Postoperative outcomes of total elbow replacement in haemophilic elbow arthropathy: A systematic review

Abstract

Introduction: Total elbow replacement (TER) is a surgical treatment option for haemophilic elbow arthropathy.Aim: To review the outcomes of TER in haemophilic elbow arthropathy. The primary outcome measures were perioperative blood loss, postoperative complications, revision rates and length of hospital stay (LOS). Secondary outcomes were elbow range of motion (ROM), functional outcome scores and the visual analogue pain scale (VAS).Materials and methods: PubMed, Medline, Embase and the Cochrane register were searched conforming to the PRISMA guidelines. Only studies with a minimum postoperative follow-up of 1 year were included. Quality appraisal was performed utilizing the MINORS criteria.Results: One hundred and thirty-eight articles were identified. Following article screening, only seven studies met the inclusion criteria. A total of 51 TERs in 38 patients were performed, with the Coonrad-Morrey prosthesis utilized in 51% of cases. The pooled postoperative complication and revision rates were 49% and 29%, respectively. Surgery-related postoperative mortality was 3.9%. The mean preoperative Mayo elbow performance score (MEPS) was 43 ± 20 whereas the mean postoperative MEPS was 89 ± 6. Mean preoperative VAS was 7.2 ± 1.9 while the mean postoperative VAS was 2.0 ± 1.4. Mean preoperative and postoperative elbow flexion arcs were 54 ± 15 and 91 ± 10 degrees, respectively. Mean preoperative and postoperative forearm rotation arcs were 86 ± 40 and 135 ± 19 degrees, respectively. Conclusion:TER for haemophilic elbow arthropathy provides good to excellent improvements in pain and elbow ROM postoperatively. However, the overall complication and revision rates are relatively high, when compared to TER performed for other indications.

Total elbow arthroplasty for hemophilic osteoproliferative elbow arthritis with severe flexion contracture: A case report

“…4 According to the latest systematic review, postoperative complication rate, including periprosthetic joint infection, TEA with aseptic loosening, ulnar nerve neuropathy, and significant postoperative hematoma was 49%. 7 Revision rates were found to be 29% in patients with hemophilia. 7 Furthermore, the revision rate for TEA in hemophilic elbow arthropathy is somewhat higher, when compared to other joint arthroplasties such as hip and knee replacement.…”

“…7 Revision rates were found to be 29% in patients with hemophilia. 7 Furthermore, the revision rate for TEA in hemophilic elbow arthropathy is somewhat higher, when compared to other joint arthroplasties such as hip and knee replacement. 7 Joint instability after arthroplasty might lead to wear or breakage of the polyethylene bushing and subsequent failure.…”

“…[4][5][6] A recent review article described postoperative outcomes of 51 TEAs in 38 patients with hemophilic arthropathy across 7 publications. 7 For hemophilic elbow arthropathy, TEA provides good improvement of elbow pain and elbow function postoperatively. 7 However, repeated bleeding and inflammation in the elbow joints can lead to the early development of skeletal deformities and abnormal and difficult anatomy, which might complicate surgery.…”

“…7 For hemophilic elbow arthropathy, TEA provides good improvement of elbow pain and elbow function postoperatively. 7 However, repeated bleeding and inflammation in the elbow joints can lead to the early development of skeletal deformities and abnormal and difficult anatomy, which might complicate surgery. 4,6 Moreover, the rate of complication from infection and the revision rate are higher than those for TEA performed for other indications such as inflammatory arthropathy, osteoarthritis, and traumatic elbow injuries.…”

“…4,6 Moreover, the rate of complication from infection and the revision rate are higher than those for TEA performed for other indications such as inflammatory arthropathy, osteoarthritis, and traumatic elbow injuries. 7 This report describes a case of a 50-year-old hemophilia patient diagnosed as having hypertrophic elbow osteoarthropathy with severe flexion contracture, who underwent unconstrained TEA, complicated by intraoperative medial humeral supracondylar fracture.…”