Outcomes of semiconstrained total elbow arthroplasty performed for arthritis in patients under 55 years old

Siala, Mahdi; Laumonerie, Pierre; Hedjoudje, Abdellah; Delclaux, Stéphanie; Bonnevialle, Nicolas; Mansat, Pierre

doi:10.1016/j.jse.2019.08.006

Cited by 18 publications

(12 citation statements)

References 26 publications

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“…Case-series 6 unique case-series, published between 1998 and 2020, reported the survival of 628 linked total elbow replacements (linked TERs) at 9 time points with follow-up ranging from 10 to 20 years (Tables 3 and 4, see Supplementary data) (13)(14)(15)(16)(17). 6 series reported survival at exactly 10 years (616 linked TERs), 2 at 15 years (487 linked TERs), and 1 at 20 years (435 linked TERs).…”

Section: Resultsmentioning

confidence: 99%

How long does an elbow replacement last? A systematic review and meta-analysis of case-series and national registry reports with more than 10 years of follow-up

Evans

Mohammad

et al. 2022

ActaO

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Background and purpose: This study aims to determine, for the first time, generalizable data on the longevity and long-term function of elbow replacements.Methods: In this systematic review and meta-analysis, we searched MEDLINE and Embase for articles reporting 10-year or greater survival of total elbow replacements (TERs) and distal humeral hemiarthroplasty. Implant survival and patient reported outcome measures (PROMs) data were extracted. National joint replacement registries were also analyzed. We weighted each series and calculated a pooled survival estimate at 10, 15, and 20 years. For PROMs we pooled the standardized mean difference (SMD) at 10 years.Findings: Despite its widespread use, we identified only 9 series reporting all-cause survival of 628 linked TERs and 610 unlinked TERs and no series for distal humeral hemiarthroplasty. The studied population was treated for rheumatoid arthritis in over 90% of cases. The estimated 10-year survival for linked TERs was 92% (95% CI 90–95) and unlinked TERs 84% (CI 81–88). 2 independent registries contributed 32 linked TERs and 530 unlinked TERs. The pooled registry 10-year survival for unlinked TERs was 86% (CI 83–89). Pooled 10-year PROMs from 164 TERs (33 linked and 131 unlinked), revealed a substantial improvement from baseline scores (SMD 2.7 [CI 1.6–3.8]).Interpretation: Over 80% of all elbow replacements and over 90% of linked elbow replacements can last more than 10 years with sustained patient-reported benefits. This information is long overdue and will be particularly useful to patients as well as healthcare providers.

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Section: Resultsmentioning

confidence: 99%

How long does an elbow replacement last? A systematic review and meta-analysis of case-series and national registry reports with more than 10 years of follow-up

Evans

Mohammad

et al. 2022

ActaO

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“…A total of 215 cases of triceps insufficiency were reported in 80 articles 1,3,6,8,16-91 . The mean incidence was 4.5% (range, 0% to 54.8%).…”

Section: Resultsmentioning

confidence: 99%

“…The mean incidence was 4.5% (range, 0% to 54.8%). Detailed information on primary or revision surgery was retrieved from 77 articles 1,3,8,16-36,38-80,82-91 . Missing data on these parameters warranted exclusion from this section.…”

Section: Resultsmentioning

confidence: 99%

Triceps Insufficiency After Total Elbow Arthroplasty

et al. 2021

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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.

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“…There are few reported studies of the clinical outcomes of TEA in young patients. Previous reports of TEA in relatively young patients (under 55) used linked devices, [23][24][25][26] and showed that radiolucent lines occurred in 11% to 64% and loosening in 9% to 55% of patients, requiring revision surgery in 22% to 82% of patients (Table III). However, these studies included relatively high-demand patients with post-traumatic arthritis in 23.5% to 39.1% of patients, possibly related to prosthesis loosening.…”

Section: Discussionmentioning

confidence: 97%

“…They emphasized that TEA in patients aged under 50 years should be approached with caution, and patients should be informed about the high risk of complications and mechanical failure. Siala et al 26 also suggested that TEA should be considered with caution in young patients following their results of 19 Coonrad-Morrey TEAs, with 58% experiencing complications and a 42% revision rate.…”

Section: Discussionmentioning

confidence: 99%

Outcome of unlinked total elbow arthroplasty for rheumatoid arthritis in patients younger than 50 years old

et al. 2023

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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 IV Cite this article: Bone Jt Open 2023;4(1):19–26.

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Outcomes of semiconstrained total elbow arthroplasty performed for arthritis in patients under 55 years old

Cited by 18 publications

References 26 publications

How long does an elbow replacement last? A systematic review and meta-analysis of case-series and national registry reports with more than 10 years of follow-up

How long does an elbow replacement last? A systematic review and meta-analysis of case-series and national registry reports with more than 10 years of follow-up

Triceps Insufficiency After Total Elbow Arthroplasty

Outcome of unlinked total elbow arthroplasty for rheumatoid arthritis in patients younger than 50 years old

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