Mid- and Long-Term Results of Total Elbow Arthroplasty: Post-Traumatic Consequences and Rheumatoid Arthritis
- Authors: Aliev A.G.1, Ambrosenkov A.V.1, Boyarov A.A.1, Zhabin G.I.1, Dzhavadov A.A.1
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Affiliations:
- Vreden Russian Research Institute of Traumatology and Orthopedics
- Issue: Vol 25, No 1 (2019)
- Pages: 41-51
- Section: Clinical studies
- URL: https://journal-vniispk.ru/2311-2905/article/view/125146
- DOI: https://doi.org/10.21823/2311-2905-2019-25-1-41-51
- ID: 125146
Cite item
Abstract
Objective of the study: to identify differences in the functional outcomes of total elbow arthroplasty in posttraumatic and rheumatoid cases, to determine the factors affecting the outcomes and rate of the complication.
Materials and methods. A retrospective study included 269 patients (272 elbows), who underwent primary total elbow arthroplasty (TEA), 100 men (37.2%), and 169 women (62.8%). The first group included 191 patients (191 elbows) who had elbow trauma. The average follow-up after the operation was 6.9 years (from 0.5 up to 21 years). The compared group included 78 patients (81 elbows) operated on for rheumatoid arthritis (RA). The average follow-up time after total elbow arthroplasty was 3.8 years (0.4 to 16.5 years).
Results. Tea significantly improved joint function (mean values in post-trauma patients on the Mayo score were 73.8±14.1 points, on the oxford questionnaire — 30.5±8.9, DASH — 40.3±18.4, EQ-5D — 0.536±0.234; in patients with rheumatoid arthritis, on the Mayo score — 75.4±15.5 points, DASH — 38.6±15.8, OES — 35.5±7.9, EQ-5D — 0.580±0.2). In the first group, the frequency of postoperative complications requiring a revision was significantly higher than in the compared group (23.8% and 13.6%, respectively, OR 3.2; 95% CI 0.7-3.0). In the first group, a statistically significant risk of aseptic loosening of the implants was observed in patients operated on for pseudarthrosis of the distal humerus (OR 8.5; 95% CI 1.7-43.6) and post-traumatic deformity (OR 10.5; 95% CI 1.3-88.5). The use of some endoprostheses is also associated with a high risk of aseptic instability (OR 3.5; 95% CI 0.9-13.3). A significant risk of a deep periprosthetic infection was observed in patients with post-traumatic bone defect (OR 7.0; 95% CI 1.2-40.1) and post-traumatic deformity of the elbow joint (OR 14.0; 95% CI 2.5-77.8). Risk factors for loosening endoprostheses in patients with RA were: defective cementation of humeral component (OR 35.0; 95% CI 3.8325.0), valgus deviation of the humeral component >9° (OR 9.2; 95% CI 1.0-82.2), low constructive reliability of the endoprosthesis (OR 13.6; 95% CI 2.3-79.4), patient age >59 years (OR 12.8; 95% CI 1.5-113.0 ), BMI >32 kg/m2 (OR 8.4; 95% CI 1.5-47.5), and CRP level >36.1 mg/l (OR 4.8; 95% CI 0.4-65.8).
Conclusion. Mid-term and longterm results showed that TEA helps restore the amplitudes of elbow movement and the function of the limb, both in elbows with post-traumatic consequences and with RA. However, the frequency of postoperative complications requiring a revision is significantly higher in the group of patients with consequences of the fractures than in the group of patients with RA.
About the authors
A. G. Aliev
Vreden Russian Research Institute of Traumatology and Orthopedics
Author for correspondence.
Email: mur23mur@yandex.ru
Alimumd G. Aliev — PhD student.
St. Petersburg
Russian FederationA. V. Ambrosenkov
Vreden Russian Research Institute of Traumatology and Orthopedics
Email: fake@neicon.ru
Andrei V. Ambrosenkov — cand. Sci. (Med.), the head of Hip, Knee and Elbow Pathology Department.
