0000000000001767] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare reoperation risk after total elbow arthroplasty (TEA) and open reduction internal fixation (ORIF) for intra-articular distal humerus fractures in elderly patients. DESIGN Retrospective comparative. SETTING Five percent Medicare Part B claims database. PATIENTS Patients older than 65 years of age with closed distal humerus fractures undergoing TEA or ORIF from 1996 to 2016. INTERVENTION TEA and ORIF. MAIN OUTCOME MEASURE Reoperation risk based on multivariate Cox proportional hazards modeling. RESULTS A total of 142 TEA and 522 ORIF cases were identified. TEA patients had a greater age and Charlson Comorbidity Index , as well as a higher prevalence of rheumatoid arthritis and osteoporosis than ORIF patients (P < 0.05). Although reoperation risk was lower for TEA than that for ORIF within the entire cohort (11.3% vs. 25.1%; hazard ratio = 0.49; P = 0.014), no significant difference was found for TEA and ORIF performed between 2006 and 2016 (12.6% vs. 18.4%; hazard ratio = 0.73; P = 0.380). The death rate was 65.5% in the TEA group at 3.6 years and 55.7% in the ORIF group at 4.9 years. CONCLUSIONS TEA was associated with a decreased reoperation risk compared with ORIF, although this difference did not exist for more recent procedures after popularization of the locking plate technology and half of the reoperations after ORIF were for instrumentation removal. The high death rate within several years of the index procedure may contribute to the low TEA revision rate beyond the short-term when following patients into the medium and long term. Further study comparing TEA and locked plating using prospective, randomized data with long-term follow-up and functional outcomes is warranted. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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14
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Giannicola G, Sessa P, Calella P, Gumina S, Cinotti G. Chronic complex persistent elbow instability: a consecutive and prospective case series and review of recent literature. J Shoulder Elbow Surg 2020; 29:e103-e117. [PMID: 32197771 DOI: 10.1016/j.jse.2019.11.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/10/2019] [Accepted: 11/16/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chronic complex persistent elbow instability (CCPEI) is a condition that even expert elbow surgeons find challenging to treat. The results of the few studies that have dealt with the treatment of this condition are conflicting. We describe the surgical results of a consecutive prospective series of patients with CCPEI and provide a review of the recent literature. METHODS We assessed 21 patients with previous failed surgical or conservative treatment, with a terrible-triad injury in 13, Monteggia-like lesion in 6, humeral shear fracture-dislocation in 1, and radial head fracture-dislocation in 1. Overall, 21 open débridement procedures, 15 ulnar nerve transpositions, 6 ulnar in situ neurolysis procedures, 7 total elbow arthroplasties, 8 radial head arthroplasties, 1 radial head resection with humeroradial anconeus interpositional arthroplasty, 4 coronoid graft reconstructions, 14 ligament retensioning procedures, 3 ulnar nonunion treatments, and 2 ulnar osteotomies were performed. Two dynamic external fixators were applied. The Mayo Elbow Performance Score, quick Disabilities of the Arm, Shoulder and Hand score, and modified American Shoulder and Elbow Surgeons score were used preoperatively and postoperatively. RESULTS The mean follow-up period was 29.4 months. A significant improvement was found between preoperative and postoperative clinical scores and range-of-motion values. The reintervention and major complication rates were 19% and 23%, respectively. Arthritic evolution was observed in 71% of the cases. CONCLUSIONS CCPEI is a challenging condition with an uncertain prognosis. The variability in patients' pathoanatomic conditions requires customized surgical treatment aimed at elbow stabilizer reconstruction when the ulnohumeral joint is preserved or aimed at joint replacement in case of severe articular degeneration. The time interval between the initial trauma and index surgical procedure significantly affects the feasibility of reconstructive procedures.
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Affiliation(s)
- Giuseppe Giannicola
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome-Policlinico Umberto I, Rome, Italy
| | - Pasquale Sessa
- Department of Orthopedics and Traumatology, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy.
