Mid- and Long-Term Results of Total Elbow Arthroplasty: Post-Traumatic Consequences and Rheumatoid Arthritis

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.

Keywords

elbow arthroplasty / elbow post-traumatic osteoarthritis / elbow rheumatoid arthritis

References

[1] 1.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.

[2] 2.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.

[3] 3.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.

[4] 4.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.

[5] 5.Lill H., josten c. [Proximal and distal humerus fractures in advanced age]. Orthopade. 2000;29(4):327-341. (in German). Doi: 10.1007/pl000037330.

[6] 6.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.

[7] 7.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.

[8] 8.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.

[9] 9.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.

[10] 10.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.

[11] 11.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.

[12] 12.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.

[13] 13.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

[14] 14.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.

[15] 15.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.

[16] 16.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.

[17] 17.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.

[18] 18.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.

[19] 19.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.

[20] 20.Morrey B.F., Schneeberger A.G. Total elbow arthroplasty for post-traumatic arthrosis. Instr Course Lect. 2009;58:495-504.

[21] 21.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.

[22] 22.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.

[23] 23.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].

[24] 24.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.

[25] 25.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.