St. Petersburg Russian FederationA. A. Boyarov
Vreden Russian Research Institute of Traumatology and Orthopedics
Email: fake@neicon.ru
Andrei A. Boyarov — cand. Sci. (Med.), orthopedic surgeon, Hip, Knee and Elbow Pathology Department.
St. Petersburg Russian FederationG. I. Zhabin
Vreden Russian Research Institute of Traumatology and Orthopedics
Email: fake@neicon.ru
Georgii I. Zhabin — Dr. Sci. (Med.), professor, orthopedic surgeon, Hip, Knee and Elbow Pathology Department.
St. Petersburg
Russian FederationA. A. Dzhavadov
Vreden Russian Research Institute of Traumatology and Orthopedics
Email: fake@neicon.ru
Alisagib A. Dzhavadov — clinical resident.
St. Petersburg
Russian FederationReferences
- Слободской А.Б., Прохоренко В.М., Дунаев А.Г., Воронин И.В., Бадак И.С., Лежнев А.Г. Эндопротезирование локтевого сустава у молодых пациентов. Гений ортопедии. 2015;(2):26-31.
- Goodman A.D., Johnson J.P., Kleiner J.E., Gil J.A., Daniels A.H. The expanding use of total elbow arthroplasty for distal humerus fractures: a retrospective database analysis of 56,379 inpatients from 2002-2014. Phys Sportsmed 2018;46(4):492-498. doi: 10.1080/00913847.2018.1508315.
- Robinson M.C, Hill R.M., Jacobs N., Dall G., Court-Brown C.M. Adult distal humeral metaphyseal fractures: epidemiology and results of treatment. J Orthop Trauma. 2003;17(1):38-47. doi: 10.1097/00005131-200301000-00006.
- Barco R., Streubel P.N., Morrey B.F., Sanchez-Sotelo J. Total elbow arthroplasty for distal humeral fractures: a ten-year-minimum follow-up study. J Bone Joint Surg Am. 2017;99(18):1524-1531. doi: 10.2106/jbjs.16.01222.
- Lill H., josten c. [Proximal and distal humerus fractures in advanced age]. Orthopade. 2000;29(4):327-341. (in German). doi: 10.1007/pl000037330.
- Слободской А.Б., Прохоренко В.М., Дунаев А.Г., Бадак И.С., Воронин И.В., Быстряков П.А. Эндопротезирование локтевого сустава. Гений ортопедии. 2011;(3):61-65.
- Chalidis B., Dimitriou C., Papadopoulos P., Petsatodis G., Giannoudis P. Total elbow arthroplasty for the treatment of insufficient distal humeral fractures. A retrospective clinical study and review of the literature. Injury. 2009;40(6):582-590. doi: 10.1016/j.injury.2009.01.123.
- Srinivasan K., Agarwal M., Matthews S.J., Giannoudis P.V. Fractures of the distal humerus in the elderly: is internal fixation the treatment of choice? Clin Orthop Relat Res. 2005;(434):222-230.
- Moghaddam-Alvandi A., Dremel E., Guven F., Heppert V., Wagner C., Studier-Fischer S. Et al. [Arthrodesis of the elbow joint. Indications, surgical technique and clinical results].Unfallchirurg. 2010;113:300-307. (In German). doi: 10.1007/s00113-009-1722-y.
- Zarkadas P., Cass B., Throckmorton T., Adams R., Sanchez-Sotelo J., Morrey B. Long-term outcome of resection arthroplasty for the failed total elbow arthroplasty. J Bone Joint Surg Am. 2010;92(15):2576-2582. doi: 10.2106/jbjs.i.00577.
- Moro J.K., King G.J. Total elbow arthroplasty in the treatment of posttraumatic conditions of the elbow. Clin Orthop Relat Res. 2000;370:102-114. doi: 10.1097/00003086-200001000-00010.