| | - Piergiorgio Calella
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome-Policlinico Umberto I, Rome, Italy
| | - Stefano Gumina
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, Polo Pontino, Latina, Italy
| | - Gianluca Cinotti
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome-Policlinico Umberto I, Rome, Italy
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15
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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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16
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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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17
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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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18
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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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19
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Ul Islam S, Glover AW, Waseem M. Challenges and Solutions in Management of Distal Humerus Fractures. Open Orthop J 2017; 11:1292-1307. [PMID: 29290867 PMCID: PMC5721336 DOI: 10.2174/1874325001711011292] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 10/02/2017] [Accepted: 10/05/2017] [Indexed: 11/22/2022] Open
Abstract
Background Management of distal humerus fractures remains a challenge for trauma surgeons and advancements in treatment options continue to be made to achieve the best results for patients presenting with these complex fractures. Our aim in this article is to provide the surgeons with a detailed review of current literature to help them make an evidence based decision when faced with managing such complex injuries in their surgical practice. Methods This is a comprehensive review of the current literature that details various aspects of distal distal humerus fractures such as classification, surgical anatomy, surgical approaches, treatment options, choices of devices, outcomes and complications. Results With the advancements in techniques and equipment, there has been improvement in patients' outcomes following surgical management of these fractures and a large proportion of these patients are able to achieve pre-injury level of function. The contoured locking plates have enabled successful fixation of many of these fractures that were previously considered unfixable. For those not amenable to surgical fixation, total elbow arthroplasty and elbow hemiarthroplasty are considered as good alternatives. Conclusion Since the days where the 'bag of bones' technique was the preferred method of treating these complex injuries, techniques and outcomes have advanced greatly. However, they still present a significant technical challenge and need meticulous technique and experience to achieve optimal results.
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Affiliation(s)
- Saif Ul Islam
- Macclesfield District General Hospital, Cheshire, United Kingdom
| | | | - Mohammad Waseem
- Macclesfield District General Hospital, Cheshire, United Kingdom
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20
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Schoch B, Wong J, Abboud J, Lazarus M, Getz C, Ramsey M. Results of Total Elbow Arthroplasty in Patients Less Than 50 Years Old. J Hand Surg Am 2017; 42:797-802. [PMID: 28823536 DOI: 10.1016/j.jhsa.2017.06.101] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 06/15/2017] [Accepted: 06/28/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Total elbow arthroplasty (TEA) is a treatment option for end-stage arthritis in low-demand patients willing to accept the limitations of TEA. Concern remains regarding the longevity of TEA implants, especially in younger patients. The purpose of this study was to determine the failure rate and complication profile of TEA performed in patients aged less than 50 years. METHODS Between 2009 and 2013, 11 linked TEAs were performed in patients aged less than 50 years (mean age, 37 years; range, 22-47 years). Outcome measures included pain; range of motion; Disabilities of the Arm, Shoulder, and Hand scores; Mayo Elbow Performance scores; complications; and reoperations. Elbows were observed for a minimum of 2 years or until mechanical failure. Mean follow-up was 3.2 years. RESULTS At follow-up, 82% of TEAs had experienced a complication. Six elbows sustained mechanical failures (5 had ulnar loosening and one had humeral loosening). Pain improved from 8.0 to 4.9. Extension improved from 34° to 22° and flexion increased from 113° to 128°. Mean Disabilities of the Arm, Shoulder, and Hand score for surviving implants at follow-up was 42.9 (range, 17.5-56.7). Mayo Elbow Performance scores for surviving implants were rated as excellent (2), good (1), and fair (2). CONCLUSIONS High rates of early mechanical failure, predominately ulnar loosening, were observed in TEA in patients aged less than 50 years. Surgeons should remain cautious in performing TEA in young patients who can be expected to use the TEA in a more demanding fashion, placing them at higher risk for mechanical failure. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Bradley Schoch
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL
| | - Justin Wong
- Department of Orthopedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Joseph Abboud
- Department of Orthopedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Mark Lazarus
- Department of Orthopedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Charles Getz
- Department of Orthopedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Matthew Ramsey
- Department of Orthopedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
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Rangarajan R, Papandrea RF, Cil A. Distal Humeral Hemiarthroplasty Versus Total Elbow Arthroplasty for Acute Distal Humeral Fractures. Orthopedics 2017; 40:13-23. [PMID: 28375524 DOI: 10.3928/01477447-20161227-02] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
For acute distal humeral fractures not amenable to open reduction and internal fixation, total elbow arthroplasty has become an established alternative. However, lifelong activity restrictions designed to prevent early mechanical failure make this a poor option for some patients. This has led to a renewed interest in distal humeral hemiarthroplasty. Using modern implants and techniques, distal humeral hemiarthroplasty has shown outcomes comparable to those of total elbow arthroplasty at short- to mid-term follow-up, with an overall higher but different complication rate. Long-term data are needed, but the available literature suggests that distal humeral hemiarthroplasty be considered as another option on the treatment spectrum in select patient populations. [Orthopedics. 2017; 40(1):13-23.].
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