- Throckmorton T., Zarkadas P., Sanchez-Sotelo J., Morrey B. Failure patterns after linked semiconstrained total elbow arthroplasty for posttraumatic arthritis. J Bone Joint Surg Am. 2010;92(6):1432-1441. doi: 10.2106/jbjs.i.00145.
- Прохоренко В.М., Александров Т.И., Чорний С.И., Слободской А.Б. Эндопротезирование локтевого сустава при внутрисуставных переломах и последствиях травм. Современные проблемы науки и образования. 2017;(5). Режим доступа: http://science-education.ru/ru/article/view?Id=26967
- Larsen A., Dale K., Eek M. Radiographic evaluation of rheumatoid arthritis and related onditions by standard reference films. Acta Radiol Diagn (Stockh). 1977;18(4):481-491. doi: 10.1177/028418517701800415.
- Morrey B., Adams R. Semiconstrained arthroplasty for the treatment of rheumatoid arthritis of the Elbow. J Bone Joint Surg Am. 1992;74(4):479-90. doi: 10.2106/00004623-199274040-00003.
- Van der Lugt J.c., Geskus R.B., Rozing P.M. Limited influence of prosthetic position on aseptic loosening of elbow replacements: 125 elbows followed for anaverage period of 5.6 years. Acta Orthop. 2005;76(5):654-661. doi: 10.1080/17453670510041736.
- Алиев А.Г., Тихилов Р.М., Шубняков И.И., Коваленко А.Н., Амбросенков А.В., Антипов А.П. Среднесрочные результаты эндопротезирования локтевого сустава у пациентов с ревматоидным артритом. Научнопрактическая ревматология. 2018;56(5):635-640.
- Cil A., Veillette C., Sanchez-Sotelo J., Morrey B.F. Linked elbow replacement: a salvage procedure for distal humeral nonunion. J Bone Joint Surg Am. 2008;90(9):1939-1950. doi: 10.2106/jbjs.g.00690.
- Kho J.Y., Adams B.D., O’Rourke H. Outcome of semiconstrained total elbow arthroplasty in posttraumatic conditions with analysis of bushing wear on stress radiographs. Iowa Orthop J. 2015;35:124-129.
- Morrey B.F., Schneeberger A.G. Total elbow arthroplasty for post-traumatic arthrosis. Instr Course Lect. 2009;58:495-504.
- Слободской А.Б., Прохоренко В.М., Осинцев Е.Ю., Дунаев А.Г., Воронин И.В., Бадак И.С., Логинов И.В. Эндопротезирование при лечении дефектов локтевого сустава. Acta Biomedica Scientifica. 2017;3(115):38-43. Режим доступа: https://doi.Org/10.12737/article_59f0360cd65976.65941108.
- Науменко Л.Ю., Носивец Д.С. Доступ к локтевому Суставу при эндопротезировании. Травма. 2014;(3). Режим доступа: https://cyberleninka.ru/article/n/dostup-k-loktevomu-sustavu-pri-endoprotezirovanii.
- King A., Booker S.J., Thomas W.J., Smith C.D. Triceps on, alignment off? A comparison of total elbow arthroplasty component positioning with a triceps-on and a triceps-off approach. Ann R Coll Surg Engl. 2018;(16):1-6. doi: 10.1308/rcsann.2018.0117. [Epub ahead of print].
- Perretta D., van Leeuwen W., Dyer G., Ring D., Chen, N. Risk factors for reoperation after total elbow arthroplasty. J Shoulder Elbow Surg. 2017;26(5):824-829. doi: 10.1016/j.jse.2016.12.064.
- Park S., Kim J., Cho S., Rhee S., Kwon S. Complications and revision rate compared by type of total elbow arthroplasty. J Shoulder Elbow Surg. 2013;22(8):1121-1127. doi: 10.1016/j.jse.2013.03.003.